{   "hospital_name": "UC San Diego Medical Center",   "last_updated_on": "2026-04-01",   "version": "3.0",    "location_name": [     "Hillcrest Medical Center",  "Jacobs Medical Center", "Moores Cancer Center", "Sulpizio Cardiovascular Center","UC San Diego Health - East Camopus"  ],   "hospital_address": [     "200 West Arbor Dr, San Diego, CA 92103",     "9300 Campus Point Drive, San Diego,  CA 92037", "3855 Health Sciences Drive, San Diego, CA 92037" ,"9434 Medical Center Drive, San Diego, CA 92037","6655 Alvarado Road, San Diego, CA 92120"   ],   "license_information": {     "license_number": "090000101",     "state": "CA"   }, "type_2_npi": ["1184722779"],   "attestation": {     "attestation": "To the best of its knowledge and belief, this 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 in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.",     "confirm_attestation": true, "attester_name": "Carlos Bohorquez"   },   "standard_charge_information": [{"description":"Heart Transplant Or Implant Of Heart Assist System With McC","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"minimum":28.02,"maximum":643921.79,"gross_charge":1319408.40,"discounted_cash":725674.62,"setting":"inpatient","payers_information":[{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EATING DISORDER","standard_charge_percentage":58.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":773701.09},{"payer_name":"BEECH STREET [1012]","plan_name":"CAPPCARE\/BEECH STREET","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":989556.30},{"payer_name":"XIMED [2016]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH PLAN","standard_charge_percentage":78.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1029138.55},{"payer_name":"ALTERNATE HEALTH NET BH [2059]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MARKET PLACE","standard_charge_algorithm":"Case rate ($281,868.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $259,305.54, add-ons for qualifying new technology services are included. If operating cost exceeds $308,464.43 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $23,249.74, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $260,558.69 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $258,516.43 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,520.40. The transfer capital threshold is the transfer adjustment factor * $20,520.40. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 180%.","methodology":"other","median_amount":152179.06,"10th_percentile":152179.06,"90th_percentile":152179.06,"count":"1 through 10","additional_payer_notes":"All Inpatient","standard_charge_dollar":281868.20},{"payer_name":"ALTERNATE HEALTH NET BH [2059]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"AETNA [1003]","plan_name":"AETNA BEHAVIORAL EATING DISORDER","standard_charge_percentage":43.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":576581.47},{"payer_name":"MC HEALTHNET HMO [164004]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"ALTERNATE SHERIFF CUSTODY [1106]","plan_name":"SHERIFF COUNTY CONTRACT # 514250","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":857615.46},{"payer_name":"QUALITY HEALTH [1069]","plan_name":"QUALITY HEALTH MANAGEMENT","standard_charge_algorithm":"Case rate ($348,065.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $321,993.28, add-ons for qualifying new technology services are included. If operating cost exceeds $370,677.90 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $27,231.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $323,246.43 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $321,204.17 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $24,030.30. The transfer capital threshold is the transfer adjustment factor * $24,030.30. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 185%.","methodology":"other","count":"0","additional_payer_notes":"Surgery  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":643921.79},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($348,065.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $321,993.28, add-ons for qualifying new technology services are included. If operating cost exceeds $370,677.90 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $27,231.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $323,246.43 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $321,204.17 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $24,030.30. The transfer capital threshold is the transfer adjustment factor * $24,030.30. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":348065.83},{"payer_name":"MC HUMANA HMO [164013]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"RIVER CITY MEDICAL GROUP [2066]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"MEDI-CAL [1048]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"ALTERNATE MEDICARE [2007]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($348,065.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $321,993.28, add-ons for qualifying new technology services are included. If operating cost exceeds $370,677.90 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $27,231.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $323,246.43 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $321,204.17 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $24,030.30. The transfer capital threshold is the transfer adjustment factor * $24,030.30. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":341104.51},{"payer_name":"MENIFEE MED GRP [2076]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA COMMERCIAL","standard_charge_algorithm":"Fee schedule rate ($28.02). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":39.23},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE [10230006]","standard_charge_algorithm":"Case rate ($121,000). A payment threshold will be met when non-excluded charges is greater than 831949. For days after this threshold has been met, a payment of (non-excluded charges minus 831949) multiplied by .50 will be used instead of the standard payment.","methodology":"other","median_amount":558849.28,"10th_percentile":558849.28,"90th_percentile":601615.27,"count":"1 through 10","additional_payer_notes":"Heart-VAD\/TAH Over Threshold","standard_charge_dollar":1319408.40},{"payer_name":"MC BLUE SHIELD HMO [164015]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"INTERNATIONAL EMBASSY OF KUWAIT","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":897197.71},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE TRANSPLANT [11170001]","standard_charge_algorithm":"Case rate ($121,000). A payment threshold will be met when non-excluded charges is greater than 831949. For days after this threshold has been met, a payment of (non-excluded charges minus 831949) multiplied by .50 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Heart-VAD\/TAH Over Threshold Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1319408.40},{"payer_name":"UCR PROMPT PAY PAYOR [8240]","plan_name":"UCSD CHARITY MEDICARE CONTRACT","standard_charge_algorithm":"Case rate ($348,065.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $321,993.28, add-ons for qualifying new technology services are included. If operating cost exceeds $370,677.90 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $27,231.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $323,246.43 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $321,204.17 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $24,030.30. The transfer capital threshold is the transfer adjustment factor * $24,030.30. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"Medicare All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":348065.83},{"payer_name":"ALTERNATE MEDI-CAL [2001]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_percentage":91.72,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1210161.38},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"IMPERIAL COUNTY PHYSICIAN MED GRP","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":276927.52},{"payer_name":"KAISER [1046]","plan_name":"KAISER","standard_charge_percentage":77.00,"methodology":"percent of total billed charges","median_amount":554019.93,"10th_percentile":254450.00,"90th_percentile":1103751.20,"count":"12","additional_payer_notes":"undefined","standard_charge_dollar":1015944.47},{"payer_name":"USAA [1091]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"AETNA [1003]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($136,719). An additional variable per diem reimbursement will be applied in addition to the case rate. A payment threshold will be met when non-excluded charges is greater than 908034. For days after this threshold has been met, a payment of (non-excluded charges minus 908034) multiplied by .60 will be used instead of the standard payment. The variable per diem rates are RC 0000, 0100:0219 @ $9,035.","methodology":"other","median_amount":389764.00,"10th_percentile":122025.77,"90th_percentile":2453076.84,"count":"1 through 10","additional_payer_notes":"Heart VAD\/TAH Over Threshold","standard_charge_dollar":1319408.40},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA HMO","standard_charge_percentage":83.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1100386.61},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA PPO","standard_charge_percentage":83.40,"methodology":"percent of total billed charges","median_amount":1110758.80,"10th_percentile":1110758.80,"90th_percentile":1110758.80,"count":"1 through 10","additional_payer_notes":"undefined","standard_charge_dollar":1100386.61},{"payer_name":"CIGNA [1023]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay.","standard_charge_dollar":6200.00},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":276927.52},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($344,950.99). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $318,996.75, add-ons for qualifying new technology services are included. If operating cost exceeds $368,155.64 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $26,641.32, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $320,249.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $318,207.64 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $23,911.99. The transfer capital threshold is the transfer adjustment factor * $23,911.99. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":344950.99},{"payer_name":"ALTERNATE AETNA [1004]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($136,719). An additional variable per diem reimbursement will be applied in addition to the case rate. A payment threshold will be met when non-excluded charges is greater than 908034. For days after this threshold has been met, a payment of (non-excluded charges minus 908034) multiplied by .60 will be used instead of the standard payment. The variable per diem rates are RC 0000, 0100:0219 @ $9,035.","methodology":"other","count":"0","additional_payer_notes":"Heart VAD\/TAH Over Threshold Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1319408.40},{"payer_name":"ALTERNATE KAISER RAD ONC [2089]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1319408.40},{"payer_name":"AMA - AMERICAN MEDICAL ASSOCIATION [1009]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","median_amount":314887.53,"10th_percentile":314887.53,"90th_percentile":314887.53,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":282579.10},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"DEPARTMENT OF LABOR [1028]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($348,065.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $321,993.28, add-ons for qualifying new technology services are included. If operating cost exceeds $370,677.90 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $27,231.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $323,246.43 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $321,204.17 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $24,030.30. The transfer capital threshold is the transfer adjustment factor * $24,030.30. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":452485.58},{"payer_name":"IMPERIAL HEALTH HOLDINGS [1132]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"AFFILIATED DOCTORS OF ORANGE COUNTY [2041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"MC AETNA HMO [164001]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"CAREMORE [2028]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"ASTIVA HEALTH [2095]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedure 1, Case rate ($33,566). Procedures 2 - 9999, Per diem ($10,284).","methodology":"other","count":"0","additional_payer_notes":"Cardiac Ablation Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1319408.40},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($281,868.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $259,305.54, add-ons for qualifying new technology services are included. If operating cost exceeds $308,464.43 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $23,249.74, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $260,558.69 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $258,516.43 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,520.40. The transfer capital threshold is the transfer adjustment factor * $20,520.40. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","median_amount":463291.21,"10th_percentile":463291.21,"90th_percentile":463291.21,"count":"1 through 10","additional_payer_notes":"Inpatient Pre\/Post or Other\/VAD","standard_charge_dollar":281868.20},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDI-CAL","standard_charge_algorithm":"Case rate ($344,950.99). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $318,996.75, add-ons for qualifying new technology services are included. If operating cost exceeds $368,155.64 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $26,641.32, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $320,249.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $318,207.64 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $23,911.99. The transfer capital threshold is the transfer adjustment factor * $23,911.99. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 80%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Pre\/Post  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":275960.79},{"payer_name":"AETNA [1003]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($281,868.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $259,305.54, add-ons for qualifying new technology services are included. If operating cost exceeds $308,464.43 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $23,249.74, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $260,558.69 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $258,516.43 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,520.40. The transfer capital threshold is the transfer adjustment factor * $20,520.40. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":281868.20},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED HMO NON CONTRACTED [10260001]","standard_charge_algorithm":"Case rate ($281,868.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $259,305.54, add-ons for qualifying new technology services are included. If operating cost exceeds $308,464.43 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $23,249.74, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $260,558.69 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $258,516.43 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,520.40. The transfer capital threshold is the transfer adjustment factor * $20,520.40. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":281868.20},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED PPO NON CONTRACTED [10260002]","standard_charge_algorithm":"Case rate ($281,868.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $259,305.54, add-ons for qualifying new technology services are included. If operating cost exceeds $308,464.43 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $23,249.74, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $260,558.69 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $258,516.43 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,520.40. The transfer capital threshold is the transfer adjustment factor * $20,520.40. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":281868.20},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($348,065.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $321,993.28, add-ons for qualifying new technology services are included. If operating cost exceeds $370,677.90 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $27,231.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $323,246.43 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $321,204.17 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $24,030.30. The transfer capital threshold is the transfer adjustment factor * $24,030.30. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":348065.83},{"payer_name":"SDSM [2017]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"CLEVER CARE [2061]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"ALTERNATE SCAN HEALTH [2088]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":268450.15},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($281,868.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $259,305.54, add-ons for qualifying new technology services are included. If operating cost exceeds $308,464.43 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $23,249.74, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $260,558.69 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $258,516.43 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,520.40. The transfer capital threshold is the transfer adjustment factor * $20,520.40. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":281868.20},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"OLYMPUS MANAGED HEALTHCARE INC [11020001]","standard_charge_algorithm":"Case rate ($136,719). An additional variable per diem reimbursement will be applied in addition to the case rate. A payment threshold will be met when non-excluded charges is greater than 908034. For days after this threshold has been met, a payment of (non-excluded charges minus 908034) multiplied by .60 will be used instead of the standard payment. The variable per diem rates are RC 0000, 0100:0219 @ $9,035.","methodology":"other","count":"0","additional_payer_notes":"Heart VAD\/TAH Over Threshold Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1319408.40},{"payer_name":"ENCOMPASS MED GRP [1030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($348,065.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $321,993.28, add-ons for qualifying new technology services are included. If operating cost exceeds $370,677.90 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $27,231.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $323,246.43 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $321,204.17 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $24,030.30. The transfer capital threshold is the transfer adjustment factor * $24,030.30. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":348065.83},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($348,065.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $321,993.28, add-ons for qualifying new technology services are included. If operating cost exceeds $370,677.90 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $27,231.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $323,246.43 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $321,204.17 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $24,030.30. The transfer capital threshold is the transfer adjustment factor * $24,030.30. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":348065.83},{"payer_name":"PRIMARY CARE ASSOCIATES OF CA [2067]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"ALTERNATE VA - VETERANS ADMINISTRATION [1239]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($348,065.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $321,993.28, add-ons for qualifying new technology services are included. If operating cost exceeds $370,677.90 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $27,231.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $323,246.43 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $321,204.17 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $24,030.30. The transfer capital threshold is the transfer adjustment factor * $24,030.30. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":348065.83},{"payer_name":"MC UNITED HEALTHCARE HMO [164005]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"UNLISTED MEDICARE ADVANTAGE (NON-CONTRACTED) [1051]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"COMMUNITY HEALTH GROUP [1022]","plan_name":"COMMUNITY HEALTH GROUP MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 129%.","methodology":"other","median_amount":636399.60,"10th_percentile":636399.60,"90th_percentile":636399.60,"count":"1 through 10","additional_payer_notes":"Transplants","standard_charge_dollar":364527.04},{"payer_name":"BANKERS LIFE [1011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNA PRIORITY SELECT","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedure 1, Case rate ($24,880). Procedures 2 - 9999, Per diem ($7,623).","methodology":"other","count":"0","additional_payer_notes":"Cardiac Ablation Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1319408.40},{"payer_name":"VANTAGE [1092]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"SIMNSA HEALTH PLAN [2047]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"MC CIGNA GENERIC PAYOR [164007]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"MC UHC ALLIANCE HMO [164020]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"ADMAR [1001]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":857615.46},{"payer_name":"BPS - BENEFIT PLAN SERVICES [1015]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":857615.46},{"payer_name":"MC UNITED HEALTHCARE GENERIC PAYOR [164011]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":339094.92},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"KAISER [1046]","plan_name":"KAISER MEDICARE ADVANTAGE","standard_charge_percentage":77.00,"methodology":"percent of total billed charges","median_amount":1304274.63,"10th_percentile":544439.94,"90th_percentile":1543881.18,"count":"1 through 10","additional_payer_notes":"undefined","standard_charge_dollar":1015944.47},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD COVERED CA TRIO HMO","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1319408.40},{"payer_name":"TRIWEST [2003]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($348,065.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $321,993.28, add-ons for qualifying new technology services are included. If operating cost exceeds $370,677.90 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $27,231.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $323,246.43 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $321,204.17 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $24,030.30. The transfer capital threshold is the transfer adjustment factor * $24,030.30. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","median_amount":652437.65,"10th_percentile":652437.65,"90th_percentile":652437.65,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":348065.83},{"payer_name":"UC AFF ANTHEM\/SDSM HMO [164024]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"EASY ACCESS CARE [2077]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"MC ANTHEM BLUE CROSS GENERIC PAYOR [164009]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($281,868.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $259,305.54, add-ons for qualifying new technology services are included. If operating cost exceeds $308,464.43 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $23,249.74, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $260,558.69 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $258,516.43 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,520.40. The transfer capital threshold is the transfer adjustment factor * $20,520.40. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":281868.20},{"payer_name":"TRANSAMERICA [1084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1319408.40},{"payer_name":"MGM RESORTS [1053]","plan_name":"MGM RESORT","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":989556.30},{"payer_name":"ALPHACARE [2062]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS UC CARE","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","median_amount":340757.81,"10th_percentile":340757.81,"90th_percentile":340757.81,"count":"1 through 10","additional_payer_notes":"undefined","standard_charge_dollar":348323.82},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay.","standard_charge_dollar":6200.00},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS HOUSE STAFF","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":348323.82},{"payer_name":"FIRST HEALTH [1032]","plan_name":"FIRST HEALTH","standard_charge_percentage":85.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1121497.14},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE","standard_charge_algorithm":"Case rate ($121,000). A payment threshold will be met when non-excluded charges is greater than 831949. For days after this threshold has been met, a payment of (non-excluded charges minus 831949) multiplied by .50 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Heart-VAD\/TAH Over Threshold Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1319408.40},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay.","standard_charge_dollar":6200.00},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE","standard_charge_algorithm":"Case rate ($121,000). A payment threshold will be met when non-excluded charges is greater than 831949. For days after this threshold has been met, a payment of (non-excluded charges minus 831949) multiplied by .50 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Heart-VAD\/TAH Over Threshold Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1319408.40},{"payer_name":"MC HEALTHNET GENERIC PAYOR [164010]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"MC CIGNA HMO [164003]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"TRI-CITY [1085]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"INTERPLAN [1045]","plan_name":"INTERPLAN","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":923585.88},{"payer_name":"CHRISTIAN HEALTHCARE MINISTRIES [2030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"ARCH HEALTH PARTNERS [2000]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"BLUE CROSS [1013]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($281,868.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $259,305.54, add-ons for qualifying new technology services are included. If operating cost exceeds $308,464.43 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $23,249.74, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $260,558.69 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $258,516.43 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,520.40. The transfer capital threshold is the transfer adjustment factor * $20,520.40. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":281868.20},{"payer_name":"BLUE CROSS [1013]","plan_name":"UCSD STUDENT HEALTH INS PLAN - BC SHIP","standard_charge_percentage":26.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":352282.04},{"payer_name":"UNLISTED HOSPICE [1035]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"MC UHC VEBA GENERIC HMO [164032]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"ELIZABETH HOSPICE [2018]","plan_name":"ELIZABETH HOSPICE GIP","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay.","standard_charge_dollar":950.00},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","median_amount":289831.54,"10th_percentile":289831.54,"90th_percentile":289831.54,"count":"1 through 10","additional_payer_notes":"Transplants","standard_charge_dollar":282579.10},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"US BEHAVIORAL MENTAL\/EATING DISORDER","standard_charge_percentage":70.00,"standard_charge_algorithm":"70% of billed.","methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":923585.88},{"payer_name":"SEDGWICK [1077]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($348,065.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $321,993.28, add-ons for qualifying new technology services are included. If operating cost exceeds $370,677.90 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $27,231.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $323,246.43 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $321,204.17 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $24,030.30. The transfer capital threshold is the transfer adjustment factor * $24,030.30. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":452485.58},{"payer_name":"MULTIPLAN [1058]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":857615.46},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","median_amount":465464.57,"10th_percentile":465464.57,"90th_percentile":465464.57,"count":"1 through 10","additional_payer_notes":"Surgery","standard_charge_dollar":1319408.40},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","median_amount":277375.00,"10th_percentile":277375.00,"90th_percentile":277375.00,"count":"1 through 10","additional_payer_notes":"Surgery","standard_charge_dollar":1319408.40},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA EPN\/IFP","standard_charge_algorithm":"Per diem ($7,687). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .468 will be used instead of the standard payment.","methodology":"other","median_amount":1748532.64,"10th_percentile":1748532.64,"90th_percentile":1748532.64,"count":"1 through 10","additional_payer_notes":"Surgery","standard_charge_dollar":1319408.40},{"payer_name":"INTEGRATED HEALTH PARTNERS [2068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE ST PAULS","standard_charge_algorithm":"Case rate ($348,065.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $321,993.28, add-ons for qualifying new technology services are included. If operating cost exceeds $370,677.90 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $27,231.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $323,246.43 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $321,204.17 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $24,030.30. The transfer capital threshold is the transfer adjustment factor * $24,030.30. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":348065.83},{"payer_name":"PACIFIC FOUNDATION [1063]","plan_name":"PACIFIC FOUNDATION FOR MEDICAL CARE","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":989556.30},{"payer_name":"GREATER NEWPORT PHYSICIANS [2096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"MC SCAN GENERIC PAYOR [164034]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE QUALCOMM ","standard_charge_percentage":88.57,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1168600.02},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"Inpatient  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"KEY MED GRP [2074]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"UC AFF MC HUMANA GENERIC PAYOR [164027]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"CARNIVAL CRUISES [1018]","plan_name":"CARNIVAL CRUISES [10180001]","standard_charge_percentage":90.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1187467.56},{"payer_name":"MC BRAND NEW DAY HMO [164030]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"MC UHC VEBA HMO [164033]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"MERCY PHYSICIANS MED GRP [1052]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"MC BRAND NEW DAY GENERIC PAYOR [164031]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_percentage":44.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":580539.70},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET MEDICARE ADVANTAGE UC EMPLOYER GROUP","standard_charge_algorithm":"Fee schedule rate ($28.02). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":28.02},{"payer_name":"TRI-CITY MEDICAL CENTER [1129]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE QUALCOMM SCRIPPS (ACO)","standard_charge_percentage":85.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1121497.14},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"PRIVATE HEALTHCARE SYSTEM","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":857615.46},{"payer_name":"BLUE SHIELD TRANSPLANTS [1113]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1319408.40},{"payer_name":"SCRIPPS COASTAL MED GRP [1074]","plan_name":"SCRIPPS COASTAL MED GRP [10740001]","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":857615.46},{"payer_name":"MC ANTHEM BLUE CROSS HMO [164002]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"MC AETNA GENERIC PAYOR [164008]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"MVP HEALTHCARE [1060]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CALIFORNIA UC CARE \/ HSP","standard_charge_percentage":26.66,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":351754.28},{"payer_name":"INLAND FACULTY MEDICAL GROUP [2063]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"SHARP HEALTHCARE TRANSPLANT [1119]","plan_name":"SHARP HEALTHCARE TRANSPLANT [11190001]","standard_charge_algorithm":"Per diem ($3,550).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":3550.00},{"payer_name":"NATIONAL HEALTHCARE SOLUTIONS INC [1100]","plan_name":"NATIONAL HEALTHCARE SOLUTIONS INC [11000001]","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1055526.72},{"payer_name":"KERN HEALTH SYSTEMS [2033]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"CHESAPEAKE LIFE [1021]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1319408.40},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1319408.40},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"ROYAL EMBASSY","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":923585.88},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","median_amount":280543.68,"10th_percentile":280543.68,"90th_percentile":280543.68,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":282579.10},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"GLOBAL EXCEL [1036]","plan_name":"GLOBAL EXCEL","standard_charge_algorithm":"Case rate ($348,065.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $321,993.28, add-ons for qualifying new technology services are included. If operating cost exceeds $370,677.90 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $27,231.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $323,246.43 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $321,204.17 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $24,030.30. The transfer capital threshold is the transfer adjustment factor * $24,030.30. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 165%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":348065.83},{"payer_name":"REDLANDS COMMUNITY HOSPITAL [2005]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"UC AFF BLUE SHIELD SR\/SDSM [164037]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"VILLAGE HEALTH [1094]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"PREMIER PATIENT CARE IPA [2069]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"INTER VALLEY HEALTH PLAN [2024]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"CALIFORNIA HEALTH & WELLNESS MEDI-CAL [1122]","plan_name":"CALIFORNIA HEALTH AND WELLNESS MEDI-CAL (no longer Medi-Cal plan as of 1\/1\/24)","standard_charge_algorithm":"Per diem ($2,600).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2600.00},{"payer_name":"EASY CHOICE [1029]","plan_name":"EASY CHOICE","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"HEALTH NET [1039]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"SD PHYSICIANS MED GRP [1076]","plan_name":"SD PHYSICIANS MED GRP SR [10760002]","standard_charge_percentage":55.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":725674.62},{"payer_name":"WORKERS COMPENSATION [1097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($348,065.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $321,993.28, add-ons for qualifying new technology services are included. If operating cost exceeds $370,677.90 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $27,231.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $323,246.43 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $321,204.17 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $24,030.30. The transfer capital threshold is the transfer adjustment factor * $24,030.30. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":452485.58},{"payer_name":"ALTERNATE BRAND NEW DAY [2079]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"CIGNA HMO","standard_charge_percentage":83.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1100386.61},{"payer_name":"UNITED AMERICAN [1087]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"CAL OPTIMA [1016]","plan_name":"CalOptima Medicare","standard_charge_algorithm":"Case rate ($348,065.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $321,993.28, add-ons for qualifying new technology services are included. If operating cost exceeds $370,677.90 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $27,231.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $323,246.43 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $321,204.17 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $24,030.30. The transfer capital threshold is the transfer adjustment factor * $24,030.30. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":348065.83},{"payer_name":"CHAMPVA [1020]","plan_name":"VETERANS ADMINISTRATION - CHAMPVA","standard_charge_algorithm":"Case rate ($348,065.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $321,993.28, add-ons for qualifying new technology services are included. If operating cost exceeds $370,677.90 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $27,231.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $323,246.43 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $321,204.17 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $24,030.30. The transfer capital threshold is the transfer adjustment factor * $24,030.30. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":348065.83},{"payer_name":"RIVERSIDE MEDICAL CLINIC [2064]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET ENHANCED CARE PPO","standard_charge_algorithm":"Case rate ($263,948.32). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $243,126.52, add-ons for qualifying new technology services are included. If operating cost exceeds $292,285.41 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $21,508.88, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $245,168.78. The transfer operating threshold is the transfer adjustment factor * $243,126.52 If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,779.54. The transfer capital threshold is the transfer adjustment factor * $18,779.54. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 281%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services (MSDRG no DSH GME IME) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263948.32},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($344,950.99). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $318,996.75, add-ons for qualifying new technology services are included. If operating cost exceeds $368,155.64 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $26,641.32, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $320,249.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $318,207.64 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $23,911.99. The transfer capital threshold is the transfer adjustment factor * $23,911.99. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":344950.99},{"payer_name":"PYRAMID LIFE [1068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"BLUE SHIELD [1014]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($281,868.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $259,305.54, add-ons for qualifying new technology services are included. If operating cost exceeds $308,464.43 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $23,249.74, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $260,558.69 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $258,516.43 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,520.40. The transfer capital threshold is the transfer adjustment factor * $20,520.40. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":281868.20},{"payer_name":"ETS - LIFETRAC NETWORK [1103]","plan_name":"LIFETRAC","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","median_amount":180474.58,"10th_percentile":180474.58,"90th_percentile":180474.58,"count":"1 through 10","additional_payer_notes":"undefined","standard_charge_dollar":857615.46},{"payer_name":"TRIWEST ALTERNATE [2036]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($348,065.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $321,993.28, add-ons for qualifying new technology services are included. If operating cost exceeds $370,677.90 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $27,231.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $323,246.43 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $321,204.17 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $24,030.30. The transfer capital threshold is the transfer adjustment factor * $24,030.30. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":348065.83},{"payer_name":"MUTUAL OF OMAHA [1059]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":339094.92},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"SHARP HEALTH CARE","standard_charge_percentage":85.80,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1132052.41},{"payer_name":"IMPERIAL HEALTH PLAN [2081]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE PPO","standard_charge_percentage":92.42,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1219397.24},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UHC SELECT AND SELECT PLUS","standard_charge_percentage":74.25,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":979660.74},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($344,950.99). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $318,996.75, add-ons for qualifying new technology services are included. If operating cost exceeds $368,155.64 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $26,641.32, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $320,249.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $318,207.64 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $23,911.99. The transfer capital threshold is the transfer adjustment factor * $23,911.99. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":344950.99},{"payer_name":"HERITAGE VICTOR VALLEY MEDICAL GROUP [2045]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($344,950.99). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $318,996.75, add-ons for qualifying new technology services are included. If operating cost exceeds $368,155.64 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $26,641.32, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $320,249.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $318,207.64 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $23,911.99. The transfer capital threshold is the transfer adjustment factor * $23,911.99. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":344950.99},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":276927.52},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($136,719). An additional variable per diem reimbursement will be applied in addition to the case rate. A payment threshold will be met when non-excluded charges is greater than 908034. For days after this threshold has been met, a payment of (non-excluded charges minus 908034) multiplied by .60 will be used instead of the standard payment. The variable per diem rates are RC 0000, 0100:0219 @ $9,035.","methodology":"other","count":"0","additional_payer_notes":"Heart VAD\/TAH Over Threshold Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1319408.40},{"payer_name":"SIERRA MEDICAL GROUP [2048]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedure 1, Case rate ($47,950). Procedures 2 - 9999, Per diem ($14,691).","methodology":"other","count":"0","additional_payer_notes":"Cardiac Ablation Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1319408.40},{"payer_name":"AETNA TRANSPLANTS [1112]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($136,719). An additional variable per diem reimbursement will be applied in addition to the case rate. A payment threshold will be met when non-excluded charges is greater than 908034. For days after this threshold has been met, a payment of (non-excluded charges minus 908034) multiplied by .60 will be used instead of the standard payment. The variable per diem rates are RC 0000, 0100:0219 @ $9,035.","methodology":"other","count":"0","additional_payer_notes":"Heart VAD\/TAH Over Threshold Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1319408.40},{"payer_name":"CIGNA [1023]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_percentage":44.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":580539.70},{"payer_name":"SCAN HEALTH [1072]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":268450.15},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","median_amount":1532428.54,"10th_percentile":1532428.54,"90th_percentile":1532428.54,"count":"1 through 10","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay.","standard_charge_dollar":9034.00},{"payer_name":"MONARCH HEALTHCARE [2006]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"SCRIPPS HEALTH PLAN SERVICES [1075]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":85.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1121497.14},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay.","standard_charge_dollar":6200.00},{"payer_name":"HUMANA [1042]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($281,868.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $259,305.54, add-ons for qualifying new technology services are included. If operating cost exceeds $308,464.43 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $23,249.74, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $260,558.69 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $258,516.43 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,520.40. The transfer capital threshold is the transfer adjustment factor * $20,520.40. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":281868.20},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay.","standard_charge_dollar":6200.00},{"payer_name":"HIGH DESERT MEDICAL GROUP [2053]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"STATE OF CALIFORNIA [1082]","plan_name":"California State Prison","standard_charge_algorithm":"Case rate ($348,065.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $321,993.28, add-ons for qualifying new technology services are included. If operating cost exceeds $370,677.90 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $27,231.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $323,246.43 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $321,204.17 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $24,030.30. The transfer capital threshold is the transfer adjustment factor * $24,030.30. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 250%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":348065.83},{"payer_name":"SAN DIEGO SOCKERS [2015]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($348,065.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $321,993.28, add-ons for qualifying new technology services are included. If operating cost exceeds $370,677.90 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $27,231.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $323,246.43 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $321,204.17 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $24,030.30. The transfer capital threshold is the transfer adjustment factor * $24,030.30. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":452485.58},{"payer_name":"AMERICAN SPECIALTY HEALTH PLAN [2038]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"WELL CARE [1096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"IMMIGRATION HEALTH SERVICES [1043]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($348,065.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $321,993.28, add-ons for qualifying new technology services are included. If operating cost exceeds $370,677.90 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $27,231.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $323,246.43 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $321,204.17 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $24,030.30. The transfer capital threshold is the transfer adjustment factor * $24,030.30. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":341104.51},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA COMMERCIAL","standard_charge_algorithm":"Fee schedule rate ($28.02). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":39.23},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":85.00,"methodology":"percent of total billed charges","median_amount":446924.12,"10th_percentile":446924.12,"90th_percentile":446924.12,"count":"1 through 10","additional_payer_notes":"undefined","standard_charge_dollar":1121497.14},{"payer_name":"MC UHC HARMONY HMO [164026]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MA\/SDPMG","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":268450.15},{"payer_name":"MC SCAN HMO [164035]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"ST JOSEPH ST JUDE [2065]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"GOLDEN PHYSICIANS MEDICAL GROUP [2082]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE","standard_charge_percentage":85.80,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1132052.41},{"payer_name":"ADVANTRA FREEDOM [1002]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"MC HUMANA GENERIC PAYOR [164014]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"EMPIRE PHYS MED GRP [2072]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"HEMET COMMUNITY MED GRP - PROMISECARE [1040]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE SAN DIEGO","standard_charge_algorithm":"Case rate ($344,950.99). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $318,996.75, add-ons for qualifying new technology services are included. If operating cost exceeds $368,155.64 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $26,641.32, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $320,249.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $318,207.64 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $23,911.99. The transfer capital threshold is the transfer adjustment factor * $23,911.99. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":344950.99},{"payer_name":"CMN - CANADIAN MEDICAL NETWORK [1024]","plan_name":"CMN GLOBAL INC","standard_charge_algorithm":"Case rate ($348,065.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $321,993.28, add-ons for qualifying new technology services are included. If operating cost exceeds $370,677.90 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $27,231.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $323,246.43 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $321,204.17 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $24,030.30. The transfer capital threshold is the transfer adjustment factor * $24,030.30. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 170%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":591711.91},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"MC BLUE SHIELD GENERIC PAYOR [164016]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($344,950.99). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $318,996.75, add-ons for qualifying new technology services are included. If operating cost exceeds $368,155.64 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $26,641.32, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $320,249.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $318,207.64 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $23,911.99. The transfer capital threshold is the transfer adjustment factor * $23,911.99. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":344950.99},{"payer_name":"BEACON HEALTH STRATEGY [2039]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($344,950.99). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $318,996.75, add-ons for qualifying new technology services are included. If operating cost exceeds $368,155.64 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $26,641.32, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $320,249.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $318,207.64 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $23,911.99. The transfer capital threshold is the transfer adjustment factor * $23,911.99. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":344950.99},{"payer_name":"LA CARE HEALTH PLAN [2025]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"SCRIPPS HOSPICE [2008]","plan_name":"SCRIPPS HEALTH HOSPICE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay.","standard_charge_dollar":700.00},{"payer_name":"HEALTH CARE SUPPORT [2011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"UC AFF ANTHEM\/XIMED HMO [164022]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"Community Care IPA Medi-Cal Managed Care","standard_charge_algorithm":"Includes a variable per diem for days 0-99999: RC 0100:0169 @ $1,750; RC 0200:0202 @ $1,750; RC 0208:0213 @ $1,750; RC 0219 @ $1,750; RC 0206 @ $2,300; RC 0207 @ $2,300.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1319408.40},{"payer_name":"BRAND NEW DAY [1089]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"AXA ASSISTANCE [1098]","plan_name":"AXA ASSISTANCE USA,INC","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1055526.72},{"payer_name":"FRESENIUS [1034]","plan_name":"FRESENIUS HEALTH PARTNERS, INC","standard_charge_algorithm":"Case rate ($281,868.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $259,305.54, add-ons for qualifying new technology services are included. If operating cost exceeds $308,464.43 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $23,249.74, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $260,558.69 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $258,516.43 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,520.40. The transfer capital threshold is the transfer adjustment factor * $20,520.40. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":281868.20},{"payer_name":"LAKESIDE MEDICAL GROUP [2054]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"MEDICARE [1050]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($348,065.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $321,993.28, add-ons for qualifying new technology services are included. If operating cost exceeds $370,677.90 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $27,231.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $323,246.43 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $321,204.17 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $24,030.30. The transfer capital threshold is the transfer adjustment factor * $24,030.30. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 98%.","methodology":"other","median_amount":346238.34,"10th_percentile":341108.84,"90th_percentile":730884.37,"count":"23","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":341104.51},{"payer_name":"CIGNA [1023]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":728313.44},{"payer_name":"BLUE CROSS TRANSPLANT [1116]","plan_name":"BLUE DISTINCTION ","standard_charge_algorithm":"Per diem ($3,618).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":3618.00},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"SALUDPOL Peru Police","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":923585.88},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedure 1, Case rate ($47,950). Procedures 2 - 9999, Per diem ($14,691).","methodology":"other","median_amount":304895.00,"10th_percentile":22008.00,"90th_percentile":905903.64,"count":"1 through 10","additional_payer_notes":"Cardiac Ablation","standard_charge_dollar":1319408.40},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay.","standard_charge_dollar":6200.00},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"EMBASSY OF STATE OF KUWAIT [11010001]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":897197.71},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"KUWAIT OIL COMPANY [11010005]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":897197.71},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 110%.","methodology":"other","median_amount":1383178.02,"10th_percentile":1383178.02,"90th_percentile":1383178.02,"count":"1 through 10","additional_payer_notes":"All Inpatient","standard_charge_dollar":310837.01},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_percentage":91.72,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1210161.38},{"payer_name":"UC AFF HUMANA\/SDSM [164025]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"HMSA - HAWAII MEDICAL SERVICE ASSOC MDCR [1041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"BLUE SHIELD PROMISE [1017]","plan_name":"CARE 1ST HEALTHPLAN MEDICARE ADVANTAGE (BS PROMISE)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":728313.44},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE","standard_charge_percentage":85.80,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1132052.41},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE DISTINCTION ","standard_charge_algorithm":"Per diem ($3,618).","methodology":"per diem","median_amount":891405.44,"10th_percentile":303000.00,"90th_percentile":1737816.46,"count":"1 through 10","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay.","standard_charge_dollar":3618.00},{"payer_name":"HEALTHNET TRANSPLANTS [1114]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MID-COUNTY PHYSICIANS NARROW NETWORK","standard_charge_percentage":69.13,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":912107.03},{"payer_name":"AETNA [1003]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","median_amount":280318.30,"10th_percentile":280318.30,"90th_percentile":280318.30,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":282579.10},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedure 1, Case rate ($33,566). Procedures 2 - 9999, Per diem ($10,284).","methodology":"other","count":"0","additional_payer_notes":"Cardiac Ablation Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1319408.40},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EPO [10130074]","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedure 1, Case rate ($47,950). Procedures 2 - 9999, Per diem ($14,691).","methodology":"other","count":"0","additional_payer_notes":"Cardiac Ablation Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1319408.40},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay.","standard_charge_dollar":6200.00},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($344,950.99). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $318,996.75, add-ons for qualifying new technology services are included. If operating cost exceeds $368,155.64 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $26,641.32, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $320,249.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $318,207.64 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $23,911.99. The transfer capital threshold is the transfer adjustment factor * $23,911.99. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":344950.99},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Commercial","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 150%.","methodology":"other","count":"0","additional_payer_notes":"General Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":423868.65},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Medicare","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"General Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":310837.01},{"payer_name":"MC HNET BLUE&GOLD ACO [164017]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158329.01},{"payer_name":"CENTRAL HEALTH PLAN [2026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"MEDCARE PARTNERS [2084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"CASSIDY MED GRP [1019]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":857615.46},{"payer_name":"BEAVER MED GRP [2075]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"USOC - US OLYMPIC COMMITTEE [1123]","plan_name":"USOC VIK (BSC UC CARE)","standard_charge_percentage":43.10,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":568665.02},{"payer_name":"HEALTHCARE PARTNERS [2073]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE","standard_charge_percentage":85.80,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1132052.41},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($344,950.99). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $318,996.75, add-ons for qualifying new technology services are included. If operating cost exceeds $368,155.64 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $26,641.32, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $320,249.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $318,207.64 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $23,911.99. The transfer capital threshold is the transfer adjustment factor * $23,911.99. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":344950.99},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK","standard_charge_percentage":85.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1121497.14},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($281,868.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $259,305.54, add-ons for qualifying new technology services are included. If operating cost exceeds $308,464.43 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $23,249.74, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $260,558.69 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $258,516.43 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,520.40. The transfer capital threshold is the transfer adjustment factor * $20,520.40. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":281868.20},{"payer_name":"COMMUNITY ELDERCARE [1027]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"OPTUM CARE NETWORK - PCAMG [1064]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":857615.46},{"payer_name":"CLIPPERS WORKERS COMPENSATION [2097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($348,065.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $321,993.28, add-ons for qualifying new technology services are included. If operating cost exceeds $370,677.90 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $27,231.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $323,246.43 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $321,204.17 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $24,030.30. The transfer capital threshold is the transfer adjustment factor * $24,030.30. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":452485.58},{"payer_name":"VA - VETERANS ADMINISTRATION [1093]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($348,065.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $321,993.28, add-ons for qualifying new technology services are included. If operating cost exceeds $370,677.90 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $27,231.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $323,246.43 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $321,204.17 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $24,030.30. The transfer capital threshold is the transfer adjustment factor * $24,030.30. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":348065.83},{"payer_name":"US MARSHAL SERVICES [1090]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10},{"payer_name":"DESERT OASIS HEALTH CARE [2052]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($344,950.99). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $318,996.75, add-ons for qualifying new technology services are included. If operating cost exceeds $368,155.64 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $26,641.32, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $320,249.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $318,207.64 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $23,911.99. The transfer capital threshold is the transfer adjustment factor * $23,911.99. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":344950.99},{"payer_name":"STERLING OPTION 1 [1083]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($282,579.10). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $259,961.98, add-ons for qualifying new technology services are included. If operating cost exceeds $308,646.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $23,776.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.8. The base transfer operating payment is the transfer adjustment factor * $261,215.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $259,172.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $20,574.86. The transfer capital threshold is the transfer adjustment factor * $20,574.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. For stays with condition code 49 or 50, reimbursement is reduced by any reported device reduction amounts.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":282579.10}]}]}
,{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures","code_information":[{"code":"003","type":"TRIS-DRG"},{"code":"003","type":"MS-DRG"}],"standard_charges":[{"minimum":21.23,"maximum":488058.18,"gross_charge":1412409.90,"discounted_cash":776825.45,"setting":"inpatient","payers_information":[{"payer_name":"ALTERNATE HEALTH NET BH [2059]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"ALTERNATE HEALTH NET BH [2059]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"BEECH STREET [1012]","plan_name":"CAPPCARE\/BEECH STREET","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1059307.43},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH PLAN","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":847445.94},{"payer_name":"XIMED [2016]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":212752.75,"10th_percentile":212752.75,"90th_percentile":212752.75,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":214215.82},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MARKET PLACE","standard_charge_algorithm":"Case rate ($213,677.38). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $196,588.51, add-ons for qualifying new technology services are included. If operating cost exceeds $245,747.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $18,271.41, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,346.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $195,799.40 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,542.08. The transfer capital threshold is the transfer adjustment factor * $15,542.08. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 180%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":213677.38},{"payer_name":"AETNA [1003]","plan_name":"AETNA BEHAVIORAL EATING DISORDER","standard_charge_percentage":43.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":617223.13},{"payer_name":"ALTERNATE SHERIFF CUSTODY [1106]","plan_name":"SHERIFF COUNTY CONTRACT # 514250","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":918066.44},{"payer_name":"TRICARE [1086]","plan_name":"TRICARE ","standard_charge_algorithm":"If the length of stay is greater than 2, the reimbursement is as follows: Case rate ($404,158.55). For stays with a post-acute discharge disposition of 03, 05, 06, 62, 63, or 65, the transfer payment is a per diem payment of $17,271.73, and the first day is paid a rate of $34,543.47. For stays with a transfer discharge disposition of 02 or 82, the transfer payment is a per diem payment of $17,271.73, and the first day is paid a rate of $34,543.47. The transfer payment is capped at $308,447.34. Billed amount less exclusions adjusted by a cost-to-charge ratio of 0.2348 that exceeds an outlier threshold of $456,829.72 is considered a cost outlier and adds an additional payment of 80% of the excess amount. For stays with a post-acute or transfer discharge disposition, the outlier threshold is multiplied by (LOS \/ 23.3999996185303). Includes reimbursement from new technology add-ons. If the length of stay is less than or equal to 2, the reimbursement is as follows: , capped at $308,447.34. For stays with a post-acute discharge disposition of 03, 05, 06, 62, 63, or 65, the transfer payment is a per diem payment of $17,271.73, and the first day is paid a rate of $34,543.47. For stays with a transfer discharge disposition of 02 or 82, the transfer payment is a per diem payment of $17,271.73, and the first day is paid a rate of $34,543.47. The transfer payment is capped at $308,447.34. Billed amount less exclusions adjusted by a cost-to-charge ratio of 0.2348 that exceeds an outlier threshold of $456,829.72 is considered a cost outlier and adds an additional payment of 80% of the excess amount. For stays with a post-acute or transfer discharge disposition, the outlier threshold is multiplied by (LOS \/ 23.3999996185303). Includes reimbursement from new technology add-ons.","methodology":"other","median_amount":405995.16,"10th_percentile":344451.99,"90th_percentile":4053049.56,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":236380.57},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CALIFORNIA UC CARE \/ HSP","standard_charge_percentage":26.66,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":376548.48},{"payer_name":"QUALITY HEALTH [1069]","plan_name":"QUALITY HEALTH MANAGEMENT","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 185%.","methodology":"other","count":"0","additional_payer_notes":"Surgery  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":488058.18},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263815.23},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263815.23},{"payer_name":"MC HUMANA HMO [164013]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"RIVER CITY MEDICAL GROUP [2066]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"MEDI-CAL [1048]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"ALTERNATE MEDICARE [2007]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","median_amount":1042757.24,"10th_percentile":1042757.24,"90th_percentile":1042757.24,"count":"1 through 10","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":258538.93},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA COMMERCIAL","standard_charge_percentage":85.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1200548.42},{"payer_name":"MENIFEE MED GRP [2076]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE [10230006]","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"MC BLUE SHIELD HMO [164015]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EATING DISORDER","standard_charge_percentage":58.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":828237.17},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"INTERNATIONAL EMBASSY OF KUWAIT","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":960438.73},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE TRANSPLANT [11170001]","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"UCR PROMPT PAY PAYOR [8240]","plan_name":"UCSD CHARITY MEDICARE CONTRACT","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Medicare All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263815.23},{"payer_name":"ALTERNATE MEDI-CAL [2001]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"IMPERIAL COUNTY PHYSICIAN MED GRP","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":209931.50},{"payer_name":"KAISER [1046]","plan_name":"KAISER","standard_charge_percentage":63.00,"methodology":"percent of total billed charges","median_amount":647993.00,"10th_percentile":160616.72,"90th_percentile":1654184.87,"count":"18","additional_payer_notes":"undefined","standard_charge_dollar":889818.24},{"payer_name":"USAA [1091]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"AETNA [1003]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","median_amount":656744.63,"10th_percentile":115386.40,"90th_percentile":2721545.02,"count":"13","additional_payer_notes":"undefined","standard_charge_dollar":847445.94},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":209931.50},{"payer_name":"CIGNA [1023]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"ALTERNATE AETNA [1004]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":847445.94},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE QUALCOMM ","standard_charge_percentage":45.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":644623.88},{"payer_name":"ALTERNATE KAISER RAD ONC [2089]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"AMA - AMERICAN MEDICAL ASSOCIATION [1009]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"DEPARTMENT OF LABOR [1028]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","median_amount":455659.56,"10th_percentile":455659.56,"90th_percentile":455659.56,"count":"1 through 10","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":342959.80},{"payer_name":"IMPERIAL HEALTH HOLDINGS [1132]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":225382.82,"10th_percentile":225382.82,"90th_percentile":225382.82,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":214215.82},{"payer_name":"AFFILIATED DOCTORS OF ORANGE COUNTY [2041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"CAREMORE [2028]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"ASTIVA HEALTH [2095]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"AETNA [1003]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($213,677.38). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $196,588.51, add-ons for qualifying new technology services are included. If operating cost exceeds $245,747.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $18,271.41, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,346.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $195,799.40 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,542.08. The transfer capital threshold is the transfer adjustment factor * $15,542.08. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":213677.38},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($213,677.38). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $196,588.51, add-ons for qualifying new technology services are included. If operating cost exceeds $245,747.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $18,271.41, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,346.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $195,799.40 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,542.08. The transfer capital threshold is the transfer adjustment factor * $15,542.08. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Pre\/Post or Other\/VAD Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":213677.38},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDI-CAL","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 80%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Pre\/Post  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":209164.84},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA HMO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":710442.18},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA PPO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","median_amount":1441917.88,"10th_percentile":1441917.88,"90th_percentile":1441917.88,"count":"1 through 10","additional_payer_notes":"undefined","standard_charge_dollar":710442.18},{"payer_name":"MC AETNA GENERIC PAYOR [164008]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"MC UNITED HEALTHCARE HMO [164005]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED HMO NON CONTRACTED [10260001]","standard_charge_algorithm":"Case rate ($213,677.38). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $196,588.51, add-ons for qualifying new technology services are included. If operating cost exceeds $245,747.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $18,271.41, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,346.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $195,799.40 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,542.08. The transfer capital threshold is the transfer adjustment factor * $15,542.08. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":213677.38},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED PPO NON CONTRACTED [10260002]","standard_charge_algorithm":"Case rate ($213,677.38). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $196,588.51, add-ons for qualifying new technology services are included. If operating cost exceeds $245,747.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $18,271.41, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,346.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $195,799.40 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,542.08. The transfer capital threshold is the transfer adjustment factor * $15,542.08. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":213677.38},{"payer_name":"CLEVER CARE [2061]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($213,677.38). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $196,588.51, add-ons for qualifying new technology services are included. If operating cost exceeds $245,747.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $18,271.41, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,346.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $195,799.40 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,542.08. The transfer capital threshold is the transfer adjustment factor * $15,542.08. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":213677.38},{"payer_name":"SCRIPPS COASTAL MED GRP [1074]","plan_name":"SCRIPPS COASTAL MED GRP [10740001]","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":918066.44},{"payer_name":"ALTERNATE SCAN HEALTH [2088]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":203505.03},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"OLYMPUS MANAGED HEALTHCARE INC [11020001]","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":847445.94},{"payer_name":"PRIMARY CARE ASSOCIATES OF CA [2067]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"ENCOMPASS MED GRP [1030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263815.23},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263815.23},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","median_amount":235013.04,"10th_percentile":235013.04,"90th_percentile":458754.98,"count":"1 through 10","additional_payer_notes":"All Inpatient","standard_charge_dollar":214215.82},{"payer_name":"MC AETNA HMO [164001]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"ALTERNATE VA - VETERANS ADMINISTRATION [1239]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263815.23},{"payer_name":"SDSM [2017]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"UNLISTED MEDICARE ADVANTAGE (NON-CONTRACTED) [1051]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"COMMUNITY HEALTH GROUP [1022]","plan_name":"COMMUNITY HEALTH GROUP MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 113%.","methodology":"other","median_amount":296249.18,"10th_percentile":296249.18,"90th_percentile":599934.05,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":242063.88},{"payer_name":"BANKERS LIFE [1011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNA PRIORITY SELECT","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 3, Case rate ($28,037). Procedures 4 - 9999, Per diem ($7,009).","methodology":"other","count":"0","additional_payer_notes":"Computer Assisted Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"VANTAGE [1092]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"SIMNSA HEALTH PLAN [2047]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":888867.99,"10th_percentile":888867.99,"90th_percentile":888867.99,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":214215.82},{"payer_name":"MC CIGNA GENERIC PAYOR [164007]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"MC UHC ALLIANCE HMO [164020]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"ADMAR [1001]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":918066.44},{"payer_name":"MC HEALTHNET HMO [164004]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"BPS - BENEFIT PLAN SERVICES [1015]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":918066.44},{"payer_name":"MC UNITED HEALTHCARE GENERIC PAYOR [164011]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":257058.98},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":370856.99,"10th_percentile":370856.99,"90th_percentile":370856.99,"count":"1 through 10","additional_payer_notes":"All Inptient Services","standard_charge_dollar":214215.82},{"payer_name":"KAISER [1046]","plan_name":"KAISER MEDICARE ADVANTAGE","standard_charge_percentage":63.00,"methodology":"percent of total billed charges","median_amount":617517.93,"10th_percentile":390637.54,"90th_percentile":1110822.97,"count":"1 through 10","additional_payer_notes":"undefined","standard_charge_dollar":889818.24},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD COVERED CA TRIO HMO","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"TRIWEST [2003]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","median_amount":387358.79,"10th_percentile":268988.15,"90th_percentile":601788.71,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":263815.23},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA COMMERCIAL","standard_charge_percentage":85.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1200548.42},{"payer_name":"EASY ACCESS CARE [2077]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"TRANSAMERICA [1084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($213,677.38). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $196,588.51, add-ons for qualifying new technology services are included. If operating cost exceeds $245,747.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $18,271.41, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,346.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $195,799.40 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,542.08. The transfer capital threshold is the transfer adjustment factor * $15,542.08. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":213677.38},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"ALPHACARE [2062]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS HOUSE STAFF","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":372876.21},{"payer_name":"FIRST HEALTH [1032]","plan_name":"FIRST HEALTH","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1059307.43},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"US BEHAVIORAL MENTAL\/EATING DISORDER","standard_charge_percentage":70.00,"standard_charge_algorithm":"70% of billed.","methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":988686.93},{"payer_name":"MC ANTHEM BLUE CROSS GENERIC PAYOR [164009]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"MC HEALTHNET GENERIC PAYOR [164010]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"MC CIGNA HMO [164003]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"INTERPLAN [1045]","plan_name":"INTERPLAN","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":988686.93},{"payer_name":"TRI-CITY [1085]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"CHRISTIAN HEALTHCARE MINISTRIES [2030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"ARCH HEALTH PARTNERS [2000]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"BLUE CROSS [1013]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($213,677.38). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $196,588.51, add-ons for qualifying new technology services are included. If operating cost exceeds $245,747.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $18,271.41, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,346.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $195,799.40 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,542.08. The transfer capital threshold is the transfer adjustment factor * $15,542.08. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":213677.38},{"payer_name":"BLUE CROSS [1013]","plan_name":"UCSD STUDENT HEALTH INS PLAN - BC SHIP","standard_charge_percentage":26.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":377113.44},{"payer_name":"MC UHC VEBA GENERIC HMO [164032]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"UNLISTED HOSPICE [1035]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"ELIZABETH HOSPICE [2018]","plan_name":"ELIZABETH HOSPICE GIP","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay.","standard_charge_dollar":950.00},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":102231.14,"10th_percentile":102231.14,"90th_percentile":102231.14,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":214215.82},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"SEDGWICK [1077]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":342959.80},{"payer_name":"MULTIPLAN [1058]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":918066.44},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","median_amount":251193.15,"10th_percentile":251193.15,"90th_percentile":1424505.28,"count":"1 through 10","additional_payer_notes":"Surgery","standard_charge_dollar":1412409.90},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA EPN\/IFP","standard_charge_algorithm":"Per diem ($7,687). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .468 will be used instead of the standard payment.","methodology":"other","median_amount":1845409.06,"10th_percentile":1845409.06,"90th_percentile":1845409.06,"count":"1 through 10","additional_payer_notes":"Surgery","standard_charge_dollar":1412409.90},{"payer_name":"INTEGRATED HEALTH PARTNERS [2068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE ST PAULS","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":481585.71,"10th_percentile":481585.71,"90th_percentile":481585.71,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":263815.23},{"payer_name":"GREATER NEWPORT PHYSICIANS [2096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"PACIFIC FOUNDATION [1063]","plan_name":"PACIFIC FOUNDATION FOR MEDICAL CARE","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1059307.43},{"payer_name":"MC SCAN GENERIC PAYOR [164034]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":608853.38,"10th_percentile":608853.38,"90th_percentile":608853.38,"count":"1 through 10","additional_payer_notes":"Inpatient ","standard_charge_dollar":214215.82},{"payer_name":"KEY MED GRP [2074]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"CARNIVAL CRUISES [1018]","plan_name":"CARNIVAL CRUISES [10180001]","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1129927.92},{"payer_name":"MC UHC VEBA HMO [164033]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MID-COUNTY PHYSICIANS NARROW NETWORK","standard_charge_algorithm":"Per diem ($17,123).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":17123.00},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS UC CARE","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":372876.21},{"payer_name":"MERCY PHYSICIANS MED GRP [1052]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"TRI-CITY MEDICAL CENTER [1129]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"UC AFF BLUE SHIELD SR\/SDSM [164037]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Per diem ($8,294). The outlier payment amount is calculated by taking the estimated cost amount, subtracting the threshold amount ($247,571), then multiplying the difference by the percent of outlier that is reimbursed (53%). If the calculated outlier amount is greater than $0, it is added to the reimbursement total. The estimated cost amount is the adjusted billed amount multiplied by the cost-to-charge ratio (1). The following revenue codes are excluded from the adjusted billed amount: RC 0274-0276, 0278, 0624, 0891.","methodology":"per diem","median_amount":572818.20,"10th_percentile":572818.20,"90th_percentile":576798.02,"count":"1 through 10","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay.","standard_charge_dollar":8294.00},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET MEDICARE ADVANTAGE UC EMPLOYER GROUP","standard_charge_algorithm":"Fee schedule rate ($21.23). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":21.23},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"PRIVATE HEALTHCARE SYSTEM","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":918066.44},{"payer_name":"BLUE SHIELD TRANSPLANTS [1113]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"MVP HEALTHCARE [1060]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"SCRIPPS HEALTH PLAN SERVICES [1075]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":847445.94},{"payer_name":"INLAND FACULTY MEDICAL GROUP [2063]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"NATIONAL HEALTHCARE SOLUTIONS INC [1100]","plan_name":"NATIONAL HEALTHCARE SOLUTIONS INC [11000001]","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1129927.92},{"payer_name":"KERN HEALTH SYSTEMS [2033]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"CHESAPEAKE LIFE [1021]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"ROYAL EMBASSY","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":988686.93},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":428031.81,"10th_percentile":428031.81,"90th_percentile":428031.81,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":214215.82},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":274310.21,"10th_percentile":274310.21,"90th_percentile":274310.21,"count":"1 through 10","additional_payer_notes":"Inpatient","standard_charge_dollar":214215.82},{"payer_name":"GLOBAL EXCEL [1036]","plan_name":"GLOBAL EXCEL","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 165%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263815.23},{"payer_name":"REDLANDS COMMUNITY HOSPITAL [2005]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"VILLAGE HEALTH [1094]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"PREMIER PATIENT CARE IPA [2069]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"CALIFORNIA HEALTH & WELLNESS MEDI-CAL [1122]","plan_name":"CALIFORNIA HEALTH AND WELLNESS MEDI-CAL (no longer Medi-Cal plan as of 1\/1\/24)","standard_charge_algorithm":"Per diem ($2,600).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2600.00},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","median_amount":338150.94,"10th_percentile":338150.94,"90th_percentile":338150.94,"count":"1 through 10","additional_payer_notes":"undefined","standard_charge_dollar":847445.94},{"payer_name":"HEALTH NET [1039]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"WORKERS COMPENSATION [1097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","median_amount":1775474.02,"10th_percentile":1775474.02,"90th_percentile":1775474.02,"count":"1 through 10","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":342959.80},{"payer_name":"INTER VALLEY HEALTH PLAN [2024]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"EASY CHOICE [1029]","plan_name":"EASY CHOICE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"ALTERNATE BRAND NEW DAY [2079]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"MC BRAND NEW DAY HMO [164030]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Per diem ($8,294). The outlier payment amount is calculated by taking the estimated cost amount, subtracting the threshold amount ($247,571), then multiplying the difference by the percent of outlier that is reimbursed (53%). If the calculated outlier amount is greater than $0, it is added to the reimbursement total. The estimated cost amount is the adjusted billed amount multiplied by the cost-to-charge ratio (1). The following revenue codes are excluded from the adjusted billed amount: RC 0274-0276, 0278, 0624, 0891.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":8294.00},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"CIGNA HMO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":710442.18},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":1531969.83,"10th_percentile":1531969.83,"90th_percentile":1531969.83,"count":"1 through 10","additional_payer_notes":"All Inpatient-Medicare DRG","standard_charge_dollar":214215.82},{"payer_name":"MC BRAND NEW DAY GENERIC PAYOR [164031]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"UNITED AMERICAN [1087]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"MC ANTHEM BLUE CROSS HMO [164002]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"CHAMPVA [1020]","plan_name":"VETERANS ADMINISTRATION - CHAMPVA","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263815.23},{"payer_name":"CAL OPTIMA [1016]","plan_name":"CalOptima Medicare","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263815.23},{"payer_name":"RIVERSIDE MEDICAL CLINIC [2064]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"SD PHYSICIANS MED GRP [1076]","plan_name":"SD PHYSICIANS MED GRP SR [10760002]","standard_charge_percentage":55.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":776825.45},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET ENHANCED CARE PPO","standard_charge_algorithm":"Case rate ($199,913.49). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $184,143.14, add-ons for qualifying new technology services are included. If operating cost exceeds $233,302.03 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $16,952.89, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $185,689.94. The transfer operating threshold is the transfer adjustment factor * $184,143.14 If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $14,223.55. The transfer capital threshold is the transfer adjustment factor * $14,223.55. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 281%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services (MSDRG no DSH GME IME) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":199913.49},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"PYRAMID LIFE [1068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"ETS - LIFETRAC NETWORK [1103]","plan_name":"LIFETRAC","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":918066.44},{"payer_name":"BLUE SHIELD [1014]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($213,677.38). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $196,588.51, add-ons for qualifying new technology services are included. If operating cost exceeds $245,747.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $18,271.41, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,346.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $195,799.40 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,542.08. The transfer capital threshold is the transfer adjustment factor * $15,542.08. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":213677.38},{"payer_name":"MUTUAL OF OMAHA [1059]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"TRIWEST ALTERNATE [2036]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263815.23},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"KUWAIT OIL COMPANY [11010005]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":960438.73},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":257058.98},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"IMPERIAL HEALTH PLAN [2081]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"HERITAGE VICTOR VALLEY MEDICAL GROUP [2045]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE PPO","standard_charge_percentage":49.55,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":699849.11},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UHC SELECT AND SELECT PLUS","standard_charge_algorithm":"Per diem ($14,996).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":14996.00},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":847445.94},{"payer_name":"SIERRA MEDICAL GROUP [2048]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":209931.50},{"payer_name":"MC UHC HARMONY HMO [164026]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"AETNA TRANSPLANTS [1112]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":847445.94},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"CIGNA [1023]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"UC AFF MC HUMANA GENERIC PAYOR [164027]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"MONARCH HEALTHCARE [2006]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":1558167.34,"10th_percentile":1558167.34,"90th_percentile":1558167.34,"count":"1 through 10","additional_payer_notes":"All Other Inpatient Services","standard_charge_dollar":261456.05},{"payer_name":"HUMANA [1042]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($213,677.38). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $196,588.51, add-ons for qualifying new technology services are included. If operating cost exceeds $245,747.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $18,271.41, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,346.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $195,799.40 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,542.08. The transfer capital threshold is the transfer adjustment factor * $15,542.08. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":213677.38},{"payer_name":"STATE OF CALIFORNIA [1082]","plan_name":"California State Prison","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 250%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263815.23},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"SAN DIEGO SOCKERS [2015]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":342959.80},{"payer_name":"AMERICAN SPECIALTY HEALTH PLAN [2038]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"HIGH DESERT MEDICAL GROUP [2053]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"MGM RESORTS [1053]","plan_name":"MGM RESORT","standard_charge_algorithm":"Fee schedule rate ($35.02). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":57.79},{"payer_name":"IMMIGRATION HEALTH SERVICES [1043]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":258538.93},{"payer_name":"UC AFF ANTHEM\/SDSM HMO [164024]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"WELL CARE [1096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"BLUE SHIELD PROMISE [1017]","plan_name":"CARE 1ST HEALTHPLAN MEDICARE ADVANTAGE (BS PROMISE)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MA\/SDPMG","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":203505.03},{"payer_name":"MC SCAN HMO [164035]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"ST JOSEPH ST JUDE [2065]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"GOLDEN PHYSICIANS MEDICAL GROUP [2082]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"UC AFF HUMANA\/SDSM [164025]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"ADVANTRA FREEDOM [1002]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"SCAN HEALTH [1072]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":203505.03},{"payer_name":"MC HUMANA GENERIC PAYOR [164014]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"EMPIRE PHYS MED GRP [2072]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"HEMET COMMUNITY MED GRP - PROMISECARE [1040]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE SAN DIEGO","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"MC BLUE SHIELD GENERIC PAYOR [164016]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"CMN - CANADIAN MEDICAL NETWORK [1024]","plan_name":"CMN GLOBAL INC","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 170%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":448485.89},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"BEACON HEALTH STRATEGY [2039]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"EMBASSY OF STATE OF KUWAIT [11010001]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":960438.73},{"payer_name":"LA CARE HEALTH PLAN [2025]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","median_amount":456427.90,"10th_percentile":456427.90,"90th_percentile":456427.90,"count":"1 through 10","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay.","standard_charge_dollar":26901.00},{"payer_name":"SCRIPPS HOSPICE [2008]","plan_name":"SCRIPPS HEALTH HOSPICE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay.","standard_charge_dollar":700.00},{"payer_name":"HEALTH CARE SUPPORT [2011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"UC AFF ANTHEM\/XIMED HMO [164022]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"Community Care IPA Medi-Cal Managed Care","standard_charge_algorithm":"Per diem ($1,750).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1750.00},{"payer_name":"BRAND NEW DAY [1089]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"AXA ASSISTANCE [1098]","plan_name":"AXA ASSISTANCE USA,INC","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":960438.73},{"payer_name":"FRESENIUS [1034]","plan_name":"FRESENIUS HEALTH PARTNERS, INC","standard_charge_algorithm":"Case rate ($213,677.38). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $196,588.51, add-ons for qualifying new technology services are included. If operating cost exceeds $245,747.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $18,271.41, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,346.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $195,799.40 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,542.08. The transfer capital threshold is the transfer adjustment factor * $15,542.08. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":213677.38},{"payer_name":"CIGNA [1023]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":779650.26},{"payer_name":"LAKESIDE MEDICAL GROUP [2054]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"MEDICARE [1050]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","median_amount":294394.47,"10th_percentile":203379.67,"90th_percentile":691005.00,"count":"35","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":258538.93},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"SALUDPOL Peru Police","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":988686.93},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 3, Case rate ($54,034). Procedures 4 - 9999, Per diem ($13,509).","methodology":"other","median_amount":435261.28,"10th_percentile":255497.60,"90th_percentile":558340.75,"count":"14","additional_payer_notes":"Computer Assisted","standard_charge_dollar":1412409.90},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($213,677.38). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $196,588.51, add-ons for qualifying new technology services are included. If operating cost exceeds $245,747.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $18,271.41, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,346.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $195,799.40 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,542.08. The transfer capital threshold is the transfer adjustment factor * $15,542.08. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","median_amount":402725.51,"10th_percentile":402725.51,"90th_percentile":1834582.45,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":213677.38},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","median_amount":261803.16,"10th_percentile":261803.16,"90th_percentile":508774.69,"count":"1 through 10","additional_payer_notes":"All Inpatient","standard_charge_dollar":235637.40},{"payer_name":"HMSA - HAWAII MEDICAL SERVICE ASSOC MDCR [1041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 3, Case rate ($37,824). Procedures 4 - 9999, Per diem ($9,456).","methodology":"other","count":"0","additional_payer_notes":"Computer Assisted Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":779650.26},{"payer_name":"HEALTHNET TRANSPLANTS [1114]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"AETNA [1003]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":316353.03,"10th_percentile":316353.03,"90th_percentile":316353.03,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":214215.82},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EPO [10130074]","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 3, Case rate ($54,034). Procedures 4 - 9999, Per diem ($13,509).","methodology":"other","count":"0","additional_payer_notes":"Computer Assisted Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 3, Case rate ($37,824). Procedures 4 - 9999, Per diem ($9,456).","methodology":"other","count":"0","additional_payer_notes":"Computer Assisted Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 3, Case rate ($54,034). Procedures 4 - 9999, Per diem ($13,509).","methodology":"other","count":"0","additional_payer_notes":"Computer Assisted Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"MC HNET BLUE&GOLD ACO [164017]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Commercial","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 150%.","methodology":"other","count":"0","additional_payer_notes":"General Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":321323.73},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Medicare","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"General Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":235637.40},{"payer_name":"CENTRAL HEALTH PLAN [2026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":430385.94,"10th_percentile":430385.94,"90th_percentile":430385.94,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":214215.82},{"payer_name":"MEDCARE PARTNERS [2084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"CASSIDY MED GRP [1019]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":918066.44},{"payer_name":"BEAVER MED GRP [2075]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"HEALTHCARE PARTNERS [2073]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","median_amount":873685.55,"10th_percentile":873685.55,"90th_percentile":873685.55,"count":"1 through 10","additional_payer_notes":"Surgery","standard_charge_dollar":1412409.90},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"USOC - US OLYMPIC COMMITTEE [1123]","plan_name":"USOC VIK (BSC UC CARE)","standard_charge_percentage":43.10,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":608748.67},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK","standard_charge_algorithm":"Per diem ($4,000). A payment threshold will be met when non-excluded charges is greater than 325000. For days after this threshold has been met, a per diem of (non-excluded charges for that day multiplied by .65) will be used instead of the standard payment for each day after the threshold.","methodology":"other","count":"0","additional_payer_notes":"ICU\/CCU Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"COMMUNITY ELDERCARE [1027]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"OPTUM CARE NETWORK - PCAMG [1064]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":918066.44},{"payer_name":"VA - VETERANS ADMINISTRATION [1093]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263815.23},{"payer_name":"US MARSHAL SERVICES [1090]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"CLIPPERS WORKERS COMPENSATION [2097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":342959.80},{"payer_name":"STERLING OPTION 1 [1083]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"DESERT OASIS HEALTH CARE [2052]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05}]},{"minimum":236380.57,"maximum":236380.57,"gross_charge":744614.85,"discounted_cash":409538.17,"setting":"inpatient","payers_information":[{"payer_name":"ALTERNATE HEALTH NET BH [2059]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"ALTERNATE HEALTH NET BH [2059]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"BEECH STREET [1012]","plan_name":"CAPPCARE\/BEECH STREET","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1059307.43},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH PLAN","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":847445.94},{"payer_name":"XIMED [2016]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":212752.75,"10th_percentile":212752.75,"90th_percentile":212752.75,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":214215.82},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MARKET PLACE","standard_charge_algorithm":"Case rate ($213,677.38). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $196,588.51, add-ons for qualifying new technology services are included. If operating cost exceeds $245,747.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $18,271.41, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,346.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $195,799.40 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,542.08. The transfer capital threshold is the transfer adjustment factor * $15,542.08. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 180%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":213677.38},{"payer_name":"AETNA [1003]","plan_name":"AETNA BEHAVIORAL EATING DISORDER","standard_charge_percentage":43.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":617223.13},{"payer_name":"ALTERNATE SHERIFF CUSTODY [1106]","plan_name":"SHERIFF COUNTY CONTRACT # 514250","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":918066.44},{"payer_name":"TRICARE [1086]","plan_name":"TRICARE ","standard_charge_algorithm":"If the length of stay is greater than 2, the reimbursement is as follows: Case rate ($404,158.55). For stays with a post-acute discharge disposition of 03, 05, 06, 62, 63, or 65, the transfer payment is a per diem payment of $17,271.73, and the first day is paid a rate of $34,543.47. For stays with a transfer discharge disposition of 02 or 82, the transfer payment is a per diem payment of $17,271.73, and the first day is paid a rate of $34,543.47. The transfer payment is capped at $308,447.34. Billed amount less exclusions adjusted by a cost-to-charge ratio of 0.2348 that exceeds an outlier threshold of $456,829.72 is considered a cost outlier and adds an additional payment of 80% of the excess amount. For stays with a post-acute or transfer discharge disposition, the outlier threshold is multiplied by (LOS \/ 23.3999996185303). Includes reimbursement from new technology add-ons. If the length of stay is less than or equal to 2, the reimbursement is as follows: , capped at $308,447.34. For stays with a post-acute discharge disposition of 03, 05, 06, 62, 63, or 65, the transfer payment is a per diem payment of $17,271.73, and the first day is paid a rate of $34,543.47. For stays with a transfer discharge disposition of 02 or 82, the transfer payment is a per diem payment of $17,271.73, and the first day is paid a rate of $34,543.47. The transfer payment is capped at $308,447.34. Billed amount less exclusions adjusted by a cost-to-charge ratio of 0.2348 that exceeds an outlier threshold of $456,829.72 is considered a cost outlier and adds an additional payment of 80% of the excess amount. For stays with a post-acute or transfer discharge disposition, the outlier threshold is multiplied by (LOS \/ 23.3999996185303). Includes reimbursement from new technology add-ons.","methodology":"other","median_amount":405995.16,"10th_percentile":344451.99,"90th_percentile":4053049.56,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":236380.57},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CALIFORNIA UC CARE \/ HSP","standard_charge_percentage":26.66,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":376548.48},{"payer_name":"QUALITY HEALTH [1069]","plan_name":"QUALITY HEALTH MANAGEMENT","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 185%.","methodology":"other","count":"0","additional_payer_notes":"Surgery  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":488058.18},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263815.23},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263815.23},{"payer_name":"MC HUMANA HMO [164013]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"RIVER CITY MEDICAL GROUP [2066]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"MEDI-CAL [1048]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"ALTERNATE MEDICARE [2007]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","median_amount":1042757.24,"10th_percentile":1042757.24,"90th_percentile":1042757.24,"count":"1 through 10","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":258538.93},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA COMMERCIAL","standard_charge_percentage":85.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1200548.42},{"payer_name":"MENIFEE MED GRP [2076]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE [10230006]","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"MC BLUE SHIELD HMO [164015]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EATING DISORDER","standard_charge_percentage":58.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":828237.17},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"INTERNATIONAL EMBASSY OF KUWAIT","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":960438.73},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE TRANSPLANT [11170001]","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"UCR PROMPT PAY PAYOR [8240]","plan_name":"UCSD CHARITY MEDICARE CONTRACT","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Medicare All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263815.23},{"payer_name":"ALTERNATE MEDI-CAL [2001]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"IMPERIAL COUNTY PHYSICIAN MED GRP","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":209931.50},{"payer_name":"KAISER [1046]","plan_name":"KAISER","standard_charge_percentage":63.00,"methodology":"percent of total billed charges","median_amount":647993.00,"10th_percentile":160616.72,"90th_percentile":1654184.87,"count":"18","additional_payer_notes":"undefined","standard_charge_dollar":889818.24},{"payer_name":"USAA [1091]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"AETNA [1003]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","median_amount":656744.63,"10th_percentile":115386.40,"90th_percentile":2721545.02,"count":"13","additional_payer_notes":"undefined","standard_charge_dollar":847445.94},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":209931.50},{"payer_name":"CIGNA [1023]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"ALTERNATE AETNA [1004]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":847445.94},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE QUALCOMM ","standard_charge_percentage":45.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":644623.88},{"payer_name":"ALTERNATE KAISER RAD ONC [2089]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"AMA - AMERICAN MEDICAL ASSOCIATION [1009]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"DEPARTMENT OF LABOR [1028]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","median_amount":455659.56,"10th_percentile":455659.56,"90th_percentile":455659.56,"count":"1 through 10","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":342959.80},{"payer_name":"IMPERIAL HEALTH HOLDINGS [1132]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":225382.82,"10th_percentile":225382.82,"90th_percentile":225382.82,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":214215.82},{"payer_name":"AFFILIATED DOCTORS OF ORANGE COUNTY [2041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"CAREMORE [2028]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"ASTIVA HEALTH [2095]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"AETNA [1003]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($213,677.38). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $196,588.51, add-ons for qualifying new technology services are included. If operating cost exceeds $245,747.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $18,271.41, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,346.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $195,799.40 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,542.08. The transfer capital threshold is the transfer adjustment factor * $15,542.08. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":213677.38},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($213,677.38). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $196,588.51, add-ons for qualifying new technology services are included. If operating cost exceeds $245,747.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $18,271.41, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,346.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $195,799.40 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,542.08. The transfer capital threshold is the transfer adjustment factor * $15,542.08. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Pre\/Post or Other\/VAD Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":213677.38},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDI-CAL","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 80%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Pre\/Post  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":209164.84},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA HMO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":710442.18},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA PPO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","median_amount":1441917.88,"10th_percentile":1441917.88,"90th_percentile":1441917.88,"count":"1 through 10","additional_payer_notes":"undefined","standard_charge_dollar":710442.18},{"payer_name":"MC AETNA GENERIC PAYOR [164008]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"MC UNITED HEALTHCARE HMO [164005]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED HMO NON CONTRACTED [10260001]","standard_charge_algorithm":"Case rate ($213,677.38). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $196,588.51, add-ons for qualifying new technology services are included. If operating cost exceeds $245,747.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $18,271.41, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,346.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $195,799.40 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,542.08. The transfer capital threshold is the transfer adjustment factor * $15,542.08. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":213677.38},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED PPO NON CONTRACTED [10260002]","standard_charge_algorithm":"Case rate ($213,677.38). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $196,588.51, add-ons for qualifying new technology services are included. If operating cost exceeds $245,747.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $18,271.41, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,346.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $195,799.40 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,542.08. The transfer capital threshold is the transfer adjustment factor * $15,542.08. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":213677.38},{"payer_name":"CLEVER CARE [2061]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($213,677.38). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $196,588.51, add-ons for qualifying new technology services are included. If operating cost exceeds $245,747.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $18,271.41, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,346.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $195,799.40 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,542.08. The transfer capital threshold is the transfer adjustment factor * $15,542.08. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":213677.38},{"payer_name":"SCRIPPS COASTAL MED GRP [1074]","plan_name":"SCRIPPS COASTAL MED GRP [10740001]","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":918066.44},{"payer_name":"ALTERNATE SCAN HEALTH [2088]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":203505.03},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"OLYMPUS MANAGED HEALTHCARE INC [11020001]","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":847445.94},{"payer_name":"PRIMARY CARE ASSOCIATES OF CA [2067]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"ENCOMPASS MED GRP [1030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263815.23},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263815.23},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","median_amount":235013.04,"10th_percentile":235013.04,"90th_percentile":458754.98,"count":"1 through 10","additional_payer_notes":"All Inpatient","standard_charge_dollar":214215.82},{"payer_name":"MC AETNA HMO [164001]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"ALTERNATE VA - VETERANS ADMINISTRATION [1239]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263815.23},{"payer_name":"SDSM [2017]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"UNLISTED MEDICARE ADVANTAGE (NON-CONTRACTED) [1051]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"COMMUNITY HEALTH GROUP [1022]","plan_name":"COMMUNITY HEALTH GROUP MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 113%.","methodology":"other","median_amount":296249.18,"10th_percentile":296249.18,"90th_percentile":599934.05,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":242063.88},{"payer_name":"BANKERS LIFE [1011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNA PRIORITY SELECT","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 3, Case rate ($28,037). Procedures 4 - 9999, Per diem ($7,009).","methodology":"other","count":"0","additional_payer_notes":"Computer Assisted Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"VANTAGE [1092]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"SIMNSA HEALTH PLAN [2047]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":888867.99,"10th_percentile":888867.99,"90th_percentile":888867.99,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":214215.82},{"payer_name":"MC CIGNA GENERIC PAYOR [164007]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"MC UHC ALLIANCE HMO [164020]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"ADMAR [1001]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":918066.44},{"payer_name":"MC HEALTHNET HMO [164004]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"BPS - BENEFIT PLAN SERVICES [1015]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":918066.44},{"payer_name":"MC UNITED HEALTHCARE GENERIC PAYOR [164011]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":257058.98},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":370856.99,"10th_percentile":370856.99,"90th_percentile":370856.99,"count":"1 through 10","additional_payer_notes":"All Inptient Services","standard_charge_dollar":214215.82},{"payer_name":"KAISER [1046]","plan_name":"KAISER MEDICARE ADVANTAGE","standard_charge_percentage":63.00,"methodology":"percent of total billed charges","median_amount":617517.93,"10th_percentile":390637.54,"90th_percentile":1110822.97,"count":"1 through 10","additional_payer_notes":"undefined","standard_charge_dollar":889818.24},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD COVERED CA TRIO HMO","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"TRIWEST [2003]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","median_amount":387358.79,"10th_percentile":268988.15,"90th_percentile":601788.71,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":263815.23},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA COMMERCIAL","standard_charge_percentage":85.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1200548.42},{"payer_name":"EASY ACCESS CARE [2077]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"TRANSAMERICA [1084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($213,677.38). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $196,588.51, add-ons for qualifying new technology services are included. If operating cost exceeds $245,747.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $18,271.41, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,346.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $195,799.40 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,542.08. The transfer capital threshold is the transfer adjustment factor * $15,542.08. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":213677.38},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"ALPHACARE [2062]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS HOUSE STAFF","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":372876.21},{"payer_name":"FIRST HEALTH [1032]","plan_name":"FIRST HEALTH","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1059307.43},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"US BEHAVIORAL MENTAL\/EATING DISORDER","standard_charge_percentage":70.00,"standard_charge_algorithm":"70% of billed.","methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":988686.93},{"payer_name":"MC ANTHEM BLUE CROSS GENERIC PAYOR [164009]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"MC HEALTHNET GENERIC PAYOR [164010]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"MC CIGNA HMO [164003]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"INTERPLAN [1045]","plan_name":"INTERPLAN","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":988686.93},{"payer_name":"TRI-CITY [1085]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"CHRISTIAN HEALTHCARE MINISTRIES [2030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"ARCH HEALTH PARTNERS [2000]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"BLUE CROSS [1013]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($213,677.38). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $196,588.51, add-ons for qualifying new technology services are included. If operating cost exceeds $245,747.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $18,271.41, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,346.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $195,799.40 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,542.08. The transfer capital threshold is the transfer adjustment factor * $15,542.08. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":213677.38},{"payer_name":"BLUE CROSS [1013]","plan_name":"UCSD STUDENT HEALTH INS PLAN - BC SHIP","standard_charge_percentage":26.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":377113.44},{"payer_name":"MC UHC VEBA GENERIC HMO [164032]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"UNLISTED HOSPICE [1035]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"ELIZABETH HOSPICE [2018]","plan_name":"ELIZABETH HOSPICE GIP","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay.","standard_charge_dollar":950.00},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":102231.14,"10th_percentile":102231.14,"90th_percentile":102231.14,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":214215.82},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"SEDGWICK [1077]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":342959.80},{"payer_name":"MULTIPLAN [1058]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":918066.44},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","median_amount":251193.15,"10th_percentile":251193.15,"90th_percentile":1424505.28,"count":"1 through 10","additional_payer_notes":"Surgery","standard_charge_dollar":1412409.90},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA EPN\/IFP","standard_charge_algorithm":"Per diem ($7,687). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .468 will be used instead of the standard payment.","methodology":"other","median_amount":1845409.06,"10th_percentile":1845409.06,"90th_percentile":1845409.06,"count":"1 through 10","additional_payer_notes":"Surgery","standard_charge_dollar":1412409.90},{"payer_name":"INTEGRATED HEALTH PARTNERS [2068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE ST PAULS","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":481585.71,"10th_percentile":481585.71,"90th_percentile":481585.71,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":263815.23},{"payer_name":"GREATER NEWPORT PHYSICIANS [2096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"PACIFIC FOUNDATION [1063]","plan_name":"PACIFIC FOUNDATION FOR MEDICAL CARE","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1059307.43},{"payer_name":"MC SCAN GENERIC PAYOR [164034]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":608853.38,"10th_percentile":608853.38,"90th_percentile":608853.38,"count":"1 through 10","additional_payer_notes":"Inpatient ","standard_charge_dollar":214215.82},{"payer_name":"KEY MED GRP [2074]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"CARNIVAL CRUISES [1018]","plan_name":"CARNIVAL CRUISES [10180001]","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1129927.92},{"payer_name":"MC UHC VEBA HMO [164033]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MID-COUNTY PHYSICIANS NARROW NETWORK","standard_charge_algorithm":"Per diem ($17,123).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":17123.00},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS UC CARE","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":372876.21},{"payer_name":"MERCY PHYSICIANS MED GRP [1052]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"TRI-CITY MEDICAL CENTER [1129]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"UC AFF BLUE SHIELD SR\/SDSM [164037]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Per diem ($8,294). The outlier payment amount is calculated by taking the estimated cost amount, subtracting the threshold amount ($247,571), then multiplying the difference by the percent of outlier that is reimbursed (53%). If the calculated outlier amount is greater than $0, it is added to the reimbursement total. The estimated cost amount is the adjusted billed amount multiplied by the cost-to-charge ratio (1). The following revenue codes are excluded from the adjusted billed amount: RC 0274-0276, 0278, 0624, 0891.","methodology":"per diem","median_amount":572818.20,"10th_percentile":572818.20,"90th_percentile":576798.02,"count":"1 through 10","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay.","standard_charge_dollar":8294.00},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET MEDICARE ADVANTAGE UC EMPLOYER GROUP","standard_charge_algorithm":"Fee schedule rate ($21.23). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":21.23},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"PRIVATE HEALTHCARE SYSTEM","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":918066.44},{"payer_name":"BLUE SHIELD TRANSPLANTS [1113]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"MVP HEALTHCARE [1060]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"SCRIPPS HEALTH PLAN SERVICES [1075]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":847445.94},{"payer_name":"INLAND FACULTY MEDICAL GROUP [2063]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"NATIONAL HEALTHCARE SOLUTIONS INC [1100]","plan_name":"NATIONAL HEALTHCARE SOLUTIONS INC [11000001]","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1129927.92},{"payer_name":"KERN HEALTH SYSTEMS [2033]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"CHESAPEAKE LIFE [1021]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"ROYAL EMBASSY","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":988686.93},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":428031.81,"10th_percentile":428031.81,"90th_percentile":428031.81,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":214215.82},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":274310.21,"10th_percentile":274310.21,"90th_percentile":274310.21,"count":"1 through 10","additional_payer_notes":"Inpatient","standard_charge_dollar":214215.82},{"payer_name":"GLOBAL EXCEL [1036]","plan_name":"GLOBAL EXCEL","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 165%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263815.23},{"payer_name":"REDLANDS COMMUNITY HOSPITAL [2005]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"VILLAGE HEALTH [1094]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"PREMIER PATIENT CARE IPA [2069]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"CALIFORNIA HEALTH & WELLNESS MEDI-CAL [1122]","plan_name":"CALIFORNIA HEALTH AND WELLNESS MEDI-CAL (no longer Medi-Cal plan as of 1\/1\/24)","standard_charge_algorithm":"Per diem ($2,600).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2600.00},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","median_amount":338150.94,"10th_percentile":338150.94,"90th_percentile":338150.94,"count":"1 through 10","additional_payer_notes":"undefined","standard_charge_dollar":847445.94},{"payer_name":"HEALTH NET [1039]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"WORKERS COMPENSATION [1097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","median_amount":1775474.02,"10th_percentile":1775474.02,"90th_percentile":1775474.02,"count":"1 through 10","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":342959.80},{"payer_name":"INTER VALLEY HEALTH PLAN [2024]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"EASY CHOICE [1029]","plan_name":"EASY CHOICE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"ALTERNATE BRAND NEW DAY [2079]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"MC BRAND NEW DAY HMO [164030]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Per diem ($8,294). The outlier payment amount is calculated by taking the estimated cost amount, subtracting the threshold amount ($247,571), then multiplying the difference by the percent of outlier that is reimbursed (53%). If the calculated outlier amount is greater than $0, it is added to the reimbursement total. The estimated cost amount is the adjusted billed amount multiplied by the cost-to-charge ratio (1). The following revenue codes are excluded from the adjusted billed amount: RC 0274-0276, 0278, 0624, 0891.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":8294.00},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"CIGNA HMO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":710442.18},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":1531969.83,"10th_percentile":1531969.83,"90th_percentile":1531969.83,"count":"1 through 10","additional_payer_notes":"All Inpatient-Medicare DRG","standard_charge_dollar":214215.82},{"payer_name":"MC BRAND NEW DAY GENERIC PAYOR [164031]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"UNITED AMERICAN [1087]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"MC ANTHEM BLUE CROSS HMO [164002]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"CHAMPVA [1020]","plan_name":"VETERANS ADMINISTRATION - CHAMPVA","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263815.23},{"payer_name":"CAL OPTIMA [1016]","plan_name":"CalOptima Medicare","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263815.23},{"payer_name":"RIVERSIDE MEDICAL CLINIC [2064]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"SD PHYSICIANS MED GRP [1076]","plan_name":"SD PHYSICIANS MED GRP SR [10760002]","standard_charge_percentage":55.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":776825.45},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET ENHANCED CARE PPO","standard_charge_algorithm":"Case rate ($199,913.49). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $184,143.14, add-ons for qualifying new technology services are included. If operating cost exceeds $233,302.03 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $16,952.89, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $185,689.94. The transfer operating threshold is the transfer adjustment factor * $184,143.14 If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $14,223.55. The transfer capital threshold is the transfer adjustment factor * $14,223.55. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 281%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services (MSDRG no DSH GME IME) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":199913.49},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"PYRAMID LIFE [1068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"ETS - LIFETRAC NETWORK [1103]","plan_name":"LIFETRAC","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":918066.44},{"payer_name":"BLUE SHIELD [1014]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($213,677.38). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $196,588.51, add-ons for qualifying new technology services are included. If operating cost exceeds $245,747.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $18,271.41, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,346.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $195,799.40 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,542.08. The transfer capital threshold is the transfer adjustment factor * $15,542.08. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":213677.38},{"payer_name":"MUTUAL OF OMAHA [1059]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"TRIWEST ALTERNATE [2036]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263815.23},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"KUWAIT OIL COMPANY [11010005]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":960438.73},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":257058.98},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"IMPERIAL HEALTH PLAN [2081]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"HERITAGE VICTOR VALLEY MEDICAL GROUP [2045]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE PPO","standard_charge_percentage":49.55,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":699849.11},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UHC SELECT AND SELECT PLUS","standard_charge_algorithm":"Per diem ($14,996).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":14996.00},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":847445.94},{"payer_name":"SIERRA MEDICAL GROUP [2048]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":209931.50},{"payer_name":"MC UHC HARMONY HMO [164026]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"AETNA TRANSPLANTS [1112]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":847445.94},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"CIGNA [1023]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"UC AFF MC HUMANA GENERIC PAYOR [164027]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"MONARCH HEALTHCARE [2006]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":1558167.34,"10th_percentile":1558167.34,"90th_percentile":1558167.34,"count":"1 through 10","additional_payer_notes":"All Other Inpatient Services","standard_charge_dollar":261456.05},{"payer_name":"HUMANA [1042]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($213,677.38). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $196,588.51, add-ons for qualifying new technology services are included. If operating cost exceeds $245,747.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $18,271.41, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,346.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $195,799.40 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,542.08. The transfer capital threshold is the transfer adjustment factor * $15,542.08. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":213677.38},{"payer_name":"STATE OF CALIFORNIA [1082]","plan_name":"California State Prison","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 250%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263815.23},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"SAN DIEGO SOCKERS [2015]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":342959.80},{"payer_name":"AMERICAN SPECIALTY HEALTH PLAN [2038]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"HIGH DESERT MEDICAL GROUP [2053]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"MGM RESORTS [1053]","plan_name":"MGM RESORT","standard_charge_algorithm":"Fee schedule rate ($35.02). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":57.79},{"payer_name":"IMMIGRATION HEALTH SERVICES [1043]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":258538.93},{"payer_name":"UC AFF ANTHEM\/SDSM HMO [164024]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"WELL CARE [1096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"BLUE SHIELD PROMISE [1017]","plan_name":"CARE 1ST HEALTHPLAN MEDICARE ADVANTAGE (BS PROMISE)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MA\/SDPMG","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":203505.03},{"payer_name":"MC SCAN HMO [164035]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"ST JOSEPH ST JUDE [2065]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"GOLDEN PHYSICIANS MEDICAL GROUP [2082]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"UC AFF HUMANA\/SDSM [164025]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"ADVANTRA FREEDOM [1002]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"SCAN HEALTH [1072]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":203505.03},{"payer_name":"MC HUMANA GENERIC PAYOR [164014]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"EMPIRE PHYS MED GRP [2072]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"HEMET COMMUNITY MED GRP - PROMISECARE [1040]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE SAN DIEGO","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"MC BLUE SHIELD GENERIC PAYOR [164016]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"CMN - CANADIAN MEDICAL NETWORK [1024]","plan_name":"CMN GLOBAL INC","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 170%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":448485.89},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"BEACON HEALTH STRATEGY [2039]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"EMBASSY OF STATE OF KUWAIT [11010001]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":960438.73},{"payer_name":"LA CARE HEALTH PLAN [2025]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","median_amount":456427.90,"10th_percentile":456427.90,"90th_percentile":456427.90,"count":"1 through 10","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay.","standard_charge_dollar":26901.00},{"payer_name":"SCRIPPS HOSPICE [2008]","plan_name":"SCRIPPS HEALTH HOSPICE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay.","standard_charge_dollar":700.00},{"payer_name":"HEALTH CARE SUPPORT [2011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"UC AFF ANTHEM\/XIMED HMO [164022]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"Community Care IPA Medi-Cal Managed Care","standard_charge_algorithm":"Per diem ($1,750).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 31 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1750.00},{"payer_name":"BRAND NEW DAY [1089]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"AXA ASSISTANCE [1098]","plan_name":"AXA ASSISTANCE USA,INC","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":960438.73},{"payer_name":"FRESENIUS [1034]","plan_name":"FRESENIUS HEALTH PARTNERS, INC","standard_charge_algorithm":"Case rate ($213,677.38). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $196,588.51, add-ons for qualifying new technology services are included. If operating cost exceeds $245,747.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $18,271.41, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,346.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $195,799.40 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,542.08. The transfer capital threshold is the transfer adjustment factor * $15,542.08. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":213677.38},{"payer_name":"CIGNA [1023]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":779650.26},{"payer_name":"LAKESIDE MEDICAL GROUP [2054]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"MEDICARE [1050]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","median_amount":294394.47,"10th_percentile":203379.67,"90th_percentile":691005.00,"count":"35","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":258538.93},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"SALUDPOL Peru Police","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":988686.93},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 3, Case rate ($54,034). Procedures 4 - 9999, Per diem ($13,509).","methodology":"other","median_amount":435261.28,"10th_percentile":255497.60,"90th_percentile":558340.75,"count":"14","additional_payer_notes":"Computer Assisted","standard_charge_dollar":1412409.90},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($213,677.38). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $196,588.51, add-ons for qualifying new technology services are included. If operating cost exceeds $245,747.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $18,271.41, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,346.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $195,799.40 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,542.08. The transfer capital threshold is the transfer adjustment factor * $15,542.08. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","median_amount":402725.51,"10th_percentile":402725.51,"90th_percentile":1834582.45,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":213677.38},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","median_amount":261803.16,"10th_percentile":261803.16,"90th_percentile":508774.69,"count":"1 through 10","additional_payer_notes":"All Inpatient","standard_charge_dollar":235637.40},{"payer_name":"HMSA - HAWAII MEDICAL SERVICE ASSOC MDCR [1041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 3, Case rate ($37,824). Procedures 4 - 9999, Per diem ($9,456).","methodology":"other","count":"0","additional_payer_notes":"Computer Assisted Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":779650.26},{"payer_name":"HEALTHNET TRANSPLANTS [1114]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"AETNA [1003]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":316353.03,"10th_percentile":316353.03,"90th_percentile":316353.03,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":214215.82},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EPO [10130074]","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 3, Case rate ($54,034). Procedures 4 - 9999, Per diem ($13,509).","methodology":"other","count":"0","additional_payer_notes":"Computer Assisted Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 3, Case rate ($37,824). Procedures 4 - 9999, Per diem ($9,456).","methodology":"other","count":"0","additional_payer_notes":"Computer Assisted Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 3, Case rate ($54,034). Procedures 4 - 9999, Per diem ($13,509).","methodology":"other","count":"0","additional_payer_notes":"Computer Assisted Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"MC HNET BLUE&GOLD ACO [164017]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":169489.19},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Commercial","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 150%.","methodology":"other","count":"0","additional_payer_notes":"General Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":321323.73},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Medicare","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"General Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":235637.40},{"payer_name":"CENTRAL HEALTH PLAN [2026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":430385.94,"10th_percentile":430385.94,"90th_percentile":430385.94,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":214215.82},{"payer_name":"MEDCARE PARTNERS [2084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"CASSIDY MED GRP [1019]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":918066.44},{"payer_name":"BEAVER MED GRP [2075]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"HEALTHCARE PARTNERS [2073]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","median_amount":873685.55,"10th_percentile":873685.55,"90th_percentile":873685.55,"count":"1 through 10","additional_payer_notes":"Surgery","standard_charge_dollar":1412409.90},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05},{"payer_name":"USOC - US OLYMPIC COMMITTEE [1123]","plan_name":"USOC VIK (BSC UC CARE)","standard_charge_percentage":43.10,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":608748.67},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK","standard_charge_algorithm":"Per diem ($4,000). A payment threshold will be met when non-excluded charges is greater than 325000. For days after this threshold has been met, a per diem of (non-excluded charges for that day multiplied by .65) will be used instead of the standard payment for each day after the threshold.","methodology":"other","count":"0","additional_payer_notes":"ICU\/CCU Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1412409.90},{"payer_name":"COMMUNITY ELDERCARE [1027]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"OPTUM CARE NETWORK - PCAMG [1064]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":918066.44},{"payer_name":"VA - VETERANS ADMINISTRATION [1093]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263815.23},{"payer_name":"US MARSHAL SERVICES [1090]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"CLIPPERS WORKERS COMPENSATION [2097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($263,815.23). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $244,067.98, add-ons for qualifying new technology services are included. If operating cost exceeds $292,752.60 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $21,401.75, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $244,825.67 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $243,278.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,200.46. The transfer capital threshold is the transfer adjustment factor * $18,200.46. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":342959.80},{"payer_name":"STERLING OPTION 1 [1083]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($214,215.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $197,085.70, add-ons for qualifying new technology services are included. If operating cost exceeds $245,770.32 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $18,784.62, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $197,843.39 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $196,296.59 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $15,583.33. The transfer capital threshold is the transfer adjustment factor * $15,583.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214215.82},{"payer_name":"DESERT OASIS HEALTH CARE [2052]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($261,456.05). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $241,798.41, add-ons for qualifying new technology services are included. If operating cost exceeds $290,957.30 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $20,840.18, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.9. The base transfer operating payment is the transfer adjustment factor * $242,556.11 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $241,009.31 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $18,110.85. The transfer capital threshold is the transfer adjustment factor * $18,110.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":261456.05}]}]}
,{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures","code_information":[{"code":"004","type":"TRIS-DRG"},{"code":"004","type":"MS-DRG"}],"standard_charges":[{"minimum":13.85,"maximum":319010.13,"gross_charge":924902.22,"discounted_cash":508696.22,"setting":"inpatient","payers_information":[{"payer_name":"ALTERNATE HEALTH NET BH [2059]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"ALTERNATE HEALTH NET BH [2059]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH PLAN","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":554941.33},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNA PRIORITY SELECT","standard_charge_algorithm":"Per diem ($7,746).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":7746.00},{"payer_name":"XIMED [2016]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MARKET PLACE","standard_charge_algorithm":"Case rate ($139,718.34). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $128,566.27, add-ons for qualifying new technology services are included. If operating cost exceeds $177,725.16 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,871.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $128,786.59 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $127,777.16 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,142.64. The transfer capital threshold is the transfer adjustment factor * $10,142.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 180%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139718.34},{"payer_name":"AETNA [1003]","plan_name":"AETNA BEHAVIORAL EATING DISORDER","standard_charge_percentage":43.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":404182.27},{"payer_name":"ALTERNATE SHERIFF CUSTODY [1106]","plan_name":"SHERIFF COUNTY CONTRACT # 514250","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":601186.44},{"payer_name":"TRICARE [1086]","plan_name":"TRICARE ","standard_charge_algorithm":"If the length of stay is greater than 6, the reimbursement is as follows: Case rate ($259,324.02). For stays with a post-acute discharge disposition of 03, 05, 06, 62, 63, or 65, the transfer payment is a per diem payment of $8,820.55, and the first day is paid a rate of $17,641.09. For stays with a transfer discharge disposition of 02 or 82, the transfer payment is a per diem payment of $8,820.55, and the first day is paid a rate of $17,641.09. The transfer payment is capped at $197,911.94. Billed amount less exclusions adjusted by a cost-to-charge ratio of 0.2348 that exceeds an outlier threshold of $311,995.19 is considered a cost outlier and adds an additional payment of 80% of the excess amount. For stays with a post-acute or transfer discharge disposition, the outlier threshold is multiplied by (LOS \/ 29.3999996185303). Includes reimbursement from new technology add-ons. If the length of stay is less than or equal to 6, the reimbursement is as follows: Per diem ($12,933.87), capped at $197,911.94. For stays with a post-acute discharge disposition of 03, 05, 06, 62, 63, or 65, the transfer payment is a per diem payment of $8,820.55, and the first day is paid a rate of $17,641.09. For stays with a transfer discharge disposition of 02 or 82, the transfer payment is a per diem payment of $8,820.55, and the first day is paid a rate of $17,641.09. The transfer payment is capped at $197,911.94. Billed amount less exclusions adjusted by a cost-to-charge ratio of 0.2348 that exceeds an outlier threshold of $311,995.19 is considered a cost outlier and adds an additional payment of 80% of the excess amount. For stays with a post-acute or transfer discharge disposition, the outlier threshold is multiplied by (LOS \/ 29.3999996185303). Includes reimbursement from new technology add-ons.","methodology":"other","median_amount":259324.07,"10th_percentile":259324.07,"90th_percentile":259324.07,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":151671.07},{"payer_name":"QUALITY HEALTH [1069]","plan_name":"QUALITY HEALTH MANAGEMENT","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 185%.","methodology":"other","count":"0","additional_payer_notes":"Surgery  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":319010.13},{"payer_name":"KAISER [1046]","plan_name":"KAISER","standard_charge_percentage":63.00,"methodology":"percent of total billed charges","median_amount":734406.29,"10th_percentile":734406.29,"90th_percentile":734406.29,"count":"1 through 10","additional_payer_notes":"undefined","standard_charge_dollar":582688.40},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":172437.91},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":172437.91},{"payer_name":"RIVER CITY MEDICAL GROUP [2066]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA COMMERCIAL","standard_charge_percentage":85.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":786166.89},{"payer_name":"ALTERNATE MEDICARE [2007]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":168989.15},{"payer_name":"MENIFEE MED GRP [2076]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE [10230006]","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"MC BLUE SHIELD HMO [164015]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"MC CIGNA GENERIC PAYOR [164007]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE TRANSPLANT [11170001]","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"ALTERNATE MEDI-CAL [2001]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"UCR PROMPT PAY PAYOR [8240]","plan_name":"UCSD CHARITY MEDICARE CONTRACT","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Medicare All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":172437.91},{"payer_name":"AETNA [1003]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","median_amount":728043.37,"10th_percentile":728043.37,"90th_percentile":728043.37,"count":"1 through 10","additional_payer_notes":"undefined","standard_charge_dollar":554941.33},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"IMPERIAL COUNTY PHYSICIAN MED GRP","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":137268.33},{"payer_name":"STERLING OPTION 1 [1083]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"USAA [1091]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"CIGNA [1023]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":137268.33},{"payer_name":"ASTIVA HEALTH [2095]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"ALTERNATE AETNA [1004]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":554941.33},{"payer_name":"MC UNITED HEALTHCARE HMO [164005]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"ALTERNATE KAISER RAD ONC [2089]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"AMA - AMERICAN MEDICAL ASSOCIATION [1009]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"MC HEALTHNET HMO [164004]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","median_amount":158505.64,"10th_percentile":158505.64,"90th_percentile":158505.64,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":140069.72},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"DEPARTMENT OF LABOR [1028]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":224169.28},{"payer_name":"MC ANTHEM BLUE CROSS GENERIC PAYOR [164009]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"IMPERIAL HEALTH HOLDINGS [1132]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"AFFILIATED DOCTORS OF ORANGE COUNTY [2041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"NATIONAL HEALTHCARE SOLUTIONS INC [1100]","plan_name":"NATIONAL HEALTHCARE SOLUTIONS INC [11000001]","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":739921.78},{"payer_name":"CAREMORE [2028]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Per diem ($11,022).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":11022.00},{"payer_name":"MC HUMANA HMO [164013]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"AETNA [1003]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($139,718.34). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $128,566.27, add-ons for qualifying new technology services are included. If operating cost exceeds $177,725.16 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,871.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $128,786.59 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $127,777.16 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,142.64. The transfer capital threshold is the transfer adjustment factor * $10,142.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139718.34},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($139,718.34). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $128,566.27, add-ons for qualifying new technology services are included. If operating cost exceeds $177,725.16 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,871.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $128,786.59 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $127,777.16 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,142.64. The transfer capital threshold is the transfer adjustment factor * $10,142.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Pre\/Post or Other\/VAD Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139718.34},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDI-CAL","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 80%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Pre\/Post  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":136718.66},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED HMO NON CONTRACTED [10260001]","standard_charge_algorithm":"Case rate ($139,718.34). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $128,566.27, add-ons for qualifying new technology services are included. If operating cost exceeds $177,725.16 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,871.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $128,786.59 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $127,777.16 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,142.64. The transfer capital threshold is the transfer adjustment factor * $10,142.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139718.34},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED PPO NON CONTRACTED [10260002]","standard_charge_algorithm":"Case rate ($139,718.34). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $128,566.27, add-ons for qualifying new technology services are included. If operating cost exceeds $177,725.16 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,871.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $128,786.59 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $127,777.16 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,142.64. The transfer capital threshold is the transfer adjustment factor * $10,142.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139718.34},{"payer_name":"MC AETNA GENERIC PAYOR [164008]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"CLEVER CARE [2061]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CALIFORNIA UC CARE \/ HSP","standard_charge_percentage":26.66,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":246578.93},{"payer_name":"ALTERNATE SCAN HEALTH [2088]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":133066.23},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($139,718.34). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $128,566.27, add-ons for qualifying new technology services are included. If operating cost exceeds $177,725.16 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,871.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $128,786.59 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $127,777.16 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,142.64. The transfer capital threshold is the transfer adjustment factor * $10,142.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139718.34},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MID-COUNTY PHYSICIANS NARROW NETWORK","standard_charge_algorithm":"Per diem ($17,123).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":17123.00},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"OLYMPUS MANAGED HEALTHCARE INC [11020001]","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":554941.33},{"payer_name":"TRANSAMERICA [1084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"SD PHYSICIANS MED GRP [1076]","plan_name":"SD PHYSICIANS MED GRP SR [10760002]","standard_charge_percentage":55.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":508696.22},{"payer_name":"ENCOMPASS MED GRP [1030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"PRIMARY CARE ASSOCIATES OF CA [2067]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":172437.91},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":172437.91},{"payer_name":"MC AETNA HMO [164001]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"ALTERNATE VA - VETERANS ADMINISTRATION [1239]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":172437.91},{"payer_name":"SDSM [2017]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Per diem ($15,746).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":15746.00},{"payer_name":"UNLISTED MEDICARE ADVANTAGE (NON-CONTRACTED) [1051]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"COMMUNITY HEALTH GROUP [1022]","plan_name":"COMMUNITY HEALTH GROUP MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 113%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158278.78},{"payer_name":"BANKERS LIFE [1011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"VANTAGE [1092]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"SIMNSA HEALTH PLAN [2047]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ADMAR [1001]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":601186.44},{"payer_name":"BPS - BENEFIT PLAN SERVICES [1015]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":601186.44},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","median_amount":45524.88,"10th_percentile":45524.88,"90th_percentile":45524.88,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":168083.66},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD COVERED CA TRIO HMO","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"BLUE CROSS [1013]","plan_name":"UCSD STUDENT HEALTH INS PLAN - BC SHIP","standard_charge_percentage":26.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":246948.89},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET ENHANCED CARE PPO","standard_charge_algorithm":"Case rate ($130,461.99). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $120,170.38, add-ons for qualifying new technology services are included. If operating cost exceeds $169,329.27 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,011.52, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $121,179.81. The transfer operating threshold is the transfer adjustment factor * $120,170.38 If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,282.18. The transfer capital threshold is the transfer adjustment factor * $9,282.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 281%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services (MSDRG no DSH GME IME) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":130461.99},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA COMMERCIAL","standard_charge_percentage":85.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":786166.89},{"payer_name":"EASY ACCESS CARE [2077]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"MC CIGNA HMO [164003]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($139,718.34). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $128,566.27, add-ons for qualifying new technology services are included. If operating cost exceeds $177,725.16 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,871.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $128,786.59 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $127,777.16 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,142.64. The transfer capital threshold is the transfer adjustment factor * $10,142.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139718.34},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"ALPHACARE [2062]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"INTERNATIONAL EMBASSY OF KUWAIT","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":628933.51},{"payer_name":"MC SCAN HMO [164035]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"FIRST HEALTH [1032]","plan_name":"FIRST HEALTH","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":693676.67},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS HOUSE STAFF","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":244174.19},{"payer_name":"INTERPLAN [1045]","plan_name":"INTERPLAN","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":647431.55},{"payer_name":"TRI-CITY [1085]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"CHRISTIAN HEALTHCARE MINISTRIES [2030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"CHESAPEAKE LIFE [1021]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"MUTUAL OF OMAHA [1059]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ARCH HEALTH PARTNERS [2000]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"BLUE CROSS [1013]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($139,718.34). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $128,566.27, add-ons for qualifying new technology services are included. If operating cost exceeds $177,725.16 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,871.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $128,786.59 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $127,777.16 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,142.64. The transfer capital threshold is the transfer adjustment factor * $10,142.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139718.34},{"payer_name":"UNLISTED HOSPICE [1035]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ELIZABETH HOSPICE [2018]","plan_name":"ELIZABETH HOSPICE GIP","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay.","standard_charge_dollar":950.00},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":133203.04,"10th_percentile":133203.04,"90th_percentile":133203.04,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":140069.72},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"MULTIPLAN [1058]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":601186.44},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"US BEHAVIORAL MENTAL\/EATING DISORDER","standard_charge_percentage":70.00,"standard_charge_algorithm":"70% of billed.","methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":647431.55},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"SEDGWICK [1077]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":224169.28},{"payer_name":"UC AFF HUMANA\/SDSM [164025]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"TRIWEST [2003]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","median_amount":235639.79,"10th_percentile":235639.79,"90th_percentile":235639.79,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":172437.91},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"MC UHC VEBA HMO [164033]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA EPN\/IFP","standard_charge_algorithm":"Per diem ($7,687). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .468 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"INTEGRATED HEALTH PARTNERS [2068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE ST PAULS","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":148530.74,"10th_percentile":148530.74,"90th_percentile":148530.74,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":172437.91},{"payer_name":"PACIFIC FOUNDATION [1063]","plan_name":"PACIFIC FOUNDATION FOR MEDICAL CARE","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":693676.67},{"payer_name":"GREATER NEWPORT PHYSICIANS [2096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"MC SCAN GENERIC PAYOR [164034]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"KEY MED GRP [2074]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS UC CARE","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":244174.19},{"payer_name":"MERCY PHYSICIANS MED GRP [1052]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"UC AFF BLUE SHIELD SR\/SDSM [164037]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"TRI-CITY MEDICAL CENTER [1129]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Per diem ($8,294). The outlier payment amount is calculated by taking the estimated cost amount, subtracting the threshold amount ($247,571), then multiplying the difference by the percent of outlier that is reimbursed (53%). If the calculated outlier amount is greater than $0, it is added to the reimbursement total. The estimated cost amount is the adjusted billed amount multiplied by the cost-to-charge ratio (1). The following revenue codes are excluded from the adjusted billed amount: RC 0274-0276, 0278, 0624, 0891.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":8294.00},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET MEDICARE ADVANTAGE UC EMPLOYER GROUP","standard_charge_algorithm":"Fee schedule rate ($13.85). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":13.85},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"PRIVATE HEALTHCARE SYSTEM","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":601186.44},{"payer_name":"BLUE SHIELD TRANSPLANTS [1113]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"SCRIPPS HEALTH PLAN SERVICES [1075]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":554941.33},{"payer_name":"MVP HEALTHCARE [1060]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"INLAND FACULTY MEDICAL GROUP [2063]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"KERN HEALTH SYSTEMS [2033]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"MC UHC VEBA GENERIC HMO [164032]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"ROYAL EMBASSY","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":647431.55},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":212967.31,"10th_percentile":212967.31,"90th_percentile":212967.31,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":140069.72},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":112175.12,"10th_percentile":112175.12,"90th_percentile":112175.12,"count":"1 through 10","additional_payer_notes":"Inpatient","standard_charge_dollar":140069.72},{"payer_name":"GLOBAL EXCEL [1036]","plan_name":"GLOBAL EXCEL","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 165%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":172437.91},{"payer_name":"REDLANDS COMMUNITY HOSPITAL [2005]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"VILLAGE HEALTH [1094]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EATING DISORDER","standard_charge_percentage":58.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":542362.66},{"payer_name":"PREMIER PATIENT CARE IPA [2069]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":554941.33},{"payer_name":"INTER VALLEY HEALTH PLAN [2024]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"CALIFORNIA HEALTH & WELLNESS MEDI-CAL [1122]","plan_name":"CALIFORNIA HEALTH AND WELLNESS MEDI-CAL (no longer Medi-Cal plan as of 1\/1\/24)","standard_charge_algorithm":"Per diem ($2,600).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2600.00},{"payer_name":"USOC - US OLYMPIC COMMITTEE [1123]","plan_name":"USOC VIK (BSC UC CARE)","standard_charge_percentage":43.10,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":398632.86},{"payer_name":"EASY CHOICE [1029]","plan_name":"EASY CHOICE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"HEALTH NET [1039]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"WORKERS COMPENSATION [1097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":224169.28},{"payer_name":"SCRIPPS COASTAL MED GRP [1074]","plan_name":"SCRIPPS COASTAL MED GRP [10740001]","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":601186.44},{"payer_name":"MC BRAND NEW DAY HMO [164030]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"ALTERNATE BRAND NEW DAY [2079]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Per diem ($8,294). The outlier payment amount is calculated by taking the estimated cost amount, subtracting the threshold amount ($247,571), then multiplying the difference by the percent of outlier that is reimbursed (53%). If the calculated outlier amount is greater than $0, it is added to the reimbursement total. The estimated cost amount is the adjusted billed amount multiplied by the cost-to-charge ratio (1). The following revenue codes are excluded from the adjusted billed amount: RC 0274-0276, 0278, 0624, 0891.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":8294.00},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"MC BRAND NEW DAY GENERIC PAYOR [164031]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":141778.93,"10th_percentile":141778.93,"90th_percentile":141778.93,"count":"1 through 10","additional_payer_notes":"All Inpatient-Medicare DRG","standard_charge_dollar":140069.72},{"payer_name":"UNITED AMERICAN [1087]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"MC ANTHEM BLUE CROSS HMO [164002]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"CAL OPTIMA [1016]","plan_name":"CalOptima Medicare","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":172437.91},{"payer_name":"HERITAGE VICTOR VALLEY MEDICAL GROUP [2045]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"CHAMPVA [1020]","plan_name":"VETERANS ADMINISTRATION - CHAMPVA","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":172437.91},{"payer_name":"MC BLUE SHIELD GENERIC PAYOR [164016]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"RIVERSIDE MEDICAL CLINIC [2064]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"CIGNA HMO","standard_charge_percentage":83.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":771368.45},{"payer_name":"PYRAMID LIFE [1068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ETS - LIFETRAC NETWORK [1103]","plan_name":"LIFETRAC","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":601186.44},{"payer_name":"TRIWEST ALTERNATE [2036]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":172437.91},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"EMBASSY OF STATE OF KUWAIT [11010001]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":628933.51},{"payer_name":"CARNIVAL CRUISES [1018]","plan_name":"CARNIVAL CRUISES [10180001]","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":739921.78},{"payer_name":"UC AFF ANTHEM\/XIMED HMO [164022]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":168083.66},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"BLUE SHIELD [1014]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($139,718.34). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $128,566.27, add-ons for qualifying new technology services are included. If operating cost exceeds $177,725.16 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,871.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $128,786.59 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $127,777.16 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,142.64. The transfer capital threshold is the transfer adjustment factor * $10,142.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139718.34},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"KUWAIT OIL COMPANY [11010005]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":628933.51},{"payer_name":"MC UHC ALLIANCE HMO [164020]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"IMPERIAL HEALTH PLAN [2081]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":554941.33},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":137268.33},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"SIERRA MEDICAL GROUP [2048]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"MC UHC HARMONY HMO [164026]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"AETNA TRANSPLANTS [1112]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":554941.33},{"payer_name":"CIGNA [1023]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":558115.35,"10th_percentile":558115.35,"90th_percentile":558115.35,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":140069.72},{"payer_name":"MONARCH HEALTHCARE [2006]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"UC AFF MC HUMANA GENERIC PAYOR [164027]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"MC HNET BLUE&GOLD ACO [164017]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"CMN - CANADIAN MEDICAL NETWORK [1024]","plan_name":"CMN GLOBAL INC","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 170%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293144.45},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"HUMANA [1042]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($139,718.34). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $128,566.27, add-ons for qualifying new technology services are included. If operating cost exceeds $177,725.16 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,871.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $128,786.59 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $127,777.16 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,142.64. The transfer capital threshold is the transfer adjustment factor * $10,142.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139718.34},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE PPO","standard_charge_percentage":49.55,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":458289.05},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"HIGH DESERT MEDICAL GROUP [2053]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"STATE OF CALIFORNIA [1082]","plan_name":"California State Prison","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 250%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":172437.91},{"payer_name":"SAN DIEGO SOCKERS [2015]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":224169.28},{"payer_name":"AMERICAN SPECIALTY HEALTH PLAN [2038]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"MGM RESORTS [1053]","plan_name":"MGM RESORT","standard_charge_algorithm":"Fee schedule rate ($22.85). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37.71},{"payer_name":"WELL CARE [1096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"IMMIGRATION HEALTH SERVICES [1043]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":168989.15},{"payer_name":"UC AFF ANTHEM\/SDSM HMO [164024]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"HEMET COMMUNITY MED GRP - PROMISECARE [1040]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UHC SELECT AND SELECT PLUS","standard_charge_algorithm":"Per diem ($14,996).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":14996.00},{"payer_name":"BLUE SHIELD PROMISE [1017]","plan_name":"CARE 1ST HEALTHPLAN MEDICARE ADVANTAGE (BS PROMISE)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MA\/SDPMG","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":133066.23},{"payer_name":"LA CARE HEALTH PLAN [2025]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ST JOSEPH ST JUDE [2065]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"GOLDEN PHYSICIANS MEDICAL GROUP [2082]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"SCAN HEALTH [1072]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":133066.23},{"payer_name":"ADVANTRA FREEDOM [1002]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"MC HUMANA GENERIC PAYOR [164014]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA HMO","standard_charge_percentage":83.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":771368.45},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA PPO","standard_charge_percentage":83.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":771368.45},{"payer_name":"EMPIRE PHYS MED GRP [2072]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE SAN DIEGO","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE QUALCOMM ","standard_charge_percentage":45.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":422125.37},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"BEACON HEALTH STRATEGY [2039]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"SCRIPPS HOSPICE [2008]","plan_name":"SCRIPPS HEALTH HOSPICE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay.","standard_charge_dollar":700.00},{"payer_name":"BEECH STREET [1012]","plan_name":"CAPPCARE\/BEECH STREET","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":693676.67},{"payer_name":"HEALTH CARE SUPPORT [2011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"Community Care IPA Medi-Cal Managed Care","standard_charge_algorithm":"Per diem ($1,750).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1750.00},{"payer_name":"MEDI-CAL [1048]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"BRAND NEW DAY [1089]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Per diem ($11,022).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":11022.00},{"payer_name":"AXA ASSISTANCE [1098]","plan_name":"AXA ASSISTANCE USA,INC","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":628933.51},{"payer_name":"FRESENIUS [1034]","plan_name":"FRESENIUS HEALTH PARTNERS, INC","standard_charge_algorithm":"Case rate ($139,718.34). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $128,566.27, add-ons for qualifying new technology services are included. If operating cost exceeds $177,725.16 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,871.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $128,786.59 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $127,777.16 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,142.64. The transfer capital threshold is the transfer adjustment factor * $10,142.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139718.34},{"payer_name":"MC HEALTHNET GENERIC PAYOR [164010]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"MEDICARE [1050]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","median_amount":158291.51,"10th_percentile":139584.97,"90th_percentile":236864.83,"count":"1 through 10","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":168989.15},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"SALUDPOL Peru Police","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":647431.55},{"payer_name":"KAISER [1046]","plan_name":"KAISER MEDICARE ADVANTAGE","standard_charge_percentage":63.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":582688.40},{"payer_name":"CIGNA [1023]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":510546.03},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Per diem ($15,746).","methodology":"per diem","median_amount":1149381.43,"10th_percentile":1149381.43,"90th_percentile":1149381.43,"count":"1 through 10","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay.","standard_charge_dollar":15746.00},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK","standard_charge_algorithm":"Per diem ($4,000). A payment threshold will be met when non-excluded charges is greater than 325000. For days after this threshold has been met, a per diem of (non-excluded charges for that day multiplied by .65) will be used instead of the standard payment for each day after the threshold.","methodology":"other","count":"0","additional_payer_notes":"ICU\/CCU Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($139,718.34). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $128,566.27, add-ons for qualifying new technology services are included. If operating cost exceeds $177,725.16 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,871.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $128,786.59 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $127,777.16 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,142.64. The transfer capital threshold is the transfer adjustment factor * $10,142.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139718.34},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":154076.69},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"HMSA - HAWAII MEDICAL SERVICE ASSOC MDCR [1041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"HEALTHNET TRANSPLANTS [1114]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"AETNA [1003]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":141087.99,"10th_percentile":141087.99,"90th_percentile":141087.99,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":140069.72},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EPO [10130074]","standard_charge_algorithm":"Per diem ($15,746).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":15746.00},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Commercial","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 150%.","methodology":"other","count":"0","additional_payer_notes":"General Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":210104.58},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Medicare","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"General Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":154076.69},{"payer_name":"CENTRAL HEALTH PLAN [2026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"MEDCARE PARTNERS [2084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"CASSIDY MED GRP [1019]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":601186.44},{"payer_name":"BEAVER MED GRP [2075]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"HEALTHCARE PARTNERS [2073]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"MC UNITED HEALTHCARE GENERIC PAYOR [164011]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"COMMUNITY ELDERCARE [1027]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"OPTUM CARE NETWORK - PCAMG [1064]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":601186.44},{"payer_name":"CLIPPERS WORKERS COMPENSATION [2097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":224169.28},{"payer_name":"VA - VETERANS ADMINISTRATION [1093]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":172437.91},{"payer_name":"US MARSHAL SERVICES [1090]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":510546.03},{"payer_name":"DESERT OASIS HEALTH CARE [2052]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"LAKESIDE MEDICAL GROUP [2054]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72}]},{"minimum":151671.07,"maximum":151671.07,"gross_charge":826464.64,"discounted_cash":454555.55,"setting":"inpatient","payers_information":[{"payer_name":"ALTERNATE HEALTH NET BH [2059]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"ALTERNATE HEALTH NET BH [2059]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH PLAN","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":554941.33},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNA PRIORITY SELECT","standard_charge_algorithm":"Per diem ($7,746).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":7746.00},{"payer_name":"XIMED [2016]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MARKET PLACE","standard_charge_algorithm":"Case rate ($139,718.34). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $128,566.27, add-ons for qualifying new technology services are included. If operating cost exceeds $177,725.16 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,871.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $128,786.59 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $127,777.16 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,142.64. The transfer capital threshold is the transfer adjustment factor * $10,142.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 180%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139718.34},{"payer_name":"AETNA [1003]","plan_name":"AETNA BEHAVIORAL EATING DISORDER","standard_charge_percentage":43.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":404182.27},{"payer_name":"ALTERNATE SHERIFF CUSTODY [1106]","plan_name":"SHERIFF COUNTY CONTRACT # 514250","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":601186.44},{"payer_name":"TRICARE [1086]","plan_name":"TRICARE ","standard_charge_algorithm":"If the length of stay is greater than 6, the reimbursement is as follows: Case rate ($259,324.02). For stays with a post-acute discharge disposition of 03, 05, 06, 62, 63, or 65, the transfer payment is a per diem payment of $8,820.55, and the first day is paid a rate of $17,641.09. For stays with a transfer discharge disposition of 02 or 82, the transfer payment is a per diem payment of $8,820.55, and the first day is paid a rate of $17,641.09. The transfer payment is capped at $197,911.94. Billed amount less exclusions adjusted by a cost-to-charge ratio of 0.2348 that exceeds an outlier threshold of $311,995.19 is considered a cost outlier and adds an additional payment of 80% of the excess amount. For stays with a post-acute or transfer discharge disposition, the outlier threshold is multiplied by (LOS \/ 29.3999996185303). Includes reimbursement from new technology add-ons. If the length of stay is less than or equal to 6, the reimbursement is as follows: Per diem ($12,933.87), capped at $197,911.94. For stays with a post-acute discharge disposition of 03, 05, 06, 62, 63, or 65, the transfer payment is a per diem payment of $8,820.55, and the first day is paid a rate of $17,641.09. For stays with a transfer discharge disposition of 02 or 82, the transfer payment is a per diem payment of $8,820.55, and the first day is paid a rate of $17,641.09. The transfer payment is capped at $197,911.94. Billed amount less exclusions adjusted by a cost-to-charge ratio of 0.2348 that exceeds an outlier threshold of $311,995.19 is considered a cost outlier and adds an additional payment of 80% of the excess amount. For stays with a post-acute or transfer discharge disposition, the outlier threshold is multiplied by (LOS \/ 29.3999996185303). Includes reimbursement from new technology add-ons.","methodology":"other","median_amount":259324.07,"10th_percentile":259324.07,"90th_percentile":259324.07,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":151671.07},{"payer_name":"QUALITY HEALTH [1069]","plan_name":"QUALITY HEALTH MANAGEMENT","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 185%.","methodology":"other","count":"0","additional_payer_notes":"Surgery  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":319010.13},{"payer_name":"KAISER [1046]","plan_name":"KAISER","standard_charge_percentage":63.00,"methodology":"percent of total billed charges","median_amount":734406.29,"10th_percentile":734406.29,"90th_percentile":734406.29,"count":"1 through 10","additional_payer_notes":"undefined","standard_charge_dollar":582688.40},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":172437.91},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":172437.91},{"payer_name":"RIVER CITY MEDICAL GROUP [2066]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA COMMERCIAL","standard_charge_percentage":85.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":786166.89},{"payer_name":"ALTERNATE MEDICARE [2007]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":168989.15},{"payer_name":"MENIFEE MED GRP [2076]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE [10230006]","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"MC BLUE SHIELD HMO [164015]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"MC CIGNA GENERIC PAYOR [164007]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE TRANSPLANT [11170001]","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"ALTERNATE MEDI-CAL [2001]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"UCR PROMPT PAY PAYOR [8240]","plan_name":"UCSD CHARITY MEDICARE CONTRACT","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Medicare All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":172437.91},{"payer_name":"AETNA [1003]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","median_amount":728043.37,"10th_percentile":728043.37,"90th_percentile":728043.37,"count":"1 through 10","additional_payer_notes":"undefined","standard_charge_dollar":554941.33},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"IMPERIAL COUNTY PHYSICIAN MED GRP","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":137268.33},{"payer_name":"STERLING OPTION 1 [1083]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"USAA [1091]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"CIGNA [1023]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":137268.33},{"payer_name":"ASTIVA HEALTH [2095]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"ALTERNATE AETNA [1004]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":554941.33},{"payer_name":"MC UNITED HEALTHCARE HMO [164005]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"ALTERNATE KAISER RAD ONC [2089]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"AMA - AMERICAN MEDICAL ASSOCIATION [1009]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"MC HEALTHNET HMO [164004]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","median_amount":158505.64,"10th_percentile":158505.64,"90th_percentile":158505.64,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":140069.72},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"DEPARTMENT OF LABOR [1028]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":224169.28},{"payer_name":"MC ANTHEM BLUE CROSS GENERIC PAYOR [164009]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"IMPERIAL HEALTH HOLDINGS [1132]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"AFFILIATED DOCTORS OF ORANGE COUNTY [2041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"NATIONAL HEALTHCARE SOLUTIONS INC [1100]","plan_name":"NATIONAL HEALTHCARE SOLUTIONS INC [11000001]","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":739921.78},{"payer_name":"CAREMORE [2028]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Per diem ($11,022).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":11022.00},{"payer_name":"MC HUMANA HMO [164013]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"AETNA [1003]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($139,718.34). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $128,566.27, add-ons for qualifying new technology services are included. If operating cost exceeds $177,725.16 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,871.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $128,786.59 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $127,777.16 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,142.64. The transfer capital threshold is the transfer adjustment factor * $10,142.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139718.34},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($139,718.34). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $128,566.27, add-ons for qualifying new technology services are included. If operating cost exceeds $177,725.16 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,871.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $128,786.59 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $127,777.16 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,142.64. The transfer capital threshold is the transfer adjustment factor * $10,142.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Pre\/Post or Other\/VAD Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139718.34},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDI-CAL","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 80%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Pre\/Post  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":136718.66},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED HMO NON CONTRACTED [10260001]","standard_charge_algorithm":"Case rate ($139,718.34). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $128,566.27, add-ons for qualifying new technology services are included. If operating cost exceeds $177,725.16 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,871.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $128,786.59 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $127,777.16 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,142.64. The transfer capital threshold is the transfer adjustment factor * $10,142.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139718.34},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED PPO NON CONTRACTED [10260002]","standard_charge_algorithm":"Case rate ($139,718.34). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $128,566.27, add-ons for qualifying new technology services are included. If operating cost exceeds $177,725.16 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,871.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $128,786.59 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $127,777.16 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,142.64. The transfer capital threshold is the transfer adjustment factor * $10,142.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139718.34},{"payer_name":"MC AETNA GENERIC PAYOR [164008]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"CLEVER CARE [2061]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CALIFORNIA UC CARE \/ HSP","standard_charge_percentage":26.66,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":246578.93},{"payer_name":"ALTERNATE SCAN HEALTH [2088]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":133066.23},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($139,718.34). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $128,566.27, add-ons for qualifying new technology services are included. If operating cost exceeds $177,725.16 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,871.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $128,786.59 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $127,777.16 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,142.64. The transfer capital threshold is the transfer adjustment factor * $10,142.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139718.34},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MID-COUNTY PHYSICIANS NARROW NETWORK","standard_charge_algorithm":"Per diem ($17,123).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":17123.00},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"OLYMPUS MANAGED HEALTHCARE INC [11020001]","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":554941.33},{"payer_name":"TRANSAMERICA [1084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"SD PHYSICIANS MED GRP [1076]","plan_name":"SD PHYSICIANS MED GRP SR [10760002]","standard_charge_percentage":55.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":508696.22},{"payer_name":"ENCOMPASS MED GRP [1030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"PRIMARY CARE ASSOCIATES OF CA [2067]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":172437.91},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":172437.91},{"payer_name":"MC AETNA HMO [164001]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"ALTERNATE VA - VETERANS ADMINISTRATION [1239]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":172437.91},{"payer_name":"SDSM [2017]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Per diem ($15,746).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":15746.00},{"payer_name":"UNLISTED MEDICARE ADVANTAGE (NON-CONTRACTED) [1051]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"COMMUNITY HEALTH GROUP [1022]","plan_name":"COMMUNITY HEALTH GROUP MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 113%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158278.78},{"payer_name":"BANKERS LIFE [1011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"VANTAGE [1092]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"SIMNSA HEALTH PLAN [2047]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ADMAR [1001]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":601186.44},{"payer_name":"BPS - BENEFIT PLAN SERVICES [1015]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":601186.44},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","median_amount":45524.88,"10th_percentile":45524.88,"90th_percentile":45524.88,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":168083.66},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD COVERED CA TRIO HMO","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"BLUE CROSS [1013]","plan_name":"UCSD STUDENT HEALTH INS PLAN - BC SHIP","standard_charge_percentage":26.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":246948.89},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET ENHANCED CARE PPO","standard_charge_algorithm":"Case rate ($130,461.99). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $120,170.38, add-ons for qualifying new technology services are included. If operating cost exceeds $169,329.27 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,011.52, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $121,179.81. The transfer operating threshold is the transfer adjustment factor * $120,170.38 If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,282.18. The transfer capital threshold is the transfer adjustment factor * $9,282.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 281%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services (MSDRG no DSH GME IME) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":130461.99},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA COMMERCIAL","standard_charge_percentage":85.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":786166.89},{"payer_name":"EASY ACCESS CARE [2077]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"MC CIGNA HMO [164003]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($139,718.34). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $128,566.27, add-ons for qualifying new technology services are included. If operating cost exceeds $177,725.16 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,871.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $128,786.59 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $127,777.16 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,142.64. The transfer capital threshold is the transfer adjustment factor * $10,142.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139718.34},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"ALPHACARE [2062]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"INTERNATIONAL EMBASSY OF KUWAIT","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":628933.51},{"payer_name":"MC SCAN HMO [164035]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"FIRST HEALTH [1032]","plan_name":"FIRST HEALTH","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":693676.67},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS HOUSE STAFF","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":244174.19},{"payer_name":"INTERPLAN [1045]","plan_name":"INTERPLAN","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":647431.55},{"payer_name":"TRI-CITY [1085]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"CHRISTIAN HEALTHCARE MINISTRIES [2030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"CHESAPEAKE LIFE [1021]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"MUTUAL OF OMAHA [1059]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ARCH HEALTH PARTNERS [2000]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"BLUE CROSS [1013]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($139,718.34). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $128,566.27, add-ons for qualifying new technology services are included. If operating cost exceeds $177,725.16 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,871.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $128,786.59 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $127,777.16 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,142.64. The transfer capital threshold is the transfer adjustment factor * $10,142.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139718.34},{"payer_name":"UNLISTED HOSPICE [1035]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ELIZABETH HOSPICE [2018]","plan_name":"ELIZABETH HOSPICE GIP","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay.","standard_charge_dollar":950.00},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":133203.04,"10th_percentile":133203.04,"90th_percentile":133203.04,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":140069.72},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"MULTIPLAN [1058]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":601186.44},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"US BEHAVIORAL MENTAL\/EATING DISORDER","standard_charge_percentage":70.00,"standard_charge_algorithm":"70% of billed.","methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":647431.55},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"SEDGWICK [1077]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":224169.28},{"payer_name":"UC AFF HUMANA\/SDSM [164025]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"TRIWEST [2003]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","median_amount":235639.79,"10th_percentile":235639.79,"90th_percentile":235639.79,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":172437.91},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"MC UHC VEBA HMO [164033]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA EPN\/IFP","standard_charge_algorithm":"Per diem ($7,687). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .468 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"INTEGRATED HEALTH PARTNERS [2068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE ST PAULS","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":148530.74,"10th_percentile":148530.74,"90th_percentile":148530.74,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":172437.91},{"payer_name":"PACIFIC FOUNDATION [1063]","plan_name":"PACIFIC FOUNDATION FOR MEDICAL CARE","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":693676.67},{"payer_name":"GREATER NEWPORT PHYSICIANS [2096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"MC SCAN GENERIC PAYOR [164034]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"KEY MED GRP [2074]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS UC CARE","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":244174.19},{"payer_name":"MERCY PHYSICIANS MED GRP [1052]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"UC AFF BLUE SHIELD SR\/SDSM [164037]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"TRI-CITY MEDICAL CENTER [1129]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Per diem ($8,294). The outlier payment amount is calculated by taking the estimated cost amount, subtracting the threshold amount ($247,571), then multiplying the difference by the percent of outlier that is reimbursed (53%). If the calculated outlier amount is greater than $0, it is added to the reimbursement total. The estimated cost amount is the adjusted billed amount multiplied by the cost-to-charge ratio (1). The following revenue codes are excluded from the adjusted billed amount: RC 0274-0276, 0278, 0624, 0891.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":8294.00},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET MEDICARE ADVANTAGE UC EMPLOYER GROUP","standard_charge_algorithm":"Fee schedule rate ($13.85). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":13.85},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"PRIVATE HEALTHCARE SYSTEM","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":601186.44},{"payer_name":"BLUE SHIELD TRANSPLANTS [1113]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"SCRIPPS HEALTH PLAN SERVICES [1075]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":554941.33},{"payer_name":"MVP HEALTHCARE [1060]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"INLAND FACULTY MEDICAL GROUP [2063]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"KERN HEALTH SYSTEMS [2033]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"MC UHC VEBA GENERIC HMO [164032]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"ROYAL EMBASSY","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":647431.55},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":212967.31,"10th_percentile":212967.31,"90th_percentile":212967.31,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":140069.72},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":112175.12,"10th_percentile":112175.12,"90th_percentile":112175.12,"count":"1 through 10","additional_payer_notes":"Inpatient","standard_charge_dollar":140069.72},{"payer_name":"GLOBAL EXCEL [1036]","plan_name":"GLOBAL EXCEL","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 165%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":172437.91},{"payer_name":"REDLANDS COMMUNITY HOSPITAL [2005]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"VILLAGE HEALTH [1094]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EATING DISORDER","standard_charge_percentage":58.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":542362.66},{"payer_name":"PREMIER PATIENT CARE IPA [2069]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":554941.33},{"payer_name":"INTER VALLEY HEALTH PLAN [2024]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"CALIFORNIA HEALTH & WELLNESS MEDI-CAL [1122]","plan_name":"CALIFORNIA HEALTH AND WELLNESS MEDI-CAL (no longer Medi-Cal plan as of 1\/1\/24)","standard_charge_algorithm":"Per diem ($2,600).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2600.00},{"payer_name":"USOC - US OLYMPIC COMMITTEE [1123]","plan_name":"USOC VIK (BSC UC CARE)","standard_charge_percentage":43.10,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":398632.86},{"payer_name":"EASY CHOICE [1029]","plan_name":"EASY CHOICE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"HEALTH NET [1039]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"WORKERS COMPENSATION [1097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":224169.28},{"payer_name":"SCRIPPS COASTAL MED GRP [1074]","plan_name":"SCRIPPS COASTAL MED GRP [10740001]","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":601186.44},{"payer_name":"MC BRAND NEW DAY HMO [164030]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"ALTERNATE BRAND NEW DAY [2079]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Per diem ($8,294). The outlier payment amount is calculated by taking the estimated cost amount, subtracting the threshold amount ($247,571), then multiplying the difference by the percent of outlier that is reimbursed (53%). If the calculated outlier amount is greater than $0, it is added to the reimbursement total. The estimated cost amount is the adjusted billed amount multiplied by the cost-to-charge ratio (1). The following revenue codes are excluded from the adjusted billed amount: RC 0274-0276, 0278, 0624, 0891.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":8294.00},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"MC BRAND NEW DAY GENERIC PAYOR [164031]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":141778.93,"10th_percentile":141778.93,"90th_percentile":141778.93,"count":"1 through 10","additional_payer_notes":"All Inpatient-Medicare DRG","standard_charge_dollar":140069.72},{"payer_name":"UNITED AMERICAN [1087]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"MC ANTHEM BLUE CROSS HMO [164002]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"CAL OPTIMA [1016]","plan_name":"CalOptima Medicare","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":172437.91},{"payer_name":"HERITAGE VICTOR VALLEY MEDICAL GROUP [2045]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"CHAMPVA [1020]","plan_name":"VETERANS ADMINISTRATION - CHAMPVA","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":172437.91},{"payer_name":"MC BLUE SHIELD GENERIC PAYOR [164016]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"RIVERSIDE MEDICAL CLINIC [2064]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"CIGNA HMO","standard_charge_percentage":83.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":771368.45},{"payer_name":"PYRAMID LIFE [1068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ETS - LIFETRAC NETWORK [1103]","plan_name":"LIFETRAC","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":601186.44},{"payer_name":"TRIWEST ALTERNATE [2036]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":172437.91},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"EMBASSY OF STATE OF KUWAIT [11010001]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":628933.51},{"payer_name":"CARNIVAL CRUISES [1018]","plan_name":"CARNIVAL CRUISES [10180001]","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":739921.78},{"payer_name":"UC AFF ANTHEM\/XIMED HMO [164022]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":168083.66},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"BLUE SHIELD [1014]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($139,718.34). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $128,566.27, add-ons for qualifying new technology services are included. If operating cost exceeds $177,725.16 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,871.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $128,786.59 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $127,777.16 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,142.64. The transfer capital threshold is the transfer adjustment factor * $10,142.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139718.34},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"KUWAIT OIL COMPANY [11010005]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":628933.51},{"payer_name":"MC UHC ALLIANCE HMO [164020]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"IMPERIAL HEALTH PLAN [2081]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":554941.33},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":137268.33},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"SIERRA MEDICAL GROUP [2048]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"MC UHC HARMONY HMO [164026]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"AETNA TRANSPLANTS [1112]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":554941.33},{"payer_name":"CIGNA [1023]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":558115.35,"10th_percentile":558115.35,"90th_percentile":558115.35,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":140069.72},{"payer_name":"MONARCH HEALTHCARE [2006]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"UC AFF MC HUMANA GENERIC PAYOR [164027]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"MC HNET BLUE&GOLD ACO [164017]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"CMN - CANADIAN MEDICAL NETWORK [1024]","plan_name":"CMN GLOBAL INC","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 170%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293144.45},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"HUMANA [1042]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($139,718.34). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $128,566.27, add-ons for qualifying new technology services are included. If operating cost exceeds $177,725.16 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,871.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $128,786.59 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $127,777.16 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,142.64. The transfer capital threshold is the transfer adjustment factor * $10,142.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139718.34},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE PPO","standard_charge_percentage":49.55,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":458289.05},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"HIGH DESERT MEDICAL GROUP [2053]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"STATE OF CALIFORNIA [1082]","plan_name":"California State Prison","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 250%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":172437.91},{"payer_name":"SAN DIEGO SOCKERS [2015]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":224169.28},{"payer_name":"AMERICAN SPECIALTY HEALTH PLAN [2038]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"MGM RESORTS [1053]","plan_name":"MGM RESORT","standard_charge_algorithm":"Fee schedule rate ($22.85). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37.71},{"payer_name":"WELL CARE [1096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"IMMIGRATION HEALTH SERVICES [1043]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":168989.15},{"payer_name":"UC AFF ANTHEM\/SDSM HMO [164024]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"HEMET COMMUNITY MED GRP - PROMISECARE [1040]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UHC SELECT AND SELECT PLUS","standard_charge_algorithm":"Per diem ($14,996).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":14996.00},{"payer_name":"BLUE SHIELD PROMISE [1017]","plan_name":"CARE 1ST HEALTHPLAN MEDICARE ADVANTAGE (BS PROMISE)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MA\/SDPMG","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":133066.23},{"payer_name":"LA CARE HEALTH PLAN [2025]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ST JOSEPH ST JUDE [2065]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"GOLDEN PHYSICIANS MEDICAL GROUP [2082]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"SCAN HEALTH [1072]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":133066.23},{"payer_name":"ADVANTRA FREEDOM [1002]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"MC HUMANA GENERIC PAYOR [164014]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA HMO","standard_charge_percentage":83.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":771368.45},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA PPO","standard_charge_percentage":83.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":771368.45},{"payer_name":"EMPIRE PHYS MED GRP [2072]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE SAN DIEGO","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE QUALCOMM ","standard_charge_percentage":45.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":422125.37},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"BEACON HEALTH STRATEGY [2039]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"SCRIPPS HOSPICE [2008]","plan_name":"SCRIPPS HEALTH HOSPICE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay.","standard_charge_dollar":700.00},{"payer_name":"BEECH STREET [1012]","plan_name":"CAPPCARE\/BEECH STREET","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":693676.67},{"payer_name":"HEALTH CARE SUPPORT [2011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"Community Care IPA Medi-Cal Managed Care","standard_charge_algorithm":"Per diem ($1,750).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1750.00},{"payer_name":"MEDI-CAL [1048]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"BRAND NEW DAY [1089]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Per diem ($11,022).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":11022.00},{"payer_name":"AXA ASSISTANCE [1098]","plan_name":"AXA ASSISTANCE USA,INC","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":628933.51},{"payer_name":"FRESENIUS [1034]","plan_name":"FRESENIUS HEALTH PARTNERS, INC","standard_charge_algorithm":"Case rate ($139,718.34). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $128,566.27, add-ons for qualifying new technology services are included. If operating cost exceeds $177,725.16 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,871.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $128,786.59 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $127,777.16 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,142.64. The transfer capital threshold is the transfer adjustment factor * $10,142.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139718.34},{"payer_name":"MC HEALTHNET GENERIC PAYOR [164010]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"MEDICARE [1050]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","median_amount":158291.51,"10th_percentile":139584.97,"90th_percentile":236864.83,"count":"1 through 10","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":168989.15},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"SALUDPOL Peru Police","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":647431.55},{"payer_name":"KAISER [1046]","plan_name":"KAISER MEDICARE ADVANTAGE","standard_charge_percentage":63.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":582688.40},{"payer_name":"CIGNA [1023]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":510546.03},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Per diem ($15,746).","methodology":"per diem","median_amount":1149381.43,"10th_percentile":1149381.43,"90th_percentile":1149381.43,"count":"1 through 10","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay.","standard_charge_dollar":15746.00},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK","standard_charge_algorithm":"Per diem ($4,000). A payment threshold will be met when non-excluded charges is greater than 325000. For days after this threshold has been met, a per diem of (non-excluded charges for that day multiplied by .65) will be used instead of the standard payment for each day after the threshold.","methodology":"other","count":"0","additional_payer_notes":"ICU\/CCU Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($139,718.34). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $128,566.27, add-ons for qualifying new technology services are included. If operating cost exceeds $177,725.16 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,871.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $128,786.59 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $127,777.16 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,142.64. The transfer capital threshold is the transfer adjustment factor * $10,142.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139718.34},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":154076.69},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"HMSA - HAWAII MEDICAL SERVICE ASSOC MDCR [1041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"HEALTHNET TRANSPLANTS [1114]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"AETNA [1003]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":141087.99,"10th_percentile":141087.99,"90th_percentile":141087.99,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":140069.72},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EPO [10130074]","standard_charge_algorithm":"Per diem ($15,746).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 16 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":15746.00},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Commercial","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 150%.","methodology":"other","count":"0","additional_payer_notes":"General Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":210104.58},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Medicare","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"General Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":154076.69},{"payer_name":"CENTRAL HEALTH PLAN [2026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"MEDCARE PARTNERS [2084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"CASSIDY MED GRP [1019]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":601186.44},{"payer_name":"BEAVER MED GRP [2075]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"HEALTHCARE PARTNERS [2073]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":924902.22},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"MC UNITED HEALTHCARE GENERIC PAYOR [164011]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":110988.27},{"payer_name":"COMMUNITY ELDERCARE [1027]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"OPTUM CARE NETWORK - PCAMG [1064]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":601186.44},{"payer_name":"CLIPPERS WORKERS COMPENSATION [2097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":224169.28},{"payer_name":"VA - VETERANS ADMINISTRATION [1093]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($172,437.91). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $159,551, add-ons for qualifying new technology services are included. If operating cost exceeds $208,235.62 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $15,078.78, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $159,771.33 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $158,761.89 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,877.48. The transfer capital threshold is the transfer adjustment factor * $11,877.48. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":172437.91},{"payer_name":"US MARSHAL SERVICES [1090]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":510546.03},{"payer_name":"DESERT OASIS HEALTH CARE [2052]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($170,898.33). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $158,069.90, add-ons for qualifying new technology services are included. If operating cost exceeds $207,228.79 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $14,548.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $158,290.23 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $157,280.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,819.00. The transfer capital threshold is the transfer adjustment factor * $11,819.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":170898.33},{"payer_name":"LAKESIDE MEDICAL GROUP [2054]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($140,069.72). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $128,890.73, add-ons for qualifying new technology services are included. If operating cost exceeds $177,575.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,370.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 22.4. The base transfer operating payment is the transfer adjustment factor * $129,111.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $128,101.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,169.56. The transfer capital threshold is the transfer adjustment factor * $10,169.56. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140069.72}]}]}
,{"description":"Liver Transplant With McC Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"},{"code":"005","type":"TRIS-DRG"}],"standard_charges":[{"minimum":13.30,"maximum":237833.24,"gross_charge":679227.87,"discounted_cash":373575.33,"setting":"inpatient","payers_information":[{"payer_name":"LAKESIDE MEDICAL GROUP [2054]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"KUWAIT OIL COMPANY [11010005]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":461874.95},{"payer_name":"ALTERNATE HEALTH NET BH [2059]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 115%. Includes an additional $143,612 of payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric DonorTransplant (Optum 1\/24) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MC ANTHEM BLUE CROSS GENERIC PAYOR [164009]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH PLAN","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":407536.72},{"payer_name":"XIMED [2016]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MARKET PLACE","standard_charge_algorithm":"Case rate ($104,203.21). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $95,901.99, add-ons for qualifying new technology services are included. If operating cost exceeds $145,060.88 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,279.17, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $95,864.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,112.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,549.83. The transfer capital threshold is the transfer adjustment factor * $7,549.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 180%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104203.21},{"payer_name":"ALTERNATE SHERIFF CUSTODY [1106]","plan_name":"SHERIFF COUNTY CONTRACT # 514250","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":441498.12},{"payer_name":"TRICARE [1086]","plan_name":"TRICARE ","standard_charge_algorithm":"If the length of stay is greater than 4, the reimbursement is as follows: Case rate ($213,059.26). For stays with a transfer discharge disposition of 02 or 82, the transfer payment is a per diem payment of $11,393.54, and the first day is paid a rate of $22,787.09. The transfer payment is capped at $162,603.42. Billed amount less exclusions adjusted by a cost-to-charge ratio of 0.2348 that exceeds an outlier threshold of $265,730.43 is considered a cost outlier and adds an additional payment of 80% of the excess amount. For stays with a transfer discharge disposition, the outlier threshold is multiplied by (LOS \/ 18.7000007629395). Includes reimbursement from new technology add-ons. If the length of stay is less than or equal to 4, the reimbursement is as follows: Per diem ($16,842.63), capped at $162,603.42. For stays with a transfer discharge disposition of 02 or 82, the transfer payment is a per diem payment of $11,393.54, and the first day is paid a rate of $22,787.09. The transfer payment is capped at $162,603.42. Billed amount less exclusions adjusted by a cost-to-charge ratio of 0.2348 that exceeds an outlier threshold of $265,730.43 is considered a cost outlier and adds an additional payment of 80% of the excess amount. For stays with a transfer discharge disposition, the outlier threshold is multiplied by (LOS \/ 18.7000007629395). Includes reimbursement from new technology add-ons.","methodology":"other","median_amount":472400.73,"10th_percentile":472400.73,"90th_percentile":472400.73,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":124612.16},{"payer_name":"QUALITY HEALTH [1069]","plan_name":"QUALITY HEALTH MANAGEMENT","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 185%.","methodology":"other","count":"0","additional_payer_notes":"Surgery  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":237833.24},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":374933.78},{"payer_name":"RIVER CITY MEDICAL GROUP [2066]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"MC AETNA HMO [164001]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA COMMERCIAL","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 140%.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":179981.91},{"payer_name":"ALTERNATE MEDICARE [2007]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":125987.34},{"payer_name":"MENIFEE MED GRP [2076]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE [10230006]","standard_charge_algorithm":"Case rate ($184,809). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 491916. For days after this threshold has been met, a payment of (non-excluded charges minus 491916) multiplied by .60 will be used instead of the standard payment.","methodology":"other","median_amount":315360.42,"10th_percentile":315360.42,"90th_percentile":315360.42,"count":"1 through 10","additional_payer_notes":"Liver Cadaver Donor Transplant","standard_charge_dollar":679227.87},{"payer_name":"MC BLUE SHIELD HMO [164015]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"MC CIGNA GENERIC PAYOR [164007]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"BLUE CROSS TRANSPLANT [1116]","plan_name":"BLUE DISTINCTION ","standard_charge_algorithm":"Case rate ($228,260). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 833250. For days after this threshold has been met, a payment of (non-excluded charges minus 833250) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Donor Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE TRANSPLANT [11170001]","standard_charge_algorithm":"Case rate ($184,809). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 491916. For days after this threshold has been met, a payment of (non-excluded charges minus 491916) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver Donor Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"ALTERNATE MEDI-CAL [2001]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"UCR PROMPT PAY PAYOR [8240]","plan_name":"UCSD CHARITY MEDICARE CONTRACT","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Medicare All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"AETNA [1003]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($292,600). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1008132. For days after this threshold has been met, a payment of (non-excluded charges minus 1008132) multiplied by .60 will be used instead of the standard payment.","methodology":"other","median_amount":417944.00,"10th_percentile":271137.26,"90th_percentile":468545.00,"count":"11","additional_payer_notes":"Liver Transplant","standard_charge_dollar":679227.87},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"IMPERIAL COUNTY PHYSICIAN MED GRP","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":102375.46},{"payer_name":"USAA [1091]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"STERLING OPTION 1 [1083]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":102375.46},{"payer_name":"CIGNA [1023]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($177,528). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 571649. For days after this threshold has been met, a payment of (non-excluded charges minus 571649) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver\/Living Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"ALTERNATE AETNA [1004]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($292,600). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1008132. For days after this threshold has been met, a payment of (non-excluded charges minus 1008132) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"ASTIVA HEALTH [2095]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MC UNITED HEALTHCARE HMO [164005]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"MC AETNA GENERIC PAYOR [164008]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($127,412.52). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $117,863.47, add-ons for qualifying new technology services are included. If operating cost exceeds $167,022.36 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,527.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $117,825.73 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $117,074.35 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,797.65. The transfer capital threshold is the transfer adjustment factor * $8,797.65. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":127412.52},{"payer_name":"ALTERNATE KAISER RAD ONC [2089]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"MC HEALTHNET HMO [164004]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","median_amount":383310.47,"10th_percentile":264081.16,"90th_percentile":770302.17,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":104464.75},{"payer_name":"AMA - AMERICAN MEDICAL ASSOCIATION [1009]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"DEPARTMENT OF LABOR [1028]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":167126.06},{"payer_name":"MC ANTHEM BLUE CROSS HMO [164002]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"IMPERIAL HEALTH HOLDINGS [1132]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"AFFILIATED DOCTORS OF ORANGE COUNTY [2041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"NATIONAL HEALTHCARE SOLUTIONS INC [1100]","plan_name":"NATIONAL HEALTHCARE SOLUTIONS INC [11000001]","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":543382.30},{"payer_name":"CAREMORE [2028]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"AETNA [1003]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,203.21). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $95,901.99, add-ons for qualifying new technology services are included. If operating cost exceeds $145,060.88 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,279.17, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $95,864.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,112.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,549.83. The transfer capital threshold is the transfer adjustment factor * $7,549.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104203.21},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,203.21). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $95,901.99, add-ons for qualifying new technology services are included. If operating cost exceeds $145,060.88 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,279.17, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $95,864.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,112.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,549.83. The transfer capital threshold is the transfer adjustment factor * $7,549.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 115%. Includes an additional $143,612 of payment.","methodology":"other","median_amount":268658.03,"10th_percentile":268597.37,"90th_percentile":268719.19,"count":"1 through 10","additional_payer_notes":"Liver Cadaveric DonorTransplant","standard_charge_dollar":104203.21},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDI-CAL","standard_charge_algorithm":"Case rate ($330,814). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 975901. For days after this threshold has been met, a payment of (non-excluded charges minus 975901) multiplied by .445 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric DonorTransplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED HMO NON CONTRACTED [10260001]","standard_charge_algorithm":"Case rate ($104,203.21). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $95,901.99, add-ons for qualifying new technology services are included. If operating cost exceeds $145,060.88 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,279.17, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $95,864.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,112.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,549.83. The transfer capital threshold is the transfer adjustment factor * $7,549.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104203.21},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED PPO NON CONTRACTED [10260002]","standard_charge_algorithm":"Case rate ($104,203.21). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $95,901.99, add-ons for qualifying new technology services are included. If operating cost exceeds $145,060.88 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,279.17, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $95,864.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,112.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,549.83. The transfer capital threshold is the transfer adjustment factor * $7,549.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104203.21},{"payer_name":"CLEVER CARE [2061]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CALIFORNIA UC CARE \/ HSP","standard_charge_percentage":26.66,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":181082.15},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,203.21). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $95,901.99, add-ons for qualifying new technology services are included. If operating cost exceeds $145,060.88 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,279.17, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $95,864.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,112.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,549.83. The transfer capital threshold is the transfer adjustment factor * $7,549.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","median_amount":662282.85,"10th_percentile":662282.85,"90th_percentile":662282.85,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":104203.21},{"payer_name":"ALTERNATE SCAN HEALTH [2088]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":99241.51},{"payer_name":"TRANSAMERICA [1084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"OLYMPUS MANAGED HEALTHCARE INC [11020001]","standard_charge_algorithm":"Case rate ($292,600). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1008132. For days after this threshold has been met, a payment of (non-excluded charges minus 1008132) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"SD PHYSICIANS MED GRP [1076]","plan_name":"SD PHYSICIANS MED GRP SR [10760002]","standard_charge_percentage":55.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":373575.33},{"payer_name":"PRIMARY CARE ASSOCIATES OF CA [2067]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"ENCOMPASS MED GRP [1030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","median_amount":223022.98,"10th_percentile":223022.98,"90th_percentile":223022.98,"count":"1 through 10","additional_payer_notes":"All Inpatient","standard_charge_dollar":104464.75},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"ALTERNATE VA - VETERANS ADMINISTRATION [1239]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"SDSM [2017]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"COMMUNITY HEALTH GROUP [1022]","plan_name":"COMMUNITY HEALTH GROUP MEDICARE ADVANTAGE","standard_charge_algorithm":"Fee schedule rate ($10.31). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","median_amount":1132660.62,"10th_percentile":1132660.62,"90th_percentile":1132660.62,"count":"1 through 10","additional_payer_notes":"Transplants","standard_charge_dollar":13.30},{"payer_name":"UNLISTED MEDICARE ADVANTAGE (NON-CONTRACTED) [1051]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"BANKERS LIFE [1011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"VANTAGE [1092]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"SIMNSA HEALTH PLAN [2047]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MC HUMANA HMO [164013]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"ADMAR [1001]","plan_name":"MULTIPLAN","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":509420.90},{"payer_name":"BPS - BENEFIT PLAN SERVICES [1015]","plan_name":"MULTIPLAN","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":509420.90},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNA PRIORITY SELECT","standard_charge_algorithm":"Case rate ($326,350). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1229600. For days after this threshold has been met, a payment of (non-excluded charges minus 1229600) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD COVERED CA TRIO HMO","standard_charge_algorithm":"Case rate ($337,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 715000. For days after this threshold has been met, a payment of (non-excluded charges minus 715000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":125357.70},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA COMMERCIAL","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 140%.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":179981.91},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET ENHANCED CARE PPO","standard_charge_algorithm":"Case rate ($97,111.37). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $89,450.65, add-ons for qualifying new technology services are included. If operating cost exceeds $138,609.54 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $9,638.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $90,202.03. The transfer operating threshold is the transfer adjustment factor * $89,450.65 If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $6,909.33. The transfer capital threshold is the transfer adjustment factor * $6,909.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 281%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services (MSDRG no DSH GME IME) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":97111.37},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($127,412.52). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $117,863.47, add-ons for qualifying new technology services are included. If operating cost exceeds $167,022.36 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,527.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $117,825.73 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $117,074.35 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,797.65. The transfer capital threshold is the transfer adjustment factor * $8,797.65. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":127412.52},{"payer_name":"EASY ACCESS CARE [2077]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MC CIGNA HMO [164003]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,203.21). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $95,901.99, add-ons for qualifying new technology services are included. If operating cost exceeds $145,060.88 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,279.17, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $95,864.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,112.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,549.83. The transfer capital threshold is the transfer adjustment factor * $7,549.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104203.21},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"ALPHACARE [2062]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"INTERNATIONAL EMBASSY OF KUWAIT","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":461874.95},{"payer_name":"KAISER [1046]","plan_name":"KAISER MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($210,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 585000. For days after this threshold has been met, a payment of (non-excluded charges minus 585000) multiplied by .55 will be used instead of the standard payment.","methodology":"other","median_amount":405893.00,"10th_percentile":373900.00,"90th_percentile":432862.09,"count":"1 through 10","additional_payer_notes":"Liver Cadaveric Transplant","standard_charge_dollar":679227.87},{"payer_name":"MC SCAN HMO [164035]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($261,395). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 898622. For days after this threshold has been met, a payment of (non-excluded charges minus 898622) multiplied by .63 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"FIRST HEALTH [1032]","plan_name":"FIRST HEALTH","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":509420.90},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE","standard_charge_algorithm":"Case rate ($184,809). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 491916. For days after this threshold has been met, a payment of (non-excluded charges minus 491916) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver Donor Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"BLUE CROSS [1013]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,203.21). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $95,901.99, add-ons for qualifying new technology services are included. If operating cost exceeds $145,060.88 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,279.17, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $95,864.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,112.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,549.83. The transfer capital threshold is the transfer adjustment factor * $7,549.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104203.21},{"payer_name":"BLUE CROSS [1013]","plan_name":"UCSD STUDENT HEALTH INS PLAN - BC SHIP","standard_charge_percentage":26.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":181353.84},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($177,528). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 571649. For days after this threshold has been met, a payment of (non-excluded charges minus 571649) multiplied by .62 will be used instead of the standard payment.","methodology":"other","median_amount":79101.08,"10th_percentile":79101.08,"90th_percentile":79101.08,"count":"1 through 10","additional_payer_notes":"Liver Cadaver\/Living Transplant","standard_charge_dollar":679227.87},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE","standard_charge_algorithm":"Case rate ($184,809). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 491916. For days after this threshold has been met, a payment of (non-excluded charges minus 491916) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver Donor Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS HOUSE STAFF","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":179316.16},{"payer_name":"INTERPLAN [1045]","plan_name":"INTERPLAN","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":475459.51},{"payer_name":"TRI-CITY [1085]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"CHRISTIAN HEALTHCARE MINISTRIES [2030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"US BEHAVIORAL MENTAL\/EATING DISORDER","standard_charge_percentage":70.00,"standard_charge_algorithm":"70% of billed.","methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":475459.51},{"payer_name":"CHESAPEAKE LIFE [1021]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MUTUAL OF OMAHA [1059]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"ALTERNATE MOLINA [1240]","plan_name":"MOLINA MEDI-CAL","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 20, Case rate ($111,598). Procedures 21 - 9999, Per diem ($9,904).","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"ARCH HEALTH PARTNERS [2000]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"UNLISTED HOSPICE [1035]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"ELIZABETH HOSPICE [2018]","plan_name":"ELIZABETH HOSPICE GIP","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay.","standard_charge_dollar":950.00},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MC HUMANA GENERIC PAYOR [164014]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"MULTIPLAN [1058]","plan_name":"MULTIPLAN","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":509420.90},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"SEDGWICK [1077]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":167126.06},{"payer_name":"UC AFF HUMANA\/SDSM [164025]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($177,528). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 571649. For days after this threshold has been met, a payment of (non-excluded charges minus 571649) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver\/Living Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"TRIWEST [2003]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"MC UHC VEBA HMO [164033]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Case rate ($337,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 715000. For days after this threshold has been met, a payment of (non-excluded charges minus 715000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","median_amount":405000.00,"10th_percentile":65100.00,"90th_percentile":565133.91,"count":"1 through 10","additional_payer_notes":"Liver Cadaveric Transplant","standard_charge_dollar":679227.87},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Case rate ($337,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 715000. For days after this threshold has been met, a payment of (non-excluded charges minus 715000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","median_amount":385600.00,"10th_percentile":385600.00,"90th_percentile":385600.00,"count":"1 through 10","additional_payer_notes":"Liver Cadaveric Transplant","standard_charge_dollar":679227.87},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA EPN\/IFP","standard_charge_algorithm":"Case rate ($337,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 715000. For days after this threshold has been met, a payment of (non-excluded charges minus 715000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","median_amount":409410.00,"10th_percentile":409410.00,"90th_percentile":409410.00,"count":"1 through 10","additional_payer_notes":"Liver Cadaveric Transplant","standard_charge_dollar":679227.87},{"payer_name":"INTEGRATED HEALTH PARTNERS [2068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE ST PAULS","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"PACIFIC FOUNDATION [1063]","plan_name":"PACIFIC FOUNDATION FOR MEDICAL CARE","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":509420.90},{"payer_name":"GREATER NEWPORT PHYSICIANS [2096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MC SCAN GENERIC PAYOR [164034]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"KEY MED GRP [2074]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS UC CARE","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":179316.16},{"payer_name":"MERCY PHYSICIANS MED GRP [1052]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"TRI-CITY MEDICAL CENTER [1129]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"PRIVATE HEALTHCARE SYSTEM","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":509420.90},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Pricing is calculated over two periods plus stop loss reimbursement. The first period consists of the days from admission to 2 days before the relevant ICD Procedure date. If multiple relevant ICD Procedures are present, the first relevant ICD Procedure date on the claim is used. The reimbursement for this period is calculated as a per diem rate of $4,345. The second period consists of the days from the end of the first period to claim end. The reimbursement for this period is calculated as a case rate ($119,708). The stop loss period consists of the days from the day after the stop loss threshold ($374,604) is met to claim end. Only charges after the start of period two are considered for stop loss calculation. The reimbursement for this period is calculated as 42.2% of billed charges during the period after non-excluded charges exceed the threshold of $374,604. Only charges above the threshold on the day the threshold is met are reimbursed.","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET MEDICARE ADVANTAGE UC EMPLOYER GROUP","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 115%. Includes an additional $143,612 of payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric DonorTransplant (Optum 1\/24) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"BLUE SHIELD TRANSPLANTS [1113]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Case rate ($337,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 715000. For days after this threshold has been met, a payment of (non-excluded charges minus 715000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"MVP HEALTHCARE [1060]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"INLAND FACULTY MEDICAL GROUP [2063]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"SHARP HEALTHCARE TRANSPLANT [1119]","plan_name":"SHARP HEALTHCARE TRANSPLANT [11190001]","standard_charge_algorithm":"Case rate ($130,000). Includes a variable per diem for days 16-99999: RC 0100:0113 @ $2,650; RC 0200:0204 @ $3,550; RC 0206 @ $3,550; RC 0208:0214 @ $3,550; RC 0219 @ $3,550; RC 0115:0123 @ $2,650; RC 0125:0133 @ $2,650; RC 0137:0143 @ $2,650; RC 0147:0153 @ $2,650; RC 0157:0169 @ $2,650.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":130000.00},{"payer_name":"KERN HEALTH SYSTEMS [2033]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Case rate ($330,814). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 975901. For days after this threshold has been met, a payment of (non-excluded charges minus 975901) multiplied by .445 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric DonorTransplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"MC UHC VEBA GENERIC HMO [164032]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Case rate ($337,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 715000. For days after this threshold has been met, a payment of (non-excluded charges minus 715000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Case rate ($337,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 715000. For days after this threshold has been met, a payment of (non-excluded charges minus 715000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"ROYAL EMBASSY","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":475459.51},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE MEDI-CAL TRANSPLANT [11260001]","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 20, Case rate ($111,598). Procedures 21 - 9999, Per diem ($9,904).","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($261,395). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 898622. For days after this threshold has been met, a payment of (non-excluded charges minus 898622) multiplied by .63 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"GLOBAL EXCEL [1036]","plan_name":"GLOBAL EXCEL","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 165%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"REDLANDS COMMUNITY HOSPITAL [2005]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"VILLAGE HEALTH [1094]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":407536.72},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EATING DISORDER","standard_charge_percentage":58.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":398299.22},{"payer_name":"PREMIER PATIENT CARE IPA [2069]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"CALIFORNIA HEALTH & WELLNESS MEDI-CAL [1122]","plan_name":"CALIFORNIA HEALTH AND WELLNESS MEDI-CAL (no longer Medi-Cal plan as of 1\/1\/24)","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 20, Case rate ($107,623.36). Procedures 21 - 9999, Per diem ($9,551.42).","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"USOC - US OLYMPIC COMMITTEE [1123]","plan_name":"USOC VIK (BSC UC CARE)","standard_charge_percentage":43.10,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":292747.21},{"payer_name":"HEALTH NET [1039]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"WORKERS COMPENSATION [1097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":167126.06},{"payer_name":"INTER VALLEY HEALTH PLAN [2024]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"EASY CHOICE [1029]","plan_name":"EASY CHOICE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"UC AFF BLUE SHIELD SR\/SDSM [164037]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"ALTERNATE BRAND NEW DAY [2079]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MC BRAND NEW DAY HMO [164030]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Pricing is calculated over two periods plus stop loss reimbursement. The first period consists of the days from admission to 2 days before the relevant ICD Procedure date. If multiple relevant ICD Procedures are present, the first relevant ICD Procedure date on the claim is used. The reimbursement for this period is calculated as a per diem rate of $4,345. The second period consists of the days from the end of the first period to claim end. The reimbursement for this period is calculated as a case rate ($119,708). The stop loss period consists of the days from the day after the stop loss threshold ($374,604) is met to claim end. Only charges after the start of period two are considered for stop loss calculation. The reimbursement for this period is calculated as 42.2% of billed charges during the period after non-excluded charges exceed the threshold of $374,604. Only charges above the threshold on the day the threshold is met are reimbursed.","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 115%. Includes an additional $143,612 of payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric DonorTransplant (Optum 1\/24) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"UNITED AMERICAN [1087]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"HERITAGE VICTOR VALLEY MEDICAL GROUP [2045]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($127,412.52). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $117,863.47, add-ons for qualifying new technology services are included. If operating cost exceeds $167,022.36 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,527.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $117,825.73 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $117,074.35 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,797.65. The transfer capital threshold is the transfer adjustment factor * $8,797.65. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":127412.52},{"payer_name":"CHAMPVA [1020]","plan_name":"VETERANS ADMINISTRATION - CHAMPVA","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"MC BLUE SHIELD GENERIC PAYOR [164016]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"CAL OPTIMA [1016]","plan_name":"CalOptima Medicare","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"CIGNA HMO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":341651.62},{"payer_name":"RIVERSIDE MEDICAL CLINIC [2064]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"SCRIPPS COASTAL MED GRP [1074]","plan_name":"SCRIPPS COASTAL MED GRP [10740001]","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":441498.12},{"payer_name":"PYRAMID LIFE [1068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"ETS - LIFETRAC NETWORK [1103]","plan_name":"LIFETRAC","standard_charge_algorithm":"Case rate ($161,700). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Donor Transpalnt Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":161700.00},{"payer_name":"TRIWEST ALTERNATE [2036]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"CARNIVAL CRUISES [1018]","plan_name":"CARNIVAL CRUISES [10180001]","standard_charge_percentage":90.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":611305.08},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":125357.70},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"BLUE SHIELD [1014]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,203.21). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $95,901.99, add-ons for qualifying new technology services are included. If operating cost exceeds $145,060.88 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,279.17, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $95,864.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,112.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,549.83. The transfer capital threshold is the transfer adjustment factor * $7,549.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104203.21},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"EMBASSY OF STATE OF KUWAIT [11010001]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":461874.95},{"payer_name":"MC UHC ALLIANCE HMO [164020]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"IMPERIAL HEALTH PLAN [2081]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA HMO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":341651.62},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA PPO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":341651.62},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($292,600). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1008132. For days after this threshold has been met, a payment of (non-excluded charges minus 1008132) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE PPO","standard_charge_percentage":49.55,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":336557.41},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UHC SELECT AND SELECT PLUS","standard_charge_algorithm":"Per diem ($14,996).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":14996.00},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Case rate ($330,814). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 975901. For days after this threshold has been met, a payment of (non-excluded charges minus 975901) multiplied by .445 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric DonorTransplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($127,412.52). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $117,863.47, add-ons for qualifying new technology services are included. If operating cost exceeds $167,022.36 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,527.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $117,825.73 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $117,074.35 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,797.65. The transfer capital threshold is the transfer adjustment factor * $8,797.65. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":127412.52},{"payer_name":"SIERRA MEDICAL GROUP [2048]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","median_amount":332255.57,"10th_percentile":332255.57,"90th_percentile":332255.57,"count":"1 through 10","additional_payer_notes":"Inpatient","standard_charge_dollar":102375.46},{"payer_name":"AETNA TRANSPLANTS [1112]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($292,600). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1008132. For days after this threshold has been met, a payment of (non-excluded charges minus 1008132) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE QUALCOMM ","standard_charge_percentage":45.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":309999.60},{"payer_name":"CIGNA [1023]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MONARCH HEALTHCARE [2006]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"UC AFF MC HUMANA GENERIC PAYOR [164027]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"HUMANA [1042]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,203.21). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $95,901.99, add-ons for qualifying new technology services are included. If operating cost exceeds $145,060.88 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,279.17, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $95,864.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,112.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,549.83. The transfer capital threshold is the transfer adjustment factor * $7,549.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104203.21},{"payer_name":"MC HNET BLUE&GOLD ACO [164017]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"CMN - CANADIAN MEDICAL NETWORK [1024]","plan_name":"CMN GLOBAL INC","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 170%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":218549.47},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($177,528). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 571649. For days after this threshold has been met, a payment of (non-excluded charges minus 571649) multiplied by .62 will be used instead of the standard payment.","methodology":"other","median_amount":177528.00,"10th_percentile":177528.00,"90th_percentile":177528.00,"count":"1 through 10","additional_payer_notes":"Liver Cadaver\/Living Transplant","standard_charge_dollar":679227.87},{"payer_name":"STATE OF CALIFORNIA [1082]","plan_name":"California State Prison","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 250%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($177,528). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 571649. For days after this threshold has been met, a payment of (non-excluded charges minus 571649) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver\/Living Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"SAN DIEGO SOCKERS [2015]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":167126.06},{"payer_name":"AMERICAN SPECIALTY HEALTH PLAN [2038]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"HIGH DESERT MEDICAL GROUP [2053]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"IMMIGRATION HEALTH SERVICES [1043]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":125987.34},{"payer_name":"WELL CARE [1096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"UC AFF ANTHEM\/SDSM HMO [164024]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"HEMET COMMUNITY MED GRP - PROMISECARE [1040]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MC UHC HARMONY HMO [164026]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MID-COUNTY PHYSICIANS NARROW NETWORK","standard_charge_algorithm":"Per diem ($17,123).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":17123.00},{"payer_name":"BLUE SHIELD PROMISE [1017]","plan_name":"CARE 1ST HEALTHPLAN MEDICARE ADVANTAGE (BS PROMISE)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Case rate ($326,350). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1229600. For days after this threshold has been met, a payment of (non-excluded charges minus 1229600) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MA\/SDPMG","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":99241.51},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","median_amount":348399.49,"10th_percentile":348399.49,"90th_percentile":348399.49,"count":"1 through 10","additional_payer_notes":"Surgery","standard_charge_dollar":679227.87},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Case rate ($326,350). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1229600. For days after this threshold has been met, a payment of (non-excluded charges minus 1229600) multiplied by .62 will be used instead of the standard payment.","methodology":"other","median_amount":305000.00,"10th_percentile":84504.00,"90th_percentile":440000.00,"count":"1 through 10","additional_payer_notes":"Liver Cadaveric Transplant","standard_charge_dollar":679227.87},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($177,528). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 571649. For days after this threshold has been met, a payment of (non-excluded charges minus 571649) multiplied by .62 will be used instead of the standard payment.","methodology":"other","median_amount":305000.00,"10th_percentile":305000.00,"90th_percentile":305000.00,"count":"1 through 10","additional_payer_notes":"Liver Cadaver\/Living Transplant","standard_charge_dollar":679227.87},{"payer_name":"LA CARE HEALTH PLAN [2025]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"ST JOSEPH ST JUDE [2065]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"GOLDEN PHYSICIANS MEDICAL GROUP [2082]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"SCRIPPS HEALTH PLAN SERVICES [1075]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":407536.72},{"payer_name":"ADVANTRA FREEDOM [1002]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"SCAN HEALTH [1072]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":99241.51},{"payer_name":"EMPIRE PHYS MED GRP [2072]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDI-CAL ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 20, Case rate ($111,598). Procedures 21 - 9999, Per diem ($9,904).","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE SAN DIEGO","standard_charge_algorithm":"Case rate ($127,412.52). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $117,863.47, add-ons for qualifying new technology services are included. If operating cost exceeds $167,022.36 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,527.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $117,825.73 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $117,074.35 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,797.65. The transfer capital threshold is the transfer adjustment factor * $8,797.65. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":127412.52},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Case rate ($330,814). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 975901. For days after this threshold has been met, a payment of (non-excluded charges minus 975901) multiplied by .445 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric DonorTransplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($127,412.52). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $117,863.47, add-ons for qualifying new technology services are included. If operating cost exceeds $167,022.36 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,527.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $117,825.73 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $117,074.35 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,797.65. The transfer capital threshold is the transfer adjustment factor * $8,797.65. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":127412.52},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($127,412.52). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $117,863.47, add-ons for qualifying new technology services are included. If operating cost exceeds $167,022.36 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,527.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $117,825.73 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $117,074.35 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,797.65. The transfer capital threshold is the transfer adjustment factor * $8,797.65. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":127412.52},{"payer_name":"BEACON HEALTH STRATEGY [2039]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MC BRAND NEW DAY GENERIC PAYOR [164031]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"MGM RESORTS [1053]","plan_name":"MGM RESORT","standard_charge_algorithm":"Case rate ($150,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 315000. For days after this threshold has been met, a payment of (non-excluded charges minus 315000) multiplied by .70 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Donor Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"SCRIPPS HOSPICE [2008]","plan_name":"SCRIPPS HEALTH HOSPICE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay.","standard_charge_dollar":700.00},{"payer_name":"BEECH STREET [1012]","plan_name":"CAPPCARE\/BEECH STREET","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":509420.90},{"payer_name":"HEALTH CARE SUPPORT [2011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"UC AFF ANTHEM\/XIMED HMO [164022]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"MEDI-CAL [1048]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"Community Care IPA Medi-Cal Managed Care","standard_charge_algorithm":"Includes a variable per diem for days 0-99999: RC 0100:0169 @ $1,750; RC 0200:0202 @ $1,750; RC 0208:0213 @ $1,750; RC 0219 @ $1,750; RC 0206 @ $2,300; RC 0207 @ $2,300.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"BRAND NEW DAY [1089]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"AXA ASSISTANCE [1098]","plan_name":"AXA ASSISTANCE USA,INC","standard_charge_algorithm":"Case rate ($126,991). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 433815. For days after this threshold has been met, a payment of (non-excluded charges minus 433815) multiplied by .65 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"ALTERNATE MOLINA [1240]","plan_name":"MOLINA MEDI-CAL [12400001]","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 20, Case rate ($111,598). Procedures 21 - 9999, Per diem ($9,904).","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"AETNA [1003]","plan_name":"AETNA BEHAVIORAL EATING DISORDER","standard_charge_percentage":43.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":296822.58},{"payer_name":"FRESENIUS [1034]","plan_name":"FRESENIUS HEALTH PARTNERS, INC","standard_charge_algorithm":"Case rate ($104,203.21). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $95,901.99, add-ons for qualifying new technology services are included. If operating cost exceeds $145,060.88 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,279.17, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $95,864.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,112.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,549.83. The transfer capital threshold is the transfer adjustment factor * $7,549.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104203.21},{"payer_name":"MC HEALTHNET GENERIC PAYOR [164010]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"SALUDPOL Peru Police","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":475459.51},{"payer_name":"CIGNA [1023]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":374933.78},{"payer_name":"MEDICARE [1050]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","median_amount":131365.62,"10th_percentile":126023.66,"90th_percentile":194728.31,"count":"15","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":125987.34},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK","standard_charge_algorithm":"Per diem ($4,000). A payment threshold will be met when non-excluded charges is greater than 325000. For days after this threshold has been met, a per diem of (non-excluded charges for that day multiplied by .65) will be used instead of the standard payment for each day after the threshold.","methodology":"other","count":"0","additional_payer_notes":"ICU\/CCU Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":114911.23},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,203.21). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $95,901.99, add-ons for qualifying new technology services are included. If operating cost exceeds $145,060.88 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,279.17, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $95,864.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,112.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,549.83. The transfer capital threshold is the transfer adjustment factor * $7,549.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104203.21},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":285040.79,"10th_percentile":285040.79,"90th_percentile":285040.79,"count":"1 through 10","additional_payer_notes":"Transplants","standard_charge_dollar":104464.75},{"payer_name":"HMSA - HAWAII MEDICAL SERVICE ASSOC MDCR [1041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE DISTINCTION ","standard_charge_algorithm":"Case rate ($228,260). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 833250. For days after this threshold has been met, a payment of (non-excluded charges minus 833250) multiplied by .60 will be used instead of the standard payment.","methodology":"other","median_amount":641448.53,"10th_percentile":641448.53,"90th_percentile":641448.53,"count":"1 through 10","additional_payer_notes":"Liver Cadaveric Donor Transplant","standard_charge_dollar":679227.87},{"payer_name":"KAISER [1046]","plan_name":"KAISER","standard_charge_algorithm":"Case rate ($210,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 585000. For days after this threshold has been met, a payment of (non-excluded charges minus 585000) multiplied by .55 will be used instead of the standard payment.","methodology":"other","median_amount":396735.77,"10th_percentile":285000.00,"90th_percentile":551630.08,"count":"14","additional_payer_notes":"Liver Cadaveric Transplant","standard_charge_dollar":679227.87},{"payer_name":"AETNA [1003]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Case rate ($326,350). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1229600. For days after this threshold has been met, a payment of (non-excluded charges minus 1229600) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EPO [10130074]","standard_charge_algorithm":"Case rate ($326,350). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1229600. For days after this threshold has been met, a payment of (non-excluded charges minus 1229600) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($177,528). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 571649. For days after this threshold has been met, a payment of (non-excluded charges minus 571649) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver\/Living Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Case rate ($326,350). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1229600. For days after this threshold has been met, a payment of (non-excluded charges minus 1229600) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($127,412.52). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $117,863.47, add-ons for qualifying new technology services are included. If operating cost exceeds $167,022.36 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,527.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $117,825.73 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $117,074.35 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,797.65. The transfer capital threshold is the transfer adjustment factor * $8,797.65. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":127412.52},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":305277.42,"10th_percentile":305277.42,"90th_percentile":305277.42,"count":"1 through 10","additional_payer_notes":"Inpatient","standard_charge_dollar":104464.75},{"payer_name":"CENTRAL HEALTH PLAN [2026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Commercial","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 150%.","methodology":"other","count":"0","additional_payer_notes":"General Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":156697.13},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Medicare","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"General Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":114911.23},{"payer_name":"MEDCARE PARTNERS [2084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"CASSIDY MED GRP [1019]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":441498.12},{"payer_name":"BEAVER MED GRP [2075]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"HEALTHCARE PARTNERS [2073]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","median_amount":320523.60,"10th_percentile":320523.60,"90th_percentile":345885.41,"count":"1 through 10","additional_payer_notes":"Surgery","standard_charge_dollar":679227.87},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($127,412.52). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $117,863.47, add-ons for qualifying new technology services are included. If operating cost exceeds $167,022.36 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,527.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $117,825.73 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $117,074.35 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,797.65. The transfer capital threshold is the transfer adjustment factor * $8,797.65. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":127412.52},{"payer_name":"MC UNITED HEALTHCARE GENERIC PAYOR [164011]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"COMMUNITY ELDERCARE [1027]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"OPTUM CARE NETWORK - PCAMG [1064]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":441498.12},{"payer_name":"VA - VETERANS ADMINISTRATION [1093]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"US MARSHAL SERVICES [1090]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"CLIPPERS WORKERS COMPENSATION [2097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":167126.06},{"payer_name":"DESERT OASIS HEALTH CARE [2052]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($127,412.52). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $117,863.47, add-ons for qualifying new technology services are included. If operating cost exceeds $167,022.36 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,527.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $117,825.73 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $117,074.35 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,797.65. The transfer capital threshold is the transfer adjustment factor * $8,797.65. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":127412.52}]},{"minimum":124612.16,"maximum":124612.16,"gross_charge":542933.38,"discounted_cash":298613.36,"setting":"inpatient","payers_information":[{"payer_name":"LAKESIDE MEDICAL GROUP [2054]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"KUWAIT OIL COMPANY [11010005]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":461874.95},{"payer_name":"ALTERNATE HEALTH NET BH [2059]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 115%. Includes an additional $143,612 of payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric DonorTransplant (Optum 1\/24) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MC ANTHEM BLUE CROSS GENERIC PAYOR [164009]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH PLAN","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":407536.72},{"payer_name":"XIMED [2016]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MARKET PLACE","standard_charge_algorithm":"Case rate ($104,203.21). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $95,901.99, add-ons for qualifying new technology services are included. If operating cost exceeds $145,060.88 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,279.17, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $95,864.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,112.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,549.83. The transfer capital threshold is the transfer adjustment factor * $7,549.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 180%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104203.21},{"payer_name":"ALTERNATE SHERIFF CUSTODY [1106]","plan_name":"SHERIFF COUNTY CONTRACT # 514250","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":441498.12},{"payer_name":"TRICARE [1086]","plan_name":"TRICARE ","standard_charge_algorithm":"If the length of stay is greater than 4, the reimbursement is as follows: Case rate ($213,059.26). For stays with a transfer discharge disposition of 02 or 82, the transfer payment is a per diem payment of $11,393.54, and the first day is paid a rate of $22,787.09. The transfer payment is capped at $162,603.42. Billed amount less exclusions adjusted by a cost-to-charge ratio of 0.2348 that exceeds an outlier threshold of $265,730.43 is considered a cost outlier and adds an additional payment of 80% of the excess amount. For stays with a transfer discharge disposition, the outlier threshold is multiplied by (LOS \/ 18.7000007629395). Includes reimbursement from new technology add-ons. If the length of stay is less than or equal to 4, the reimbursement is as follows: Per diem ($16,842.63), capped at $162,603.42. For stays with a transfer discharge disposition of 02 or 82, the transfer payment is a per diem payment of $11,393.54, and the first day is paid a rate of $22,787.09. The transfer payment is capped at $162,603.42. Billed amount less exclusions adjusted by a cost-to-charge ratio of 0.2348 that exceeds an outlier threshold of $265,730.43 is considered a cost outlier and adds an additional payment of 80% of the excess amount. For stays with a transfer discharge disposition, the outlier threshold is multiplied by (LOS \/ 18.7000007629395). Includes reimbursement from new technology add-ons.","methodology":"other","median_amount":472400.73,"10th_percentile":472400.73,"90th_percentile":472400.73,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":124612.16},{"payer_name":"QUALITY HEALTH [1069]","plan_name":"QUALITY HEALTH MANAGEMENT","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 185%.","methodology":"other","count":"0","additional_payer_notes":"Surgery  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":237833.24},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":374933.78},{"payer_name":"RIVER CITY MEDICAL GROUP [2066]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"MC AETNA HMO [164001]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA COMMERCIAL","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 140%.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":179981.91},{"payer_name":"ALTERNATE MEDICARE [2007]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":125987.34},{"payer_name":"MENIFEE MED GRP [2076]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE [10230006]","standard_charge_algorithm":"Case rate ($184,809). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 491916. For days after this threshold has been met, a payment of (non-excluded charges minus 491916) multiplied by .60 will be used instead of the standard payment.","methodology":"other","median_amount":315360.42,"10th_percentile":315360.42,"90th_percentile":315360.42,"count":"1 through 10","additional_payer_notes":"Liver Cadaver Donor Transplant","standard_charge_dollar":679227.87},{"payer_name":"MC BLUE SHIELD HMO [164015]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"MC CIGNA GENERIC PAYOR [164007]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"BLUE CROSS TRANSPLANT [1116]","plan_name":"BLUE DISTINCTION ","standard_charge_algorithm":"Case rate ($228,260). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 833250. For days after this threshold has been met, a payment of (non-excluded charges minus 833250) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Donor Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE TRANSPLANT [11170001]","standard_charge_algorithm":"Case rate ($184,809). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 491916. For days after this threshold has been met, a payment of (non-excluded charges minus 491916) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver Donor Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"ALTERNATE MEDI-CAL [2001]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"UCR PROMPT PAY PAYOR [8240]","plan_name":"UCSD CHARITY MEDICARE CONTRACT","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Medicare All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"AETNA [1003]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($292,600). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1008132. For days after this threshold has been met, a payment of (non-excluded charges minus 1008132) multiplied by .60 will be used instead of the standard payment.","methodology":"other","median_amount":417944.00,"10th_percentile":271137.26,"90th_percentile":468545.00,"count":"11","additional_payer_notes":"Liver Transplant","standard_charge_dollar":679227.87},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"IMPERIAL COUNTY PHYSICIAN MED GRP","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":102375.46},{"payer_name":"USAA [1091]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"STERLING OPTION 1 [1083]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":102375.46},{"payer_name":"CIGNA [1023]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($177,528). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 571649. For days after this threshold has been met, a payment of (non-excluded charges minus 571649) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver\/Living Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"ALTERNATE AETNA [1004]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($292,600). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1008132. For days after this threshold has been met, a payment of (non-excluded charges minus 1008132) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"ASTIVA HEALTH [2095]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MC UNITED HEALTHCARE HMO [164005]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"MC AETNA GENERIC PAYOR [164008]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($127,412.52). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $117,863.47, add-ons for qualifying new technology services are included. If operating cost exceeds $167,022.36 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,527.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $117,825.73 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $117,074.35 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,797.65. The transfer capital threshold is the transfer adjustment factor * $8,797.65. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":127412.52},{"payer_name":"ALTERNATE KAISER RAD ONC [2089]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"MC HEALTHNET HMO [164004]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","median_amount":383310.47,"10th_percentile":264081.16,"90th_percentile":770302.17,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":104464.75},{"payer_name":"AMA - AMERICAN MEDICAL ASSOCIATION [1009]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"DEPARTMENT OF LABOR [1028]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":167126.06},{"payer_name":"MC ANTHEM BLUE CROSS HMO [164002]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"IMPERIAL HEALTH HOLDINGS [1132]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"AFFILIATED DOCTORS OF ORANGE COUNTY [2041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"NATIONAL HEALTHCARE SOLUTIONS INC [1100]","plan_name":"NATIONAL HEALTHCARE SOLUTIONS INC [11000001]","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":543382.30},{"payer_name":"CAREMORE [2028]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"AETNA [1003]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,203.21). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $95,901.99, add-ons for qualifying new technology services are included. If operating cost exceeds $145,060.88 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,279.17, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $95,864.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,112.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,549.83. The transfer capital threshold is the transfer adjustment factor * $7,549.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104203.21},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,203.21). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $95,901.99, add-ons for qualifying new technology services are included. If operating cost exceeds $145,060.88 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,279.17, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $95,864.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,112.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,549.83. The transfer capital threshold is the transfer adjustment factor * $7,549.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 115%. Includes an additional $143,612 of payment.","methodology":"other","median_amount":268658.03,"10th_percentile":268597.37,"90th_percentile":268719.19,"count":"1 through 10","additional_payer_notes":"Liver Cadaveric DonorTransplant","standard_charge_dollar":104203.21},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDI-CAL","standard_charge_algorithm":"Case rate ($330,814). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 975901. For days after this threshold has been met, a payment of (non-excluded charges minus 975901) multiplied by .445 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric DonorTransplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED HMO NON CONTRACTED [10260001]","standard_charge_algorithm":"Case rate ($104,203.21). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $95,901.99, add-ons for qualifying new technology services are included. If operating cost exceeds $145,060.88 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,279.17, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $95,864.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,112.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,549.83. The transfer capital threshold is the transfer adjustment factor * $7,549.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104203.21},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED PPO NON CONTRACTED [10260002]","standard_charge_algorithm":"Case rate ($104,203.21). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $95,901.99, add-ons for qualifying new technology services are included. If operating cost exceeds $145,060.88 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,279.17, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $95,864.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,112.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,549.83. The transfer capital threshold is the transfer adjustment factor * $7,549.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104203.21},{"payer_name":"CLEVER CARE [2061]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CALIFORNIA UC CARE \/ HSP","standard_charge_percentage":26.66,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":181082.15},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,203.21). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $95,901.99, add-ons for qualifying new technology services are included. If operating cost exceeds $145,060.88 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,279.17, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $95,864.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,112.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,549.83. The transfer capital threshold is the transfer adjustment factor * $7,549.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","median_amount":662282.85,"10th_percentile":662282.85,"90th_percentile":662282.85,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":104203.21},{"payer_name":"ALTERNATE SCAN HEALTH [2088]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":99241.51},{"payer_name":"TRANSAMERICA [1084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"OLYMPUS MANAGED HEALTHCARE INC [11020001]","standard_charge_algorithm":"Case rate ($292,600). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1008132. For days after this threshold has been met, a payment of (non-excluded charges minus 1008132) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"SD PHYSICIANS MED GRP [1076]","plan_name":"SD PHYSICIANS MED GRP SR [10760002]","standard_charge_percentage":55.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":373575.33},{"payer_name":"PRIMARY CARE ASSOCIATES OF CA [2067]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"ENCOMPASS MED GRP [1030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","median_amount":223022.98,"10th_percentile":223022.98,"90th_percentile":223022.98,"count":"1 through 10","additional_payer_notes":"All Inpatient","standard_charge_dollar":104464.75},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"ALTERNATE VA - VETERANS ADMINISTRATION [1239]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"SDSM [2017]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"COMMUNITY HEALTH GROUP [1022]","plan_name":"COMMUNITY HEALTH GROUP MEDICARE ADVANTAGE","standard_charge_algorithm":"Fee schedule rate ($10.31). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","median_amount":1132660.62,"10th_percentile":1132660.62,"90th_percentile":1132660.62,"count":"1 through 10","additional_payer_notes":"Transplants","standard_charge_dollar":13.30},{"payer_name":"UNLISTED MEDICARE ADVANTAGE (NON-CONTRACTED) [1051]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"BANKERS LIFE [1011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"VANTAGE [1092]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"SIMNSA HEALTH PLAN [2047]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MC HUMANA HMO [164013]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"ADMAR [1001]","plan_name":"MULTIPLAN","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":509420.90},{"payer_name":"BPS - BENEFIT PLAN SERVICES [1015]","plan_name":"MULTIPLAN","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":509420.90},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNA PRIORITY SELECT","standard_charge_algorithm":"Case rate ($326,350). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1229600. For days after this threshold has been met, a payment of (non-excluded charges minus 1229600) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD COVERED CA TRIO HMO","standard_charge_algorithm":"Case rate ($337,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 715000. For days after this threshold has been met, a payment of (non-excluded charges minus 715000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":125357.70},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA COMMERCIAL","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 140%.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":179981.91},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET ENHANCED CARE PPO","standard_charge_algorithm":"Case rate ($97,111.37). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $89,450.65, add-ons for qualifying new technology services are included. If operating cost exceeds $138,609.54 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $9,638.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $90,202.03. The transfer operating threshold is the transfer adjustment factor * $89,450.65 If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $6,909.33. The transfer capital threshold is the transfer adjustment factor * $6,909.33. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 281%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services (MSDRG no DSH GME IME) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":97111.37},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($127,412.52). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $117,863.47, add-ons for qualifying new technology services are included. If operating cost exceeds $167,022.36 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,527.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $117,825.73 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $117,074.35 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,797.65. The transfer capital threshold is the transfer adjustment factor * $8,797.65. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":127412.52},{"payer_name":"EASY ACCESS CARE [2077]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MC CIGNA HMO [164003]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,203.21). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $95,901.99, add-ons for qualifying new technology services are included. If operating cost exceeds $145,060.88 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,279.17, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $95,864.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,112.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,549.83. The transfer capital threshold is the transfer adjustment factor * $7,549.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104203.21},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"ALPHACARE [2062]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"INTERNATIONAL EMBASSY OF KUWAIT","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":461874.95},{"payer_name":"KAISER [1046]","plan_name":"KAISER MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($210,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 585000. For days after this threshold has been met, a payment of (non-excluded charges minus 585000) multiplied by .55 will be used instead of the standard payment.","methodology":"other","median_amount":405893.00,"10th_percentile":373900.00,"90th_percentile":432862.09,"count":"1 through 10","additional_payer_notes":"Liver Cadaveric Transplant","standard_charge_dollar":679227.87},{"payer_name":"MC SCAN HMO [164035]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($261,395). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 898622. For days after this threshold has been met, a payment of (non-excluded charges minus 898622) multiplied by .63 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"FIRST HEALTH [1032]","plan_name":"FIRST HEALTH","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":509420.90},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE","standard_charge_algorithm":"Case rate ($184,809). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 491916. For days after this threshold has been met, a payment of (non-excluded charges minus 491916) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver Donor Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"BLUE CROSS [1013]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,203.21). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $95,901.99, add-ons for qualifying new technology services are included. If operating cost exceeds $145,060.88 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,279.17, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $95,864.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,112.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,549.83. The transfer capital threshold is the transfer adjustment factor * $7,549.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104203.21},{"payer_name":"BLUE CROSS [1013]","plan_name":"UCSD STUDENT HEALTH INS PLAN - BC SHIP","standard_charge_percentage":26.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":181353.84},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($177,528). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 571649. For days after this threshold has been met, a payment of (non-excluded charges minus 571649) multiplied by .62 will be used instead of the standard payment.","methodology":"other","median_amount":79101.08,"10th_percentile":79101.08,"90th_percentile":79101.08,"count":"1 through 10","additional_payer_notes":"Liver Cadaver\/Living Transplant","standard_charge_dollar":679227.87},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE","standard_charge_algorithm":"Case rate ($184,809). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 491916. For days after this threshold has been met, a payment of (non-excluded charges minus 491916) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver Donor Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS HOUSE STAFF","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":179316.16},{"payer_name":"INTERPLAN [1045]","plan_name":"INTERPLAN","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":475459.51},{"payer_name":"TRI-CITY [1085]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"CHRISTIAN HEALTHCARE MINISTRIES [2030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"US BEHAVIORAL MENTAL\/EATING DISORDER","standard_charge_percentage":70.00,"standard_charge_algorithm":"70% of billed.","methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":475459.51},{"payer_name":"CHESAPEAKE LIFE [1021]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MUTUAL OF OMAHA [1059]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"ALTERNATE MOLINA [1240]","plan_name":"MOLINA MEDI-CAL","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 20, Case rate ($111,598). Procedures 21 - 9999, Per diem ($9,904).","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"ARCH HEALTH PARTNERS [2000]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"UNLISTED HOSPICE [1035]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"ELIZABETH HOSPICE [2018]","plan_name":"ELIZABETH HOSPICE GIP","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay.","standard_charge_dollar":950.00},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MC HUMANA GENERIC PAYOR [164014]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"MULTIPLAN [1058]","plan_name":"MULTIPLAN","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":509420.90},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"SEDGWICK [1077]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":167126.06},{"payer_name":"UC AFF HUMANA\/SDSM [164025]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($177,528). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 571649. For days after this threshold has been met, a payment of (non-excluded charges minus 571649) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver\/Living Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"TRIWEST [2003]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"MC UHC VEBA HMO [164033]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Case rate ($337,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 715000. For days after this threshold has been met, a payment of (non-excluded charges minus 715000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","median_amount":405000.00,"10th_percentile":65100.00,"90th_percentile":565133.91,"count":"1 through 10","additional_payer_notes":"Liver Cadaveric Transplant","standard_charge_dollar":679227.87},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Case rate ($337,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 715000. For days after this threshold has been met, a payment of (non-excluded charges minus 715000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","median_amount":385600.00,"10th_percentile":385600.00,"90th_percentile":385600.00,"count":"1 through 10","additional_payer_notes":"Liver Cadaveric Transplant","standard_charge_dollar":679227.87},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA EPN\/IFP","standard_charge_algorithm":"Case rate ($337,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 715000. For days after this threshold has been met, a payment of (non-excluded charges minus 715000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","median_amount":409410.00,"10th_percentile":409410.00,"90th_percentile":409410.00,"count":"1 through 10","additional_payer_notes":"Liver Cadaveric Transplant","standard_charge_dollar":679227.87},{"payer_name":"INTEGRATED HEALTH PARTNERS [2068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE ST PAULS","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"PACIFIC FOUNDATION [1063]","plan_name":"PACIFIC FOUNDATION FOR MEDICAL CARE","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":509420.90},{"payer_name":"GREATER NEWPORT PHYSICIANS [2096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MC SCAN GENERIC PAYOR [164034]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"KEY MED GRP [2074]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS UC CARE","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":179316.16},{"payer_name":"MERCY PHYSICIANS MED GRP [1052]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"TRI-CITY MEDICAL CENTER [1129]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"PRIVATE HEALTHCARE SYSTEM","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":509420.90},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Pricing is calculated over two periods plus stop loss reimbursement. The first period consists of the days from admission to 2 days before the relevant ICD Procedure date. If multiple relevant ICD Procedures are present, the first relevant ICD Procedure date on the claim is used. The reimbursement for this period is calculated as a per diem rate of $4,345. The second period consists of the days from the end of the first period to claim end. The reimbursement for this period is calculated as a case rate ($119,708). The stop loss period consists of the days from the day after the stop loss threshold ($374,604) is met to claim end. Only charges after the start of period two are considered for stop loss calculation. The reimbursement for this period is calculated as 42.2% of billed charges during the period after non-excluded charges exceed the threshold of $374,604. Only charges above the threshold on the day the threshold is met are reimbursed.","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET MEDICARE ADVANTAGE UC EMPLOYER GROUP","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 115%. Includes an additional $143,612 of payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric DonorTransplant (Optum 1\/24) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"BLUE SHIELD TRANSPLANTS [1113]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Case rate ($337,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 715000. For days after this threshold has been met, a payment of (non-excluded charges minus 715000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"MVP HEALTHCARE [1060]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"INLAND FACULTY MEDICAL GROUP [2063]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"SHARP HEALTHCARE TRANSPLANT [1119]","plan_name":"SHARP HEALTHCARE TRANSPLANT [11190001]","standard_charge_algorithm":"Case rate ($130,000). Includes a variable per diem for days 16-99999: RC 0100:0113 @ $2,650; RC 0200:0204 @ $3,550; RC 0206 @ $3,550; RC 0208:0214 @ $3,550; RC 0219 @ $3,550; RC 0115:0123 @ $2,650; RC 0125:0133 @ $2,650; RC 0137:0143 @ $2,650; RC 0147:0153 @ $2,650; RC 0157:0169 @ $2,650.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":130000.00},{"payer_name":"KERN HEALTH SYSTEMS [2033]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Case rate ($330,814). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 975901. For days after this threshold has been met, a payment of (non-excluded charges minus 975901) multiplied by .445 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric DonorTransplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"MC UHC VEBA GENERIC HMO [164032]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Case rate ($337,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 715000. For days after this threshold has been met, a payment of (non-excluded charges minus 715000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Case rate ($337,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 715000. For days after this threshold has been met, a payment of (non-excluded charges minus 715000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"ROYAL EMBASSY","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":475459.51},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE MEDI-CAL TRANSPLANT [11260001]","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 20, Case rate ($111,598). Procedures 21 - 9999, Per diem ($9,904).","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($261,395). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 898622. For days after this threshold has been met, a payment of (non-excluded charges minus 898622) multiplied by .63 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"GLOBAL EXCEL [1036]","plan_name":"GLOBAL EXCEL","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 165%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"REDLANDS COMMUNITY HOSPITAL [2005]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"VILLAGE HEALTH [1094]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":407536.72},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EATING DISORDER","standard_charge_percentage":58.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":398299.22},{"payer_name":"PREMIER PATIENT CARE IPA [2069]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"CALIFORNIA HEALTH & WELLNESS MEDI-CAL [1122]","plan_name":"CALIFORNIA HEALTH AND WELLNESS MEDI-CAL (no longer Medi-Cal plan as of 1\/1\/24)","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 20, Case rate ($107,623.36). Procedures 21 - 9999, Per diem ($9,551.42).","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"USOC - US OLYMPIC COMMITTEE [1123]","plan_name":"USOC VIK (BSC UC CARE)","standard_charge_percentage":43.10,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":292747.21},{"payer_name":"HEALTH NET [1039]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"WORKERS COMPENSATION [1097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":167126.06},{"payer_name":"INTER VALLEY HEALTH PLAN [2024]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"EASY CHOICE [1029]","plan_name":"EASY CHOICE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"UC AFF BLUE SHIELD SR\/SDSM [164037]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"ALTERNATE BRAND NEW DAY [2079]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MC BRAND NEW DAY HMO [164030]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Pricing is calculated over two periods plus stop loss reimbursement. The first period consists of the days from admission to 2 days before the relevant ICD Procedure date. If multiple relevant ICD Procedures are present, the first relevant ICD Procedure date on the claim is used. The reimbursement for this period is calculated as a per diem rate of $4,345. The second period consists of the days from the end of the first period to claim end. The reimbursement for this period is calculated as a case rate ($119,708). The stop loss period consists of the days from the day after the stop loss threshold ($374,604) is met to claim end. Only charges after the start of period two are considered for stop loss calculation. The reimbursement for this period is calculated as 42.2% of billed charges during the period after non-excluded charges exceed the threshold of $374,604. Only charges above the threshold on the day the threshold is met are reimbursed.","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 115%. Includes an additional $143,612 of payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric DonorTransplant (Optum 1\/24) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"UNITED AMERICAN [1087]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"HERITAGE VICTOR VALLEY MEDICAL GROUP [2045]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($127,412.52). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $117,863.47, add-ons for qualifying new technology services are included. If operating cost exceeds $167,022.36 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,527.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $117,825.73 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $117,074.35 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,797.65. The transfer capital threshold is the transfer adjustment factor * $8,797.65. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":127412.52},{"payer_name":"CHAMPVA [1020]","plan_name":"VETERANS ADMINISTRATION - CHAMPVA","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"MC BLUE SHIELD GENERIC PAYOR [164016]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"CAL OPTIMA [1016]","plan_name":"CalOptima Medicare","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"CIGNA HMO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":341651.62},{"payer_name":"RIVERSIDE MEDICAL CLINIC [2064]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"SCRIPPS COASTAL MED GRP [1074]","plan_name":"SCRIPPS COASTAL MED GRP [10740001]","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":441498.12},{"payer_name":"PYRAMID LIFE [1068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"ETS - LIFETRAC NETWORK [1103]","plan_name":"LIFETRAC","standard_charge_algorithm":"Case rate ($161,700). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Donor Transpalnt Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":161700.00},{"payer_name":"TRIWEST ALTERNATE [2036]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"CARNIVAL CRUISES [1018]","plan_name":"CARNIVAL CRUISES [10180001]","standard_charge_percentage":90.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":611305.08},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":125357.70},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"BLUE SHIELD [1014]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,203.21). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $95,901.99, add-ons for qualifying new technology services are included. If operating cost exceeds $145,060.88 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,279.17, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $95,864.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,112.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,549.83. The transfer capital threshold is the transfer adjustment factor * $7,549.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104203.21},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"EMBASSY OF STATE OF KUWAIT [11010001]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":461874.95},{"payer_name":"MC UHC ALLIANCE HMO [164020]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"IMPERIAL HEALTH PLAN [2081]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA HMO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":341651.62},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA PPO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":341651.62},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($292,600). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1008132. For days after this threshold has been met, a payment of (non-excluded charges minus 1008132) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE PPO","standard_charge_percentage":49.55,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":336557.41},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UHC SELECT AND SELECT PLUS","standard_charge_algorithm":"Per diem ($14,996).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":14996.00},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Case rate ($330,814). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 975901. For days after this threshold has been met, a payment of (non-excluded charges minus 975901) multiplied by .445 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric DonorTransplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($127,412.52). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $117,863.47, add-ons for qualifying new technology services are included. If operating cost exceeds $167,022.36 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,527.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $117,825.73 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $117,074.35 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,797.65. The transfer capital threshold is the transfer adjustment factor * $8,797.65. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":127412.52},{"payer_name":"SIERRA MEDICAL GROUP [2048]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","median_amount":332255.57,"10th_percentile":332255.57,"90th_percentile":332255.57,"count":"1 through 10","additional_payer_notes":"Inpatient","standard_charge_dollar":102375.46},{"payer_name":"AETNA TRANSPLANTS [1112]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($292,600). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1008132. For days after this threshold has been met, a payment of (non-excluded charges minus 1008132) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE QUALCOMM ","standard_charge_percentage":45.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":309999.60},{"payer_name":"CIGNA [1023]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MONARCH HEALTHCARE [2006]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"UC AFF MC HUMANA GENERIC PAYOR [164027]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"HUMANA [1042]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,203.21). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $95,901.99, add-ons for qualifying new technology services are included. If operating cost exceeds $145,060.88 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,279.17, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $95,864.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,112.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,549.83. The transfer capital threshold is the transfer adjustment factor * $7,549.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104203.21},{"payer_name":"MC HNET BLUE&GOLD ACO [164017]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"CMN - CANADIAN MEDICAL NETWORK [1024]","plan_name":"CMN GLOBAL INC","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 170%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":218549.47},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($177,528). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 571649. For days after this threshold has been met, a payment of (non-excluded charges minus 571649) multiplied by .62 will be used instead of the standard payment.","methodology":"other","median_amount":177528.00,"10th_percentile":177528.00,"90th_percentile":177528.00,"count":"1 through 10","additional_payer_notes":"Liver Cadaver\/Living Transplant","standard_charge_dollar":679227.87},{"payer_name":"STATE OF CALIFORNIA [1082]","plan_name":"California State Prison","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 250%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($177,528). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 571649. For days after this threshold has been met, a payment of (non-excluded charges minus 571649) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver\/Living Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"SAN DIEGO SOCKERS [2015]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":167126.06},{"payer_name":"AMERICAN SPECIALTY HEALTH PLAN [2038]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"HIGH DESERT MEDICAL GROUP [2053]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"IMMIGRATION HEALTH SERVICES [1043]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":125987.34},{"payer_name":"WELL CARE [1096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"UC AFF ANTHEM\/SDSM HMO [164024]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"HEMET COMMUNITY MED GRP - PROMISECARE [1040]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MC UHC HARMONY HMO [164026]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MID-COUNTY PHYSICIANS NARROW NETWORK","standard_charge_algorithm":"Per diem ($17,123).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":17123.00},{"payer_name":"BLUE SHIELD PROMISE [1017]","plan_name":"CARE 1ST HEALTHPLAN MEDICARE ADVANTAGE (BS PROMISE)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Case rate ($326,350). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1229600. For days after this threshold has been met, a payment of (non-excluded charges minus 1229600) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MA\/SDPMG","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":99241.51},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","median_amount":348399.49,"10th_percentile":348399.49,"90th_percentile":348399.49,"count":"1 through 10","additional_payer_notes":"Surgery","standard_charge_dollar":679227.87},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Case rate ($326,350). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1229600. For days after this threshold has been met, a payment of (non-excluded charges minus 1229600) multiplied by .62 will be used instead of the standard payment.","methodology":"other","median_amount":305000.00,"10th_percentile":84504.00,"90th_percentile":440000.00,"count":"1 through 10","additional_payer_notes":"Liver Cadaveric Transplant","standard_charge_dollar":679227.87},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($177,528). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 571649. For days after this threshold has been met, a payment of (non-excluded charges minus 571649) multiplied by .62 will be used instead of the standard payment.","methodology":"other","median_amount":305000.00,"10th_percentile":305000.00,"90th_percentile":305000.00,"count":"1 through 10","additional_payer_notes":"Liver Cadaver\/Living Transplant","standard_charge_dollar":679227.87},{"payer_name":"LA CARE HEALTH PLAN [2025]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"ST JOSEPH ST JUDE [2065]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"GOLDEN PHYSICIANS MEDICAL GROUP [2082]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"SCRIPPS HEALTH PLAN SERVICES [1075]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":407536.72},{"payer_name":"ADVANTRA FREEDOM [1002]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"SCAN HEALTH [1072]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":99241.51},{"payer_name":"EMPIRE PHYS MED GRP [2072]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDI-CAL ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 20, Case rate ($111,598). Procedures 21 - 9999, Per diem ($9,904).","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE SAN DIEGO","standard_charge_algorithm":"Case rate ($127,412.52). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $117,863.47, add-ons for qualifying new technology services are included. If operating cost exceeds $167,022.36 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,527.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $117,825.73 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $117,074.35 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,797.65. The transfer capital threshold is the transfer adjustment factor * $8,797.65. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":127412.52},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Case rate ($330,814). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 975901. For days after this threshold has been met, a payment of (non-excluded charges minus 975901) multiplied by .445 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric DonorTransplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($127,412.52). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $117,863.47, add-ons for qualifying new technology services are included. If operating cost exceeds $167,022.36 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,527.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $117,825.73 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $117,074.35 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,797.65. The transfer capital threshold is the transfer adjustment factor * $8,797.65. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":127412.52},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($127,412.52). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $117,863.47, add-ons for qualifying new technology services are included. If operating cost exceeds $167,022.36 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,527.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $117,825.73 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $117,074.35 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,797.65. The transfer capital threshold is the transfer adjustment factor * $8,797.65. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":127412.52},{"payer_name":"BEACON HEALTH STRATEGY [2039]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"MC BRAND NEW DAY GENERIC PAYOR [164031]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"MGM RESORTS [1053]","plan_name":"MGM RESORT","standard_charge_algorithm":"Case rate ($150,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 315000. For days after this threshold has been met, a payment of (non-excluded charges minus 315000) multiplied by .70 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Donor Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"SCRIPPS HOSPICE [2008]","plan_name":"SCRIPPS HEALTH HOSPICE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay.","standard_charge_dollar":700.00},{"payer_name":"BEECH STREET [1012]","plan_name":"CAPPCARE\/BEECH STREET","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":509420.90},{"payer_name":"HEALTH CARE SUPPORT [2011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"UC AFF ANTHEM\/XIMED HMO [164022]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"MEDI-CAL [1048]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"Community Care IPA Medi-Cal Managed Care","standard_charge_algorithm":"Includes a variable per diem for days 0-99999: RC 0100:0169 @ $1,750; RC 0200:0202 @ $1,750; RC 0208:0213 @ $1,750; RC 0219 @ $1,750; RC 0206 @ $2,300; RC 0207 @ $2,300.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"BRAND NEW DAY [1089]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"AXA ASSISTANCE [1098]","plan_name":"AXA ASSISTANCE USA,INC","standard_charge_algorithm":"Case rate ($126,991). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 433815. For days after this threshold has been met, a payment of (non-excluded charges minus 433815) multiplied by .65 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"ALTERNATE MOLINA [1240]","plan_name":"MOLINA MEDI-CAL [12400001]","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 20, Case rate ($111,598). Procedures 21 - 9999, Per diem ($9,904).","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"AETNA [1003]","plan_name":"AETNA BEHAVIORAL EATING DISORDER","standard_charge_percentage":43.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":296822.58},{"payer_name":"FRESENIUS [1034]","plan_name":"FRESENIUS HEALTH PARTNERS, INC","standard_charge_algorithm":"Case rate ($104,203.21). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $95,901.99, add-ons for qualifying new technology services are included. If operating cost exceeds $145,060.88 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,279.17, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $95,864.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,112.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,549.83. The transfer capital threshold is the transfer adjustment factor * $7,549.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104203.21},{"payer_name":"MC HEALTHNET GENERIC PAYOR [164010]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"SALUDPOL Peru Police","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":475459.51},{"payer_name":"CIGNA [1023]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":374933.78},{"payer_name":"MEDICARE [1050]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","median_amount":131365.62,"10th_percentile":126023.66,"90th_percentile":194728.31,"count":"15","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":125987.34},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK","standard_charge_algorithm":"Per diem ($4,000). A payment threshold will be met when non-excluded charges is greater than 325000. For days after this threshold has been met, a per diem of (non-excluded charges for that day multiplied by .65) will be used instead of the standard payment for each day after the threshold.","methodology":"other","count":"0","additional_payer_notes":"ICU\/CCU Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":114911.23},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,203.21). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $95,901.99, add-ons for qualifying new technology services are included. If operating cost exceeds $145,060.88 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,279.17, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $95,864.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,112.87 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,549.83. The transfer capital threshold is the transfer adjustment factor * $7,549.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104203.21},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":285040.79,"10th_percentile":285040.79,"90th_percentile":285040.79,"count":"1 through 10","additional_payer_notes":"Transplants","standard_charge_dollar":104464.75},{"payer_name":"HMSA - HAWAII MEDICAL SERVICE ASSOC MDCR [1041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE DISTINCTION ","standard_charge_algorithm":"Case rate ($228,260). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 833250. For days after this threshold has been met, a payment of (non-excluded charges minus 833250) multiplied by .60 will be used instead of the standard payment.","methodology":"other","median_amount":641448.53,"10th_percentile":641448.53,"90th_percentile":641448.53,"count":"1 through 10","additional_payer_notes":"Liver Cadaveric Donor Transplant","standard_charge_dollar":679227.87},{"payer_name":"KAISER [1046]","plan_name":"KAISER","standard_charge_algorithm":"Case rate ($210,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 585000. For days after this threshold has been met, a payment of (non-excluded charges minus 585000) multiplied by .55 will be used instead of the standard payment.","methodology":"other","median_amount":396735.77,"10th_percentile":285000.00,"90th_percentile":551630.08,"count":"14","additional_payer_notes":"Liver Cadaveric Transplant","standard_charge_dollar":679227.87},{"payer_name":"AETNA [1003]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Case rate ($326,350). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1229600. For days after this threshold has been met, a payment of (non-excluded charges minus 1229600) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EPO [10130074]","standard_charge_algorithm":"Case rate ($326,350). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1229600. For days after this threshold has been met, a payment of (non-excluded charges minus 1229600) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($177,528). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 571649. For days after this threshold has been met, a payment of (non-excluded charges minus 571649) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver\/Living Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Case rate ($326,350). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1229600. For days after this threshold has been met, a payment of (non-excluded charges minus 1229600) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":679227.87},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($127,412.52). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $117,863.47, add-ons for qualifying new technology services are included. If operating cost exceeds $167,022.36 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,527.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $117,825.73 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $117,074.35 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,797.65. The transfer capital threshold is the transfer adjustment factor * $8,797.65. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":127412.52},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":305277.42,"10th_percentile":305277.42,"90th_percentile":305277.42,"count":"1 through 10","additional_payer_notes":"Inpatient","standard_charge_dollar":104464.75},{"payer_name":"CENTRAL HEALTH PLAN [2026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Commercial","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 150%.","methodology":"other","count":"0","additional_payer_notes":"General Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":156697.13},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Medicare","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"General Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":114911.23},{"payer_name":"MEDCARE PARTNERS [2084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"CASSIDY MED GRP [1019]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":441498.12},{"payer_name":"BEAVER MED GRP [2075]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"HEALTHCARE PARTNERS [2073]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","median_amount":320523.60,"10th_percentile":320523.60,"90th_percentile":345885.41,"count":"1 through 10","additional_payer_notes":"Surgery","standard_charge_dollar":679227.87},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($127,412.52). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $117,863.47, add-ons for qualifying new technology services are included. If operating cost exceeds $167,022.36 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,527.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $117,825.73 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $117,074.35 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,797.65. The transfer capital threshold is the transfer adjustment factor * $8,797.65. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":127412.52},{"payer_name":"MC UNITED HEALTHCARE GENERIC PAYOR [164011]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81507.34},{"payer_name":"COMMUNITY ELDERCARE [1027]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"OPTUM CARE NETWORK - PCAMG [1064]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":441498.12},{"payer_name":"VA - VETERANS ADMINISTRATION [1093]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128558.51},{"payer_name":"US MARSHAL SERVICES [1090]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($104,464.75). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $96,143.50, add-ons for qualifying new technology services are included. If operating cost exceeds $144,828.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $10,771.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $96,105.78 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $95,354.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $7,569.86. The transfer capital threshold is the transfer adjustment factor * $7,569.86. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":104464.75},{"payer_name":"CLIPPERS WORKERS COMPENSATION [2097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($128,558.51). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $118,965.94, add-ons for qualifying new technology services are included. If operating cost exceeds $167,650.56 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,042.48, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $118,928.21 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $118,176.83 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,841.18. The transfer capital threshold is the transfer adjustment factor * $8,841.18. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":167126.06},{"payer_name":"DESERT OASIS HEALTH CARE [2052]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($127,412.52). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $117,863.47, add-ons for qualifying new technology services are included. If operating cost exceeds $167,022.36 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,527.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 14. The base transfer operating payment is the transfer adjustment factor * $117,825.73 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $117,074.35 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,797.65. The transfer capital threshold is the transfer adjustment factor * $8,797.65. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":127412.52}]}]}
,{"description":"Liver Transplant Without McC","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"minimum":5.98,"maximum":161700.00,"gross_charge":548491.57,"discounted_cash":301670.36,"setting":"inpatient","payers_information":[{"payer_name":"LAKESIDE MEDICAL GROUP [2054]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MID-COUNTY PHYSICIANS NARROW NETWORK","standard_charge_algorithm":"Per diem ($17,123).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 5 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":17123.00},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE QUALCOMM ","standard_charge_percentage":45.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":250331.55},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"EMBASSY OF STATE OF KUWAIT [11010001]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":372974.27},{"payer_name":"MC CIGNA GENERIC PAYOR [164007]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"MC BLUE SHIELD HMO [164015]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"ALTERNATE HEALTH NET BH [2059]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 115%. Includes an additional $143,612 of payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric DonorTransplant (Optum 1\/24) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"MC ANTHEM BLUE CROSS GENERIC PAYOR [164009]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"MC HEALTHNET GENERIC PAYOR [164010]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH PLAN","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":329094.94},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"CIGNA HMO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":275891.26},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EATING DISORDER","standard_charge_percentage":58.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":321635.46},{"payer_name":"MENIFEE MED GRP [2076]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"XIMED [2016]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"ALTERNATE SHERIFF CUSTODY [1106]","plan_name":"SHERIFF COUNTY CONTRACT # 514250","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":356519.52},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MARKET PLACE","standard_charge_algorithm":"Case rate ($47,298.11). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $43,564.77, add-ons for qualifying new technology services are included. If operating cost exceeds $92,723.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,124.76, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,113.58 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,775.66 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,395.43. The transfer capital threshold is the transfer adjustment factor * $3,395.43. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 180%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47298.11},{"payer_name":"QUALITY HEALTH [1069]","plan_name":"QUALITY HEALTH MANAGEMENT","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 195%.","methodology":"other","count":"0","additional_payer_notes":"Oncology  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":113590.54},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":302767.35},{"payer_name":"MC AETNA HMO [164001]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"RIVER CITY MEDICAL GROUP [2066]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":58251.56},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":58251.56},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA COMMERCIAL","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 140%.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81552.18},{"payer_name":"ALTERNATE MEDICARE [2007]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":57086.53},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE [10230006]","standard_charge_algorithm":"Case rate ($184,809). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 491916. For days after this threshold has been met, a payment of (non-excluded charges minus 491916) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver Donor Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"BLUE CROSS TRANSPLANT [1116]","plan_name":"BLUE DISTINCTION ","standard_charge_algorithm":"Case rate ($228,260). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 833250. For days after this threshold has been met, a payment of (non-excluded charges minus 833250) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Donor Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE TRANSPLANT [11170001]","standard_charge_algorithm":"Case rate ($184,809). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 491916. For days after this threshold has been met, a payment of (non-excluded charges minus 491916) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver Donor Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"ALTERNATE MEDI-CAL [2001]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 5 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"UCR PROMPT PAY PAYOR [8240]","plan_name":"UCSD CHARITY MEDICARE CONTRACT","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Medicare All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":58251.56},{"payer_name":"AETNA [1003]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($292,600). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1008132. For days after this threshold has been met, a payment of (non-excluded charges minus 1008132) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"IMPERIAL COUNTY PHYSICIAN MED GRP","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":46467.42},{"payer_name":"STERLING OPTION 1 [1083]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"USAA [1091]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"CIGNA [1023]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($177,528). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 571649. For days after this threshold has been met, a payment of (non-excluded charges minus 571649) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver\/Living Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"ALTERNATE AETNA [1004]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($292,600). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1008132. For days after this threshold has been met, a payment of (non-excluded charges minus 1008132) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":46467.42},{"payer_name":"ASTIVA HEALTH [2095]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"MC AETNA GENERIC PAYOR [164008]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($57,736.16). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $53,441.63, add-ons for qualifying new technology services are included. If operating cost exceeds $102,600.52 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,685.95, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $52,990.44 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $52,652.51 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,956.62. The transfer capital threshold is the transfer adjustment factor * $3,956.62. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":57736.16},{"payer_name":"MC UNITED HEALTHCARE HMO [164005]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"ALTERNATE KAISER RAD ONC [2089]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"AMA - AMERICAN MEDICAL ASSOCIATION [1009]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"MC ANTHEM BLUE CROSS HMO [164002]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"DEPARTMENT OF LABOR [1028]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":75727.03},{"payer_name":"IMPERIAL HEALTH HOLDINGS [1132]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"AFFILIATED DOCTORS OF ORANGE COUNTY [2041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"MC CIGNA HMO [164003]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"AETNA [1003]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($47,298.11). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $43,564.77, add-ons for qualifying new technology services are included. If operating cost exceeds $92,723.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,124.76, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,113.58 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,775.66 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,395.43. The transfer capital threshold is the transfer adjustment factor * $3,395.43. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47298.11},{"payer_name":"COMMUNITY HEALTH GROUP [1022]","plan_name":"COMMUNITY HEALTH GROUP MEDICARE ADVANTAGE","standard_charge_algorithm":"Fee schedule rate ($4.64). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":5.98},{"payer_name":"CLEVER CARE [2061]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"ALTERNATE SCAN HEALTH [2088]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45044.94},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($47,298.11). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $43,564.77, add-ons for qualifying new technology services are included. If operating cost exceeds $92,723.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,124.76, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,113.58 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,775.66 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,395.43. The transfer capital threshold is the transfer adjustment factor * $3,395.43. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","median_amount":630532.51,"10th_percentile":630532.51,"90th_percentile":630532.51,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":47298.11},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"OLYMPUS MANAGED HEALTHCARE INC [11020001]","standard_charge_algorithm":"Case rate ($292,600). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1008132. For days after this threshold has been met, a payment of (non-excluded charges minus 1008132) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"TRANSAMERICA [1084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"ENCOMPASS MED GRP [1030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":58251.56},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":58251.56},{"payer_name":"CAREMORE [2028]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"KUWAIT OIL COMPANY [11010005]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":372974.27},{"payer_name":"PRIMARY CARE ASSOCIATES OF CA [2067]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"ALTERNATE VA - VETERANS ADMINISTRATION [1239]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":58251.56},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS HOUSE STAFF","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":144801.77},{"payer_name":"SDSM [2017]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"UNLISTED MEDICARE ADVANTAGE (NON-CONTRACTED) [1051]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"BANKERS LIFE [1011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"VANTAGE [1092]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"SIMNSA HEALTH PLAN [2047]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"MC HUMANA HMO [164013]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"ADMAR [1001]","plan_name":"MULTIPLAN","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":411368.68},{"payer_name":"BPS - BENEFIT PLAN SERVICES [1015]","plan_name":"MULTIPLAN","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":411368.68},{"payer_name":"ALPHACARE [2062]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNA PRIORITY SELECT","standard_charge_algorithm":"Case rate ($326,350). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1229600. For days after this threshold has been met, a payment of (non-excluded charges minus 1229600) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD COVERED CA TRIO HMO","standard_charge_algorithm":"Case rate ($337,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 715000. For days after this threshold has been met, a payment of (non-excluded charges minus 715000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":56898.88},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($47,298.11). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $43,564.77, add-ons for qualifying new technology services are included. If operating cost exceeds $92,723.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,124.76, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,113.58 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,775.66 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,395.43. The transfer capital threshold is the transfer adjustment factor * $3,395.43. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 115%. Includes an additional $143,612 of payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric DonorTransplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47298.11},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDI-CAL","standard_charge_algorithm":"Case rate ($330,814). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 975901. For days after this threshold has been met, a payment of (non-excluded charges minus 975901) multiplied by .445 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric DonorTransplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA COMMERCIAL","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 140%.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":81552.18},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"EASY ACCESS CARE [2077]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET ENHANCED CARE PPO","standard_charge_algorithm":"Case rate ($43,674.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $40,229.15, add-ons for qualifying new technology services are included. If operating cost exceeds $89,388.04 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,836.71, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $40,567.07. The transfer operating threshold is the transfer adjustment factor * $40,229.15 If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,107.37. The transfer capital threshold is the transfer adjustment factor * $3,107.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 281%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services (MSDRG no DSH GME IME) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43674.44},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($57,736.16). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $53,441.63, add-ons for qualifying new technology services are included. If operating cost exceeds $102,600.52 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,685.95, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $52,990.44 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $52,652.51 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,956.62. The transfer capital threshold is the transfer adjustment factor * $3,956.62. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":57736.16},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($47,298.11). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $43,564.77, add-ons for qualifying new technology services are included. If operating cost exceeds $92,723.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,124.76, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,113.58 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,775.66 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,395.43. The transfer capital threshold is the transfer adjustment factor * $3,395.43. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47298.11},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"ARCH HEALTH PARTNERS [2000]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED HMO NON CONTRACTED [10260001]","standard_charge_algorithm":"Case rate ($47,298.11). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $43,564.77, add-ons for qualifying new technology services are included. If operating cost exceeds $92,723.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,124.76, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,113.58 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,775.66 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,395.43. The transfer capital threshold is the transfer adjustment factor * $3,395.43. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47298.11},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED PPO NON CONTRACTED [10260002]","standard_charge_algorithm":"Case rate ($47,298.11). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $43,564.77, add-ons for qualifying new technology services are included. If operating cost exceeds $92,723.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,124.76, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,113.58 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,775.66 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,395.43. The transfer capital threshold is the transfer adjustment factor * $3,395.43. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47298.11},{"payer_name":"KAISER [1046]","plan_name":"KAISER MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($210,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 585000. For days after this threshold has been met, a payment of (non-excluded charges minus 585000) multiplied by .55 will be used instead of the standard payment.","methodology":"other","median_amount":373900.00,"10th_percentile":373900.00,"90th_percentile":373900.00,"count":"1 through 10","additional_payer_notes":"Liver Cadaveric Transplant","standard_charge_dollar":548491.57},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"INTERNATIONAL EMBASSY OF KUWAIT","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":372974.27},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($261,395). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 898622. For days after this threshold has been met, a payment of (non-excluded charges minus 898622) multiplied by .63 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"FIRST HEALTH [1032]","plan_name":"FIRST HEALTH","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":411368.68},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE","standard_charge_algorithm":"Case rate ($184,809). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 491916. For days after this threshold has been met, a payment of (non-excluded charges minus 491916) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver Donor Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($177,528). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 571649. For days after this threshold has been met, a payment of (non-excluded charges minus 571649) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver\/Living Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"BLUE CROSS [1013]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($47,298.11). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $43,564.77, add-ons for qualifying new technology services are included. If operating cost exceeds $92,723.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,124.76, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,113.58 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,775.66 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,395.43. The transfer capital threshold is the transfer adjustment factor * $3,395.43. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47298.11},{"payer_name":"BLUE CROSS [1013]","plan_name":"UCSD STUDENT HEALTH INS PLAN - BC SHIP","standard_charge_percentage":26.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":146447.25},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE","standard_charge_algorithm":"Case rate ($184,809). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 491916. For days after this threshold has been met, a payment of (non-excluded charges minus 491916) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver Donor Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"INTERPLAN [1045]","plan_name":"INTERPLAN","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":383944.10},{"payer_name":"TRI-CITY [1085]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"CHRISTIAN HEALTHCARE MINISTRIES [2030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"CHESAPEAKE LIFE [1021]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"ALTERNATE MOLINA [1240]","plan_name":"MOLINA MEDI-CAL","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 20, Case rate ($111,598). Procedures 21 - 9999, Per diem ($9,904).","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"MUTUAL OF OMAHA [1059]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"MC SCAN GENERIC PAYOR [164034]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"UNLISTED HOSPICE [1035]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"ELIZABETH HOSPICE [2018]","plan_name":"ELIZABETH HOSPICE GIP","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 5 day length of stay.","standard_charge_dollar":950.00},{"payer_name":"MC HUMANA GENERIC PAYOR [164014]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"MULTIPLAN [1058]","plan_name":"MULTIPLAN","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":411368.68},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"US BEHAVIORAL MENTAL\/EATING DISORDER","standard_charge_percentage":70.00,"standard_charge_algorithm":"70% of billed.","methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":383944.10},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($177,528). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 571649. For days after this threshold has been met, a payment of (non-excluded charges minus 571649) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver\/Living Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"SEDGWICK [1077]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":75727.03},{"payer_name":"TRIWEST [2003]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":58251.56},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Case rate ($337,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 715000. For days after this threshold has been met, a payment of (non-excluded charges minus 715000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Case rate ($337,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 715000. For days after this threshold has been met, a payment of (non-excluded charges minus 715000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA EPN\/IFP","standard_charge_algorithm":"Case rate ($337,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 715000. For days after this threshold has been met, a payment of (non-excluded charges minus 715000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"INTEGRATED HEALTH PARTNERS [2068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"PACIFIC FOUNDATION [1063]","plan_name":"PACIFIC FOUNDATION FOR MEDICAL CARE","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":411368.68},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE ST PAULS","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":58251.56},{"payer_name":"GREATER NEWPORT PHYSICIANS [2096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"MC UHC VEBA HMO [164033]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"KEY MED GRP [2074]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"MEDI-CAL [1048]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 5 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"NATIONAL HEALTHCARE SOLUTIONS INC [1100]","plan_name":"NATIONAL HEALTHCARE SOLUTIONS INC [11000001]","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":438793.26},{"payer_name":"MC HNET BLUE&GOLD ACO [164017]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"SD PHYSICIANS MED GRP [1076]","plan_name":"SD PHYSICIANS MED GRP SR [10760002]","standard_charge_percentage":55.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":301670.36},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS UC CARE","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":144801.77},{"payer_name":"MERCY PHYSICIANS MED GRP [1052]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"HEALTH NET [1039]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"VILLAGE HEALTH [1094]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"TRI-CITY MEDICAL CENTER [1129]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"PRIVATE HEALTHCARE SYSTEM","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":411368.68},{"payer_name":"CARNIVAL CRUISES [1018]","plan_name":"CARNIVAL CRUISES [10180001]","standard_charge_percentage":90.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":493642.41},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Pricing is calculated over two periods plus stop loss reimbursement. The first period consists of the days from admission to 2 days before the relevant ICD Procedure date. If multiple relevant ICD Procedures are present, the first relevant ICD Procedure date on the claim is used. The reimbursement for this period is calculated as a per diem rate of $4,345. The second period consists of the days from the end of the first period to claim end. The reimbursement for this period is calculated as a case rate ($119,708). The stop loss period consists of the days from the day after the stop loss threshold ($374,604) is met to claim end. Only charges after the start of period two are considered for stop loss calculation. The reimbursement for this period is calculated as 42.2% of billed charges during the period after non-excluded charges exceed the threshold of $374,604. Only charges above the threshold on the day the threshold is met are reimbursed.","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET MEDICARE ADVANTAGE UC EMPLOYER GROUP","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 115%. Includes an additional $143,612 of payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric DonorTransplant (Optum 1\/24) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"BLUE SHIELD TRANSPLANTS [1113]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Case rate ($337,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 715000. For days after this threshold has been met, a payment of (non-excluded charges minus 715000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"UC AFF ANTHEM\/SDSM HMO [164024]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"MC SCAN HMO [164035]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"MVP HEALTHCARE [1060]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"INLAND FACULTY MEDICAL GROUP [2063]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"SHARP HEALTHCARE TRANSPLANT [1119]","plan_name":"SHARP HEALTHCARE TRANSPLANT [11190001]","standard_charge_algorithm":"Case rate ($130,000). Includes a variable per diem for days 16-99999: RC 0100:0113 @ $2,650; RC 0200:0204 @ $3,550; RC 0206 @ $3,550; RC 0208:0214 @ $3,550; RC 0219 @ $3,550; RC 0115:0123 @ $2,650; RC 0125:0133 @ $2,650; RC 0137:0143 @ $2,650; RC 0147:0153 @ $2,650; RC 0157:0169 @ $2,650.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 5 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":130000.00},{"payer_name":"KERN HEALTH SYSTEMS [2033]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Case rate ($330,814). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 975901. For days after this threshold has been met, a payment of (non-excluded charges minus 975901) multiplied by .445 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric DonorTransplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"ROYAL EMBASSY","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":383944.10},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Case rate ($337,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 715000. For days after this threshold has been met, a payment of (non-excluded charges minus 715000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Case rate ($337,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 715000. For days after this threshold has been met, a payment of (non-excluded charges minus 715000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($261,395). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 898622. For days after this threshold has been met, a payment of (non-excluded charges minus 898622) multiplied by .63 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"MC UHC VEBA GENERIC HMO [164032]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"GLOBAL EXCEL [1036]","plan_name":"GLOBAL EXCEL","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 165%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":58251.56},{"payer_name":"UNITED AMERICAN [1087]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE MEDI-CAL TRANSPLANT [11260001]","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 20, Case rate ($111,598). Procedures 21 - 9999, Per diem ($9,904).","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"REDLANDS COMMUNITY HOSPITAL [2005]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":329094.94},{"payer_name":"PREMIER PATIENT CARE IPA [2069]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"CALIFORNIA HEALTH & WELLNESS MEDI-CAL [1122]","plan_name":"CALIFORNIA HEALTH AND WELLNESS MEDI-CAL (no longer Medi-Cal plan as of 1\/1\/24)","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 20, Case rate ($107,623.36). Procedures 21 - 9999, Per diem ($9,551.42).","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"INTER VALLEY HEALTH PLAN [2024]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"EASY CHOICE [1029]","plan_name":"EASY CHOICE","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"UC AFF BLUE SHIELD SR\/SDSM [164037]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"WORKERS COMPENSATION [1097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":75727.03},{"payer_name":"MC BRAND NEW DAY HMO [164030]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"ALTERNATE BRAND NEW DAY [2079]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Pricing is calculated over two periods plus stop loss reimbursement. The first period consists of the days from admission to 2 days before the relevant ICD Procedure date. If multiple relevant ICD Procedures are present, the first relevant ICD Procedure date on the claim is used. The reimbursement for this period is calculated as a per diem rate of $4,345. The second period consists of the days from the end of the first period to claim end. The reimbursement for this period is calculated as a case rate ($119,708). The stop loss period consists of the days from the day after the stop loss threshold ($374,604) is met to claim end. Only charges after the start of period two are considered for stop loss calculation. The reimbursement for this period is calculated as 42.2% of billed charges during the period after non-excluded charges exceed the threshold of $374,604. Only charges above the threshold on the day the threshold is met are reimbursed.","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"SIERRA MEDICAL GROUP [2048]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"CAL OPTIMA [1016]","plan_name":"CalOptima Medicare","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":58251.56},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 115%. Includes an additional $143,612 of payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric DonorTransplant (Optum 1\/24) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"HERITAGE VICTOR VALLEY MEDICAL GROUP [2045]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($57,736.16). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $53,441.63, add-ons for qualifying new technology services are included. If operating cost exceeds $102,600.52 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,685.95, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $52,990.44 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $52,652.51 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,956.62. The transfer capital threshold is the transfer adjustment factor * $3,956.62. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":57736.16},{"payer_name":"CHAMPVA [1020]","plan_name":"VETERANS ADMINISTRATION - CHAMPVA","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":58251.56},{"payer_name":"RIVERSIDE MEDICAL CLINIC [2064]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"SCRIPPS COASTAL MED GRP [1074]","plan_name":"SCRIPPS COASTAL MED GRP [10740001]","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":356519.52},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":46467.42},{"payer_name":"ETS - LIFETRAC NETWORK [1103]","plan_name":"LIFETRAC","standard_charge_algorithm":"Case rate ($161,700). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Donor Transpalnt Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":161700.00},{"payer_name":"TRIWEST ALTERNATE [2036]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":58251.56},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA HMO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":275891.26},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA PPO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":275891.26},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"BLUE SHIELD [1014]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($47,298.11). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $43,564.77, add-ons for qualifying new technology services are included. If operating cost exceeds $92,723.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,124.76, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,113.58 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,775.66 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,395.43. The transfer capital threshold is the transfer adjustment factor * $3,395.43. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47298.11},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":56898.88},{"payer_name":"MC UHC ALLIANCE HMO [164020]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"IMPERIAL HEALTH PLAN [2081]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($292,600). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1008132. For days after this threshold has been met, a payment of (non-excluded charges minus 1008132) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE PPO","standard_charge_percentage":49.55,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":271777.57},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($57,736.16). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $53,441.63, add-ons for qualifying new technology services are included. If operating cost exceeds $102,600.52 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,685.95, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $52,990.44 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $52,652.51 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,956.62. The transfer capital threshold is the transfer adjustment factor * $3,956.62. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":57736.16},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Case rate ($330,814). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 975901. For days after this threshold has been met, a payment of (non-excluded charges minus 975901) multiplied by .445 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric DonorTransplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"AETNA TRANSPLANTS [1112]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($292,600). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1008132. For days after this threshold has been met, a payment of (non-excluded charges minus 1008132) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"PYRAMID LIFE [1068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"UC AFF HUMANA\/SDSM [164025]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"CIGNA [1023]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"MONARCH HEALTHCARE [2006]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"UC AFF MC HUMANA GENERIC PAYOR [164027]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"HUMANA [1042]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($47,298.11). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $43,564.77, add-ons for qualifying new technology services are included. If operating cost exceeds $92,723.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,124.76, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,113.58 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,775.66 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,395.43. The transfer capital threshold is the transfer adjustment factor * $3,395.43. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47298.11},{"payer_name":"CMN - CANADIAN MEDICAL NETWORK [1024]","plan_name":"CMN GLOBAL INC","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 170%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":99027.65},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($177,528). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 571649. For days after this threshold has been met, a payment of (non-excluded charges minus 571649) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver\/Living Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($177,528). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 571649. For days after this threshold has been met, a payment of (non-excluded charges minus 571649) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver\/Living Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"HIGH DESERT MEDICAL GROUP [2053]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"STATE OF CALIFORNIA [1082]","plan_name":"California State Prison","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 250%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":58251.56},{"payer_name":"SAN DIEGO SOCKERS [2015]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":75727.03},{"payer_name":"AMERICAN SPECIALTY HEALTH PLAN [2038]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"WELL CARE [1096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"IMMIGRATION HEALTH SERVICES [1043]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":57086.53},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDI-CAL ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 20, Case rate ($111,598). Procedures 21 - 9999, Per diem ($9,904).","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"HEMET COMMUNITY MED GRP - PROMISECARE [1040]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"MC UHC HARMONY HMO [164026]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CALIFORNIA UC CARE \/ HSP","standard_charge_percentage":26.66,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":146227.85},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Case rate ($326,350). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1229600. For days after this threshold has been met, a payment of (non-excluded charges minus 1229600) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"BLUE SHIELD PROMISE [1017]","plan_name":"CARE 1ST HEALTHPLAN MEDICARE ADVANTAGE (BS PROMISE)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MA\/SDPMG","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45044.94},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UHC SELECT AND SELECT PLUS","standard_charge_algorithm":"Per diem ($14,996).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 5 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":14996.00},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Case rate ($326,350). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1229600. For days after this threshold has been met, a payment of (non-excluded charges minus 1229600) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($177,528). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 571649. For days after this threshold has been met, a payment of (non-excluded charges minus 571649) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver\/Living Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"LA CARE HEALTH PLAN [2025]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"ST JOSEPH ST JUDE [2065]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"GOLDEN PHYSICIANS MEDICAL GROUP [2082]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"SCRIPPS HEALTH PLAN SERVICES [1075]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":329094.94},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"SCAN HEALTH [1072]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45044.94},{"payer_name":"ADVANTRA FREEDOM [1002]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"BEECH STREET [1012]","plan_name":"CAPPCARE\/BEECH STREET","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":411368.68},{"payer_name":"EMPIRE PHYS MED GRP [2072]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE SAN DIEGO","standard_charge_algorithm":"Case rate ($57,736.16). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $53,441.63, add-ons for qualifying new technology services are included. If operating cost exceeds $102,600.52 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,685.95, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $52,990.44 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $52,652.51 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,956.62. The transfer capital threshold is the transfer adjustment factor * $3,956.62. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":57736.16},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Case rate ($330,814). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 975901. For days after this threshold has been met, a payment of (non-excluded charges minus 975901) multiplied by .445 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric DonorTransplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":52157.30},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 5 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($57,736.16). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $53,441.63, add-ons for qualifying new technology services are included. If operating cost exceeds $102,600.52 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,685.95, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $52,990.44 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $52,652.51 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,956.62. The transfer capital threshold is the transfer adjustment factor * $3,956.62. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":57736.16},{"payer_name":"BEACON HEALTH STRATEGY [2039]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($57,736.16). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $53,441.63, add-ons for qualifying new technology services are included. If operating cost exceeds $102,600.52 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,685.95, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $52,990.44 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $52,652.51 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,956.62. The transfer capital threshold is the transfer adjustment factor * $3,956.62. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":57736.16},{"payer_name":"CIGNA [1023]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":302767.35},{"payer_name":"MC BRAND NEW DAY GENERIC PAYOR [164031]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"MGM RESORTS [1053]","plan_name":"MGM RESORT","standard_charge_algorithm":"Case rate ($150,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 315000. For days after this threshold has been met, a payment of (non-excluded charges minus 315000) multiplied by .70 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Donor Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"SCRIPPS HOSPICE [2008]","plan_name":"SCRIPPS HEALTH HOSPICE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 5 day length of stay.","standard_charge_dollar":700.00},{"payer_name":"USOC - US OLYMPIC COMMITTEE [1123]","plan_name":"USOC VIK (BSC UC CARE)","standard_charge_percentage":43.10,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":236399.87},{"payer_name":"HEALTH CARE SUPPORT [2011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"UC AFF ANTHEM\/XIMED HMO [164022]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"Community Care IPA Medi-Cal Managed Care","standard_charge_algorithm":"Includes a variable per diem for days 0-99999: RC 0100:0169 @ $1,750; RC 0200:0202 @ $1,750; RC 0208:0213 @ $1,750; RC 0219 @ $1,750; RC 0206 @ $2,300; RC 0207 @ $2,300.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 5 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"BRAND NEW DAY [1089]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"ALTERNATE MOLINA [1240]","plan_name":"MOLINA MEDI-CAL [12400001]","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 20, Case rate ($111,598). Procedures 21 - 9999, Per diem ($9,904).","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"AXA ASSISTANCE [1098]","plan_name":"AXA ASSISTANCE USA,INC","standard_charge_algorithm":"Case rate ($126,991). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 433815. For days after this threshold has been met, a payment of (non-excluded charges minus 433815) multiplied by .65 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"AETNA [1003]","plan_name":"AETNA BEHAVIORAL EATING DISORDER","standard_charge_percentage":43.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":239690.82},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"SALUDPOL Peru Police","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":383944.10},{"payer_name":"FRESENIUS [1034]","plan_name":"FRESENIUS HEALTH PARTNERS, INC","standard_charge_algorithm":"Case rate ($47,298.11). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $43,564.77, add-ons for qualifying new technology services are included. If operating cost exceeds $92,723.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,124.76, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,113.58 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,775.66 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,395.43. The transfer capital threshold is the transfer adjustment factor * $3,395.43. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47298.11},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK","standard_charge_algorithm":"Per diem ($4,700). A payment threshold will be met when non-excluded charges is greater than 325000. For days after this threshold has been met, a per diem of (non-excluded charges for that day multiplied by .65) will be used instead of the standard payment for each day after the threshold.","methodology":"other","count":"0","additional_payer_notes":"Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($47,298.11). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $43,564.77, add-ons for qualifying new technology services are included. If operating cost exceeds $92,723.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,124.76, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,113.58 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,775.66 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,395.43. The transfer capital threshold is the transfer adjustment factor * $3,395.43. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47298.11},{"payer_name":"HMSA - HAWAII MEDICAL SERVICE ASSOC MDCR [1041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"MEDICARE [1050]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","median_amount":59266.93,"10th_percentile":59266.93,"90th_percentile":59266.93,"count":"1 through 10","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":57086.53},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE DISTINCTION ","standard_charge_algorithm":"Case rate ($228,260). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 833250. For days after this threshold has been met, a payment of (non-excluded charges minus 833250) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Donor Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"KAISER [1046]","plan_name":"KAISER","standard_charge_algorithm":"Case rate ($210,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 585000. For days after this threshold has been met, a payment of (non-excluded charges minus 585000) multiplied by .55 will be used instead of the standard payment.","methodology":"other","median_amount":277600.00,"10th_percentile":277600.00,"90th_percentile":277600.00,"count":"1 through 10","additional_payer_notes":"Liver Cadaveric Transplant","standard_charge_dollar":548491.57},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Case rate ($326,350). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1229600. For days after this threshold has been met, a payment of (non-excluded charges minus 1229600) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EPO [10130074]","standard_charge_algorithm":"Case rate ($326,350). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1229600. For days after this threshold has been met, a payment of (non-excluded charges minus 1229600) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($177,528). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 571649. For days after this threshold has been met, a payment of (non-excluded charges minus 571649) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaver\/Living Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Case rate ($326,350). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1229600. For days after this threshold has been met, a payment of (non-excluded charges minus 1229600) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Liver Cadaveric Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":548491.57},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($57,736.16). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $53,441.63, add-ons for qualifying new technology services are included. If operating cost exceeds $102,600.52 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,685.95, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $52,990.44 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $52,652.51 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,956.62. The transfer capital threshold is the transfer adjustment factor * $3,956.62. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":57736.16},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"CENTRAL HEALTH PLAN [2026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Commercial","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 160%.","methodology":"other","count":"0","additional_payer_notes":"Oncology Care Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":75865.17},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Medicare","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"Oncology Care Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":56898.88},{"payer_name":"AETNA [1003]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"CASSIDY MED GRP [1019]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":356519.52},{"payer_name":"MEDCARE PARTNERS [2084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"MC HEALTHNET HMO [164004]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"BEAVER MED GRP [2075]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"MC BLUE SHIELD GENERIC PAYOR [164016]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 5 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"HEALTHCARE PARTNERS [2073]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","median_amount":262948.50,"10th_percentile":262948.50,"90th_percentile":262948.50,"count":"1 through 10","additional_payer_notes":"Surgery","standard_charge_dollar":548491.57},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($57,736.16). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $53,441.63, add-ons for qualifying new technology services are included. If operating cost exceeds $102,600.52 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,685.95, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $52,990.44 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $52,652.51 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,956.62. The transfer capital threshold is the transfer adjustment factor * $3,956.62. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":57736.16},{"payer_name":"MC UNITED HEALTHCARE GENERIC PAYOR [164011]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":65818.99},{"payer_name":"COMMUNITY ELDERCARE [1027]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"OPTUM CARE NETWORK - PCAMG [1064]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":356519.52},{"payer_name":"CLIPPERS WORKERS COMPENSATION [2097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":75727.03},{"payer_name":"VA - VETERANS ADMINISTRATION [1093]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($58,251.56). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $53,937.45, add-ons for qualifying new technology services are included. If operating cost exceeds $102,622.07 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,177.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $53,486.26 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $53,148.34 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,976.19. The transfer capital threshold is the transfer adjustment factor * $3,976.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":58251.56},{"payer_name":"US MARSHAL SERVICES [1090]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($47,415.73). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $43,673.38, add-ons for qualifying new technology services are included. If operating cost exceeds $92,358.00 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,605.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $43,222.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $42,884.27 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,404.44. The transfer capital threshold is the transfer adjustment factor * $3,404.44. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47415.73},{"payer_name":"DESERT OASIS HEALTH CARE [2052]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($57,736.16). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $53,441.63, add-ons for qualifying new technology services are included. If operating cost exceeds $102,600.52 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,685.95, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 7.1. The base transfer operating payment is the transfer adjustment factor * $52,990.44 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $52,652.51 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,956.62. The transfer capital threshold is the transfer adjustment factor * $3,956.62. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":57736.16}]}]}
,{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"minimum":16.71,"maximum":298349.67,"gross_charge":1338841.22,"discounted_cash":736362.67,"setting":"inpatient","payers_information":[{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MID-COUNTY PHYSICIANS NARROW NETWORK","standard_charge_algorithm":"Per diem ($17,123).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 30 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":17123.00},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE QUALCOMM ","standard_charge_percentage":45.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":611047.13},{"payer_name":"LAKESIDE MEDICAL GROUP [2054]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"MC CIGNA GENERIC PAYOR [164007]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"MC BLUE SHIELD HMO [164015]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"ALTERNATE HEALTH NET BH [2059]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 115%. Includes an additional $191,837 of payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant (Optum 1\/24) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE MEDI-CAL TRANSPLANT [11260001]","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 30, Case rate ($139,246). Procedures 31 - 9999, Per diem ($10,788).","methodology":"other","count":"0","additional_payer_notes":"Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"MC HEALTHNET GENERIC PAYOR [164010]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH PLAN","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":910412.03},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"CIGNA HMO","standard_charge_percentage":83.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1116593.58},{"payer_name":"MC ANTHEM BLUE CROSS GENERIC PAYOR [164009]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EATING DISORDER","standard_charge_percentage":58.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":785096.49},{"payer_name":"MENIFEE MED GRP [2076]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"XIMED [2016]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"ALTERNATE SHERIFF CUSTODY [1106]","plan_name":"SHERIFF COUNTY CONTRACT # 514250","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":870246.79},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MARKET PLACE","standard_charge_algorithm":"Case rate ($130,679.32). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $120,252.83, add-ons for qualifying new technology services are included. If operating cost exceeds $169,411.72 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,212.07, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,407.48 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,463.72 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,482.74. The transfer capital threshold is the transfer adjustment factor * $9,482.74. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 180%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":130679.32},{"payer_name":"QUALITY HEALTH [1069]","plan_name":"QUALITY HEALTH MANAGEMENT","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 185%.","methodology":"other","count":"0","additional_payer_notes":"Surgery  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":298349.67},{"payer_name":"RIVER CITY MEDICAL GROUP [2066]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA COMMERCIAL","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 140%.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":225778.13},{"payer_name":"ALTERNATE MEDICARE [2007]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158044.69},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":161270.09},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":161270.09},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE [10230006]","standard_charge_algorithm":"Case rate ($199,570). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 555659. For days after this threshold has been met, a payment of (non-excluded charges minus 555659) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double - Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"BLUE CROSS TRANSPLANT [1116]","plan_name":"BLUE DISTINCTION ","standard_charge_algorithm":"Case rate ($252,500). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 909000. For days after this threshold has been met, a payment of (non-excluded charges minus 909000) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Cadaveric Donor Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"ALTERNATE MEDI-CAL [2001]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 30 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE TRANSPLANT [11170001]","standard_charge_algorithm":"Case rate ($199,570). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 555659. For days after this threshold has been met, a payment of (non-excluded charges minus 555659) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double - Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"UCR PROMPT PAY PAYOR [8240]","plan_name":"UCSD CHARITY MEDICARE CONTRACT","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Medicare All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":161270.09},{"payer_name":"AETNA [1003]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($418,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1381688. For days after this threshold has been met, a payment of (non-excluded charges minus 1381688) multiplied by .60 will be used instead of the standard payment.","methodology":"other","median_amount":601845.00,"10th_percentile":601845.00,"90th_percentile":1861213.42,"count":"1 through 10","additional_payer_notes":"Double Lung Transplant","standard_charge_dollar":1338841.22},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"IMPERIAL COUNTY PHYSICIAN MED GRP","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128387.68},{"payer_name":"USAA [1091]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"STERLING OPTION 1 [1083]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"CIGNA [1023]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($196,906). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 606000. For days after this threshold has been met, a payment of (non-excluded charges minus 606000) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128387.68},{"payer_name":"ALTERNATE AETNA [1004]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($418,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1381688. For days after this threshold has been met, a payment of (non-excluded charges minus 1381688) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"ASTIVA HEALTH [2095]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"MC UNITED HEALTHCARE HMO [164005]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($159,830.67). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $147,836.89, add-ons for qualifying new technology services are included. If operating cost exceeds $196,995.78 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $13,779.36, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $147,991.54 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $147,047.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,050.03. The transfer capital threshold is the transfer adjustment factor * $11,050.03. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":159830.67},{"payer_name":"ALTERNATE KAISER RAD ONC [2089]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","median_amount":1458382.31,"10th_percentile":1458382.31,"90th_percentile":1458382.31,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":131007.84},{"payer_name":"AMA - AMERICAN MEDICAL ASSOCIATION [1009]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"IMPERIAL HEALTH HOLDINGS [1132]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"AFFILIATED DOCTORS OF ORANGE COUNTY [2041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"MC CIGNA HMO [164003]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"AETNA [1003]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($130,679.32). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $120,252.83, add-ons for qualifying new technology services are included. If operating cost exceeds $169,411.72 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,212.07, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,407.48 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,463.72 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,482.74. The transfer capital threshold is the transfer adjustment factor * $9,482.74. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":130679.32},{"payer_name":"CLEVER CARE [2061]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($130,679.32). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $120,252.83, add-ons for qualifying new technology services are included. If operating cost exceeds $169,411.72 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,212.07, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,407.48 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,463.72 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,482.74. The transfer capital threshold is the transfer adjustment factor * $9,482.74. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":130679.32},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"OLYMPUS MANAGED HEALTHCARE INC [11020001]","standard_charge_algorithm":"Case rate ($418,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1381688. For days after this threshold has been met, a payment of (non-excluded charges minus 1381688) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"ALTERNATE SCAN HEALTH [2088]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":124457.45},{"payer_name":"MC ANTHEM BLUE CROSS HMO [164002]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"TRANSAMERICA [1084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"COMMUNITY HEALTH GROUP [1022]","plan_name":"COMMUNITY HEALTH GROUP MEDICARE ADVANTAGE","standard_charge_algorithm":"Fee schedule rate ($12.95). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":16.71},{"payer_name":"ENCOMPASS MED GRP [1030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"EMBASSY OF STATE OF KUWAIT [11010001]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":910412.03},{"payer_name":"DEPARTMENT OF LABOR [1028]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":209651.12},{"payer_name":"CAREMORE [2028]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":161270.09},{"payer_name":"PRIMARY CARE ASSOCIATES OF CA [2067]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"ALTERNATE VA - VETERANS ADMINISTRATION [1239]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":161270.09},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS HOUSE STAFF","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":353454.08},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":161270.09},{"payer_name":"SDSM [2017]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"MC BRAND NEW DAY GENERIC PAYOR [164031]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"BANKERS LIFE [1011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"VANTAGE [1092]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"SIMNSA HEALTH PLAN [2047]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"ADMAR [1001]","plan_name":"MULTIPLAN","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1004130.92},{"payer_name":"MC HEALTHNET HMO [164004]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"BPS - BENEFIT PLAN SERVICES [1015]","plan_name":"MULTIPLAN","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1004130.92},{"payer_name":"ALPHACARE [2062]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNA PRIORITY SELECT","standard_charge_algorithm":"Case rate ($470,800). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1749000. For days after this threshold has been met, a payment of (non-excluded charges minus 1749000) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"UC AFF BLUE SHIELD SR\/SDSM [164037]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD COVERED CA TRIO HMO","standard_charge_algorithm":"Case rate ($241,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 810000. For days after this threshold has been met, a payment of (non-excluded charges minus 810000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":157209.41},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($130,679.32). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $120,252.83, add-ons for qualifying new technology services are included. If operating cost exceeds $169,411.72 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,212.07, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,407.48 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,463.72 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,482.74. The transfer capital threshold is the transfer adjustment factor * $9,482.74. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 115%. Includes an additional $191,837 of payment.","methodology":"other","median_amount":376705.62,"10th_percentile":376705.62,"90th_percentile":376705.62,"count":"1 through 10","additional_payer_notes":"Double Lung Transplant","standard_charge_dollar":130679.32},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDI-CAL","standard_charge_algorithm":"Case rate ($380,251). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1121741. For days after this threshold has been met, a payment of (non-excluded charges minus 1121741) multiplied by .445 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA COMMERCIAL","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 140%.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":225778.13},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"MC HUMANA HMO [164013]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"EASY ACCESS CARE [2077]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET ENHANCED CARE PPO","standard_charge_algorithm":"Case rate ($121,973.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $112,351.85, add-ons for qualifying new technology services are included. If operating cost exceeds $161,510.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,407.60, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $113,295.61. The transfer operating threshold is the transfer adjustment factor * $112,351.85 If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,678.26. The transfer capital threshold is the transfer adjustment factor * $8,678.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 281%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services (MSDRG no DSH GME IME) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121973.87},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($159,830.67). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $147,836.89, add-ons for qualifying new technology services are included. If operating cost exceeds $196,995.78 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $13,779.36, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $147,991.54 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $147,047.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,050.03. The transfer capital threshold is the transfer adjustment factor * $11,050.03. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":159830.67},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($130,679.32). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $120,252.83, add-ons for qualifying new technology services are included. If operating cost exceeds $169,411.72 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,212.07, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,407.48 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,463.72 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,482.74. The transfer capital threshold is the transfer adjustment factor * $9,482.74. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":130679.32},{"payer_name":"ARCH HEALTH PARTNERS [2000]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED HMO NON CONTRACTED [10260001]","standard_charge_algorithm":"Case rate ($130,679.32). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $120,252.83, add-ons for qualifying new technology services are included. If operating cost exceeds $169,411.72 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,212.07, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,407.48 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,463.72 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,482.74. The transfer capital threshold is the transfer adjustment factor * $9,482.74. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":130679.32},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED PPO NON CONTRACTED [10260002]","standard_charge_algorithm":"Case rate ($130,679.32). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $120,252.83, add-ons for qualifying new technology services are included. If operating cost exceeds $169,411.72 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,212.07, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,407.48 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,463.72 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,482.74. The transfer capital threshold is the transfer adjustment factor * $9,482.74. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":130679.32},{"payer_name":"KAISER [1046]","plan_name":"KAISER MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($163,381). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 378743. For days after this threshold has been met, a payment of (non-excluded charges minus 378743) multiplied by .55 will be used instead of the standard payment.","methodology":"other","median_amount":604699.35,"10th_percentile":604699.35,"90th_percentile":604699.35,"count":"1 through 10","additional_payer_notes":"Double Lung Transplant ","standard_charge_dollar":1338841.22},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"INTERNATIONAL EMBASSY OF KUWAIT","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":910412.03},{"payer_name":"FIRST HEALTH [1032]","plan_name":"FIRST HEALTH","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1004130.92},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($265,437). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 945575. For days after this threshold has been met, a payment of (non-excluded charges minus 945575) multiplied by .63 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE","standard_charge_algorithm":"Case rate ($199,570). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 555659. For days after this threshold has been met, a payment of (non-excluded charges minus 555659) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double - Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($196,906). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 606000. For days after this threshold has been met, a payment of (non-excluded charges minus 606000) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"BLUE CROSS [1013]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($130,679.32). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $120,252.83, add-ons for qualifying new technology services are included. If operating cost exceeds $169,411.72 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,212.07, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,407.48 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,463.72 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,482.74. The transfer capital threshold is the transfer adjustment factor * $9,482.74. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":130679.32},{"payer_name":"BLUE CROSS [1013]","plan_name":"UCSD STUDENT HEALTH INS PLAN - BC SHIP","standard_charge_percentage":26.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":357470.61},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE","standard_charge_algorithm":"Case rate ($199,570). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 555659. For days after this threshold has been met, a payment of (non-excluded charges minus 555659) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double - Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"INTERPLAN [1045]","plan_name":"INTERPLAN","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":937188.85},{"payer_name":"UNLISTED MEDICARE ADVANTAGE (NON-CONTRACTED) [1051]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"TRI-CITY [1085]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"CHRISTIAN HEALTHCARE MINISTRIES [2030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"ELIZABETH HOSPICE [2018]","plan_name":"ELIZABETH HOSPICE GIP","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 30 day length of stay.","standard_charge_dollar":950.00},{"payer_name":"CHESAPEAKE LIFE [1021]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"MUTUAL OF OMAHA [1059]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"ALTERNATE MOLINA [1240]","plan_name":"MOLINA MEDI-CAL","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 30, Case rate ($139,246). Procedures 31 - 9999, Per diem ($10,788).","methodology":"other","count":"0","additional_payer_notes":"Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($265,437). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 945575. For days after this threshold has been met, a payment of (non-excluded charges minus 945575) multiplied by .63 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"MC SCAN GENERIC PAYOR [164034]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"UNLISTED HOSPICE [1035]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"MULTIPLAN [1058]","plan_name":"MULTIPLAN","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1004130.92},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"US BEHAVIORAL MENTAL\/EATING DISORDER","standard_charge_percentage":70.00,"standard_charge_algorithm":"70% of billed.","methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":937188.85},{"payer_name":"SEDGWICK [1077]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":209651.12},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($196,906). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 606000. For days after this threshold has been met, a payment of (non-excluded charges minus 606000) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"TRIWEST [2003]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":161270.09},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Case rate ($241,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 810000. For days after this threshold has been met, a payment of (non-excluded charges minus 810000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","median_amount":429382.76,"10th_percentile":429382.76,"90th_percentile":429382.76,"count":"1 through 10","additional_payer_notes":"Double Lung Transplant","standard_charge_dollar":1338841.22},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Case rate ($241,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 810000. For days after this threshold has been met, a payment of (non-excluded charges minus 810000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA EPN\/IFP","standard_charge_algorithm":"Case rate ($241,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 810000. For days after this threshold has been met, a payment of (non-excluded charges minus 810000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"INTEGRATED HEALTH PARTNERS [2068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"PACIFIC FOUNDATION [1063]","plan_name":"PACIFIC FOUNDATION FOR MEDICAL CARE","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1004130.92},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE ST PAULS","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":161270.09},{"payer_name":"GREATER NEWPORT PHYSICIANS [2096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"MC UHC VEBA HMO [164033]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"KEY MED GRP [2074]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"MEDI-CAL [1048]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 30 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"NATIONAL HEALTHCARE SOLUTIONS INC [1100]","plan_name":"NATIONAL HEALTHCARE SOLUTIONS INC [11000001]","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1071072.98},{"payer_name":"MC HNET BLUE&GOLD ACO [164017]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"SCRIPPS COASTAL MED GRP [1074]","plan_name":"SCRIPPS COASTAL MED GRP [10740001]","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":870246.79},{"payer_name":"SD PHYSICIANS MED GRP [1076]","plan_name":"SD PHYSICIANS MED GRP SR [10760002]","standard_charge_percentage":55.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":736362.67},{"payer_name":"MERCY PHYSICIANS MED GRP [1052]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"VILLAGE HEALTH [1094]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"TRI-CITY MEDICAL CENTER [1129]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"PRIVATE HEALTHCARE SYSTEM","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1004130.92},{"payer_name":"HEALTH NET [1039]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"CARNIVAL CRUISES [1018]","plan_name":"CARNIVAL CRUISES [10180001]","standard_charge_percentage":90.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1204957.10},{"payer_name":"BLUE SHIELD TRANSPLANTS [1113]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Case rate ($241,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 810000. For days after this threshold has been met, a payment of (non-excluded charges minus 810000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Pricing is calculated over two periods plus stop loss reimbursement. The first period consists of the days from admission to 2 days before the relevant ICD Procedure date. If multiple relevant ICD Procedures are present, the first relevant ICD Procedure date on the claim is used. The reimbursement for this period is calculated as a per diem rate of $4,345. The second period consists of the days from the end of the first period to claim end. The reimbursement for this period is calculated as a case rate ($105,119). The stop loss period consists of the days from the day after the stop loss threshold ($355,875) is met to claim end. Only charges after the start of period two are considered for stop loss calculation. The reimbursement for this period is calculated as 42.2% of billed charges during the period after non-excluded charges exceed the threshold of $355,875. Only charges above the threshold on the day the threshold is met are reimbursed.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET MEDICARE ADVANTAGE UC EMPLOYER GROUP","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 115%. Includes an additional $191,837 of payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant (Optum 1\/24) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"UC AFF ANTHEM\/SDSM HMO [164024]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"MC SCAN HMO [164035]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"MVP HEALTHCARE [1060]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"INLAND FACULTY MEDICAL GROUP [2063]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"SHARP HEALTHCARE TRANSPLANT [1119]","plan_name":"SHARP HEALTHCARE TRANSPLANT [11190001]","standard_charge_algorithm":"Per diem ($3,550).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 30 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":3550.00},{"payer_name":"KERN HEALTH SYSTEMS [2033]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Case rate ($380,251). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1121741. For days after this threshold has been met, a payment of (non-excluded charges minus 1121741) multiplied by .445 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"ROYAL EMBASSY","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":937188.85},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Case rate ($241,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 810000. For days after this threshold has been met, a payment of (non-excluded charges minus 810000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Case rate ($241,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 810000. For days after this threshold has been met, a payment of (non-excluded charges minus 810000) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":739040.35},{"payer_name":"MC UHC VEBA GENERIC HMO [164032]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"REDLANDS COMMUNITY HOSPITAL [2005]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"UNITED AMERICAN [1087]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"CALIFORNIA HEALTH & WELLNESS MEDI-CAL [1122]","plan_name":"CALIFORNIA HEALTH AND WELLNESS MEDI-CAL (no longer Medi-Cal plan as of 1\/1\/24)","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 30, Case rate ($134,286.24). Procedures 31 - 9999, Per diem ($10,404.01).","methodology":"other","count":"0","additional_payer_notes":"Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"PREMIER PATIENT CARE IPA [2069]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"INTER VALLEY HEALTH PLAN [2024]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"EASY CHOICE [1029]","plan_name":"EASY CHOICE","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"GLOBAL EXCEL [1036]","plan_name":"GLOBAL EXCEL","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 165%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":161270.09},{"payer_name":"ALTERNATE BRAND NEW DAY [2079]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"SIERRA MEDICAL GROUP [2048]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Pricing is calculated over two periods plus stop loss reimbursement. The first period consists of the days from admission to 2 days before the relevant ICD Procedure date. If multiple relevant ICD Procedures are present, the first relevant ICD Procedure date on the claim is used. The reimbursement for this period is calculated as a per diem rate of $4,345. The second period consists of the days from the end of the first period to claim end. The reimbursement for this period is calculated as a case rate ($105,119). The stop loss period consists of the days from the day after the stop loss threshold ($355,875) is met to claim end. Only charges after the start of period two are considered for stop loss calculation. The reimbursement for this period is calculated as 42.2% of billed charges during the period after non-excluded charges exceed the threshold of $355,875. Only charges above the threshold on the day the threshold is met are reimbursed.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"HERITAGE VICTOR VALLEY MEDICAL GROUP [2045]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($159,830.67). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $147,836.89, add-ons for qualifying new technology services are included. If operating cost exceeds $196,995.78 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $13,779.36, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $147,991.54 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $147,047.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,050.03. The transfer capital threshold is the transfer adjustment factor * $11,050.03. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":159830.67},{"payer_name":"CHAMPVA [1020]","plan_name":"VETERANS ADMINISTRATION - CHAMPVA","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":161270.09},{"payer_name":"CAL OPTIMA [1016]","plan_name":"CalOptima Medicare","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":161270.09},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 115%. Includes an additional $191,837 of payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant (Optum 1\/24) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"WORKERS COMPENSATION [1097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","median_amount":272550.37,"10th_percentile":272550.37,"90th_percentile":272550.37,"count":"1 through 10","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":209651.12},{"payer_name":"RIVERSIDE MEDICAL CLINIC [2064]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"BLUE CROSS [1013]","plan_name":"STRATEGIC HEALTH","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 89, Case rate ($106,700). Procedures 90 - 9999, 70% of billed.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128387.68},{"payer_name":"ETS - LIFETRAC NETWORK [1103]","plan_name":"LIFETRAC","standard_charge_algorithm":"Case rate ($156,200). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":156200.00},{"payer_name":"TRIWEST ALTERNATE [2036]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":161270.09},{"payer_name":"BLUE SHIELD [1014]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($130,679.32). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $120,252.83, add-ons for qualifying new technology services are included. If operating cost exceeds $169,411.72 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,212.07, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,407.48 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,463.72 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,482.74. The transfer capital threshold is the transfer adjustment factor * $9,482.74. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":130679.32},{"payer_name":"MC UHC ALLIANCE HMO [164020]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"IMPERIAL HEALTH PLAN [2081]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($418,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1381688. For days after this threshold has been met, a payment of (non-excluded charges minus 1381688) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE PPO","standard_charge_percentage":49.55,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":663395.82},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UHC SELECT AND SELECT PLUS","standard_charge_algorithm":"Per diem ($14,996).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 30 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":14996.00},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Case rate ($380,251). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1121741. For days after this threshold has been met, a payment of (non-excluded charges minus 1121741) multiplied by .445 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($159,830.67). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $147,836.89, add-ons for qualifying new technology services are included. If operating cost exceeds $196,995.78 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $13,779.36, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $147,991.54 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $147,047.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,050.03. The transfer capital threshold is the transfer adjustment factor * $11,050.03. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":159830.67},{"payer_name":"PYRAMID LIFE [1068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"AETNA TRANSPLANTS [1112]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($418,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1381688. For days after this threshold has been met, a payment of (non-excluded charges minus 1381688) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"UC AFF HUMANA\/SDSM [164025]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"CIGNA [1023]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"MONARCH HEALTHCARE [2006]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":201779.04,"10th_percentile":201779.04,"90th_percentile":201779.04,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":131007.84},{"payer_name":"UC AFF MC HUMANA GENERIC PAYOR [164027]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"HUMANA [1042]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($130,679.32). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $120,252.83, add-ons for qualifying new technology services are included. If operating cost exceeds $169,411.72 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,212.07, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,407.48 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,463.72 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,482.74. The transfer capital threshold is the transfer adjustment factor * $9,482.74. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":130679.32},{"payer_name":"MC BRAND NEW DAY HMO [164030]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"SCRIPPS HEALTH PLAN SERVICES [1075]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":803304.73},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($196,906). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 606000. For days after this threshold has been met, a payment of (non-excluded charges minus 606000) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"CMN - CANADIAN MEDICAL NETWORK [1024]","plan_name":"CMN GLOBAL INC","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 170%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":274159.15},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"KUWAIT OIL COMPANY [11010005]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":910412.03},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($196,906). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 606000. For days after this threshold has been met, a payment of (non-excluded charges minus 606000) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"STATE OF CALIFORNIA [1082]","plan_name":"California State Prison","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 250%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":161270.09},{"payer_name":"SAN DIEGO SOCKERS [2015]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":209651.12},{"payer_name":"AMERICAN SPECIALTY HEALTH PLAN [2038]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"HIGH DESERT MEDICAL GROUP [2053]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"IMMIGRATION HEALTH SERVICES [1043]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":158044.69},{"payer_name":"WELL CARE [1096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDI-CAL ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 30, Case rate ($139,246). Procedures 31 - 9999, Per diem ($10,788).","methodology":"other","count":"0","additional_payer_notes":"Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"HEMET COMMUNITY MED GRP - PROMISECARE [1040]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CALIFORNIA UC CARE \/ HSP","standard_charge_percentage":26.66,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":356935.07},{"payer_name":"MC UHC HARMONY HMO [164026]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Case rate ($470,800). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1749000. For days after this threshold has been met, a payment of (non-excluded charges minus 1749000) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"BLUE SHIELD PROMISE [1017]","plan_name":"CARE 1ST HEALTHPLAN MEDICARE ADVANTAGE (BS PROMISE)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MA\/SDPMG","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":124457.45},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Case rate ($470,800). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1749000. For days after this threshold has been met, a payment of (non-excluded charges minus 1749000) multiplied by .62 will be used instead of the standard payment.","methodology":"other","median_amount":267596.00,"10th_percentile":267596.00,"90th_percentile":267596.00,"count":"1 through 10","additional_payer_notes":"Double Lung Transplant","standard_charge_dollar":1338841.22},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($196,906). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 606000. For days after this threshold has been met, a payment of (non-excluded charges minus 606000) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"LA CARE HEALTH PLAN [2025]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":157209.41},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":803304.73},{"payer_name":"ST JOSEPH ST JUDE [2065]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"GOLDEN PHYSICIANS MEDICAL GROUP [2082]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 30 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"ADVANTRA FREEDOM [1002]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"SCAN HEALTH [1072]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":124457.45},{"payer_name":"BEECH STREET [1012]","plan_name":"CAPPCARE\/BEECH STREET","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1004130.92},{"payer_name":"EMPIRE PHYS MED GRP [2072]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE SAN DIEGO","standard_charge_algorithm":"Case rate ($159,830.67). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $147,836.89, add-ons for qualifying new technology services are included. If operating cost exceeds $196,995.78 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $13,779.36, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $147,991.54 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $147,047.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,050.03. The transfer capital threshold is the transfer adjustment factor * $11,050.03. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":159830.67},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":144108.62},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Case rate ($380,251). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1121741. For days after this threshold has been met, a payment of (non-excluded charges minus 1121741) multiplied by .445 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($159,830.67). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $147,836.89, add-ons for qualifying new technology services are included. If operating cost exceeds $196,995.78 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $13,779.36, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $147,991.54 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $147,047.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,050.03. The transfer capital threshold is the transfer adjustment factor * $11,050.03. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":159830.67},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($159,830.67). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $147,836.89, add-ons for qualifying new technology services are included. If operating cost exceeds $196,995.78 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $13,779.36, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $147,991.54 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $147,047.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,050.03. The transfer capital threshold is the transfer adjustment factor * $11,050.03. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":159830.67},{"payer_name":"SCRIPPS HOSPICE [2008]","plan_name":"SCRIPPS HEALTH HOSPICE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 30 day length of stay.","standard_charge_dollar":700.00},{"payer_name":"BEACON HEALTH STRATEGY [2039]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"CIGNA [1023]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":739040.35},{"payer_name":"MGM RESORTS [1053]","plan_name":"MGM RESORT","standard_charge_algorithm":"Case rate ($180,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 405000. For days after this threshold has been met, a payment of (non-excluded charges minus 405000) multiplied by .70 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"USOC - US OLYMPIC COMMITTEE [1123]","plan_name":"USOC VIK (BSC UC CARE)","standard_charge_percentage":43.10,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":577040.57},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"SALUDPOL Peru Police","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":937188.85},{"payer_name":"HEALTH CARE SUPPORT [2011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"Community Care IPA Medi-Cal Managed Care","standard_charge_algorithm":"Includes a variable per diem for days 0-99999: RC 0100:0169 @ $1,750; RC 0200:0202 @ $1,750; RC 0208:0213 @ $1,750; RC 0219 @ $1,750; RC 0206 @ $2,300; RC 0207 @ $2,300.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 30 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"MC HUMANA GENERIC PAYOR [164014]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"UC AFF ANTHEM\/XIMED HMO [164022]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"BRAND NEW DAY [1089]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"ALTERNATE MOLINA [1240]","plan_name":"MOLINA MEDI-CAL [12400001]","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 30, Case rate ($139,246). Procedures 31 - 9999, Per diem ($10,788).","methodology":"other","count":"0","additional_payer_notes":"Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"AXA ASSISTANCE [1098]","plan_name":"AXA ASSISTANCE USA,INC","standard_charge_algorithm":"Case rate ($143,924). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 455252. For days after this threshold has been met, a payment of (non-excluded charges minus 455252) multiplied by .65 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"AETNA [1003]","plan_name":"AETNA BEHAVIORAL EATING DISORDER","standard_charge_percentage":43.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":585073.61},{"payer_name":"FRESENIUS [1034]","plan_name":"FRESENIUS HEALTH PARTNERS, INC","standard_charge_algorithm":"Case rate ($130,679.32). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $120,252.83, add-ons for qualifying new technology services are included. If operating cost exceeds $169,411.72 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,212.07, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,407.48 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,463.72 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,482.74. The transfer capital threshold is the transfer adjustment factor * $9,482.74. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":130679.32},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK","standard_charge_algorithm":"Per diem ($4,000). A payment threshold will be met when non-excluded charges is greater than 325000. For days after this threshold has been met, a per diem of (non-excluded charges for that day multiplied by .65) will be used instead of the standard payment for each day after the threshold.","methodology":"other","count":"0","additional_payer_notes":"ICU\/CCU Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($130,679.32). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $120,252.83, add-ons for qualifying new technology services are included. If operating cost exceeds $169,411.72 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,212.07, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,407.48 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,463.72 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,482.74. The transfer capital threshold is the transfer adjustment factor * $9,482.74. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":130679.32},{"payer_name":"HMSA - HAWAII MEDICAL SERVICE ASSOC MDCR [1041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"MC AETNA HMO [164001]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"MEDICARE [1050]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","median_amount":182538.73,"10th_percentile":182538.73,"90th_percentile":182538.73,"count":"1 through 10","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":158044.69},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE DISTINCTION ","standard_charge_algorithm":"Case rate ($252,500). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 909000. For days after this threshold has been met, a payment of (non-excluded charges minus 909000) multiplied by .60 will be used instead of the standard payment.","methodology":"other","median_amount":494528.25,"10th_percentile":494528.25,"90th_percentile":494528.25,"count":"1 through 10","additional_payer_notes":"Double Lung Cadaveric Donor Transplant","standard_charge_dollar":1338841.22},{"payer_name":"KAISER [1046]","plan_name":"KAISER","standard_charge_algorithm":"Case rate ($163,381). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 378743. For days after this threshold has been met, a payment of (non-excluded charges minus 378743) multiplied by .55 will be used instead of the standard payment.","methodology":"other","median_amount":463004.67,"10th_percentile":463004.67,"90th_percentile":776575.07,"count":"1 through 10","additional_payer_notes":"Double Lung Transplant ","standard_charge_dollar":1338841.22},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Case rate ($470,800). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1749000. For days after this threshold has been met, a payment of (non-excluded charges minus 1749000) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EPO [10130074]","standard_charge_algorithm":"Case rate ($470,800). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1749000. For days after this threshold has been met, a payment of (non-excluded charges minus 1749000) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($196,906). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 606000. For days after this threshold has been met, a payment of (non-excluded charges minus 606000) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 30 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Case rate ($470,800). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1749000. For days after this threshold has been met, a payment of (non-excluded charges minus 1749000) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Double Lung Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($159,830.67). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $147,836.89, add-ons for qualifying new technology services are included. If operating cost exceeds $196,995.78 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $13,779.36, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $147,991.54 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $147,047.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,050.03. The transfer capital threshold is the transfer adjustment factor * $11,050.03. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":159830.67},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":424425.89,"10th_percentile":424425.89,"90th_percentile":424425.89,"count":"1 through 10","additional_payer_notes":"Inpatient","standard_charge_dollar":131007.84},{"payer_name":"CENTRAL HEALTH PLAN [2026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"CASSIDY MED GRP [1019]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":870246.79},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Commercial","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 150%.","methodology":"other","count":"0","additional_payer_notes":"General Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":196511.76},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Medicare","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"General Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":144108.62},{"payer_name":"MEDCARE PARTNERS [2084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"AETNA [1003]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS UC CARE","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":353454.08},{"payer_name":"MC AETNA GENERIC PAYOR [164008]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"MC BLUE SHIELD GENERIC PAYOR [164016]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"BEAVER MED GRP [2075]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"HEALTHCARE PARTNERS [2073]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1338841.22},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($159,830.67). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $147,836.89, add-ons for qualifying new technology services are included. If operating cost exceeds $196,995.78 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $13,779.36, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $147,991.54 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $147,047.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,050.03. The transfer capital threshold is the transfer adjustment factor * $11,050.03. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":159830.67},{"payer_name":"MC UNITED HEALTHCARE GENERIC PAYOR [164011]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160660.95},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"COMMUNITY ELDERCARE [1027]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"OPTUM CARE NETWORK - PCAMG [1064]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":870246.79},{"payer_name":"VA - VETERANS ADMINISTRATION [1093]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":161270.09},{"payer_name":"US MARSHAL SERVICES [1090]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($131,007.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $120,556.18, add-ons for qualifying new technology services are included. If operating cost exceeds $169,240.80 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,709.20, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $120,710.83 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $119,767.07 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $9,507.90. The transfer capital threshold is the transfer adjustment factor * $9,507.90. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":131007.84},{"payer_name":"CLIPPERS WORKERS COMPENSATION [2097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($161,270.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $149,221.63, add-ons for qualifying new technology services are included. If operating cost exceeds $197,906.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $14,306.00, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $149,376.28 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $148,432.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,104.71. The transfer capital threshold is the transfer adjustment factor * $11,104.71. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":209651.12},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA HMO","standard_charge_percentage":83.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1116593.58},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA PPO","standard_charge_percentage":83.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1116593.58},{"payer_name":"DESERT OASIS HEALTH CARE [2052]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($159,830.67). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $147,836.89, add-ons for qualifying new technology services are included. If operating cost exceeds $196,995.78 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $13,779.36, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 19.7. The base transfer operating payment is the transfer adjustment factor * $147,991.54 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $147,047.79 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $11,050.03. The transfer capital threshold is the transfer adjustment factor * $11,050.03. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":159830.67}]}]}
,{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"minimum":5.45,"maximum":133335.54,"gross_charge":504447.27,"discounted_cash":277446.00,"setting":"inpatient","payers_information":[{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Commercial","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 160%.","methodology":"other","count":"0","additional_payer_notes":"Oncology Care Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":89011.14},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Medicare","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"Oncology Care Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":66758.35},{"payer_name":"LAKESIDE MEDICAL GROUP [2054]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"MC CIGNA GENERIC PAYOR [164007]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MID-COUNTY PHYSICIANS NARROW NETWORK","standard_charge_algorithm":"Per diem ($17,123).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":17123.00},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE QUALCOMM ","standard_charge_percentage":45.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":230229.73},{"payer_name":"ALTERNATE HEALTH NET BH [2059]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":504447.27},{"payer_name":"ALTERNATE HEALTH NET BH [2059]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"HMSA - HAWAII MEDICAL SERVICE ASSOC MDCR [1041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"MC ANTHEM BLUE CROSS GENERIC PAYOR [164009]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"MENIFEE MED GRP [2076]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"ALTERNATE SHERIFF CUSTODY [1106]","plan_name":"SHERIFF COUNTY CONTRACT # 514250","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":327890.73},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH PLAN","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":302668.36},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MARKET PLACE","standard_charge_algorithm":"Case rate ($55,493.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $51,102.39, add-ons for qualifying new technology services are included. If operating cost exceeds $100,261.28 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,723.08, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,710.76 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,313.28 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,993.75. The transfer capital threshold is the transfer adjustment factor * $3,993.75. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 180%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55493.60},{"payer_name":"XIMED [2016]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"QUALITY HEALTH [1069]","plan_name":"QUALITY HEALTH MANAGEMENT","standard_charge_algorithm":"Case rate ($68,377.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $63,302.88, add-ons for qualifying new technology services are included. If operating cost exceeds $111,987.50 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,878.15, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,911.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $62,513.77 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,676.85. The transfer capital threshold is the transfer adjustment factor * $4,676.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 195%.","methodology":"other","count":"0","additional_payer_notes":"Oncology  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":133335.54},{"payer_name":"AFFILIATED DOCTORS OF ORANGE COUNTY [2041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"RIVER CITY MEDICAL GROUP [2066]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA COMMERCIAL","standard_charge_percentage":85.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":428780.18},{"payer_name":"ALTERNATE MEDICARE [2007]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($68,377.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $63,302.88, add-ons for qualifying new technology services are included. If operating cost exceeds $111,987.50 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,878.15, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,911.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $62,513.77 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,676.85. The transfer capital threshold is the transfer adjustment factor * $4,676.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":67009.66},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($68,377.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $63,302.88, add-ons for qualifying new technology services are included. If operating cost exceeds $111,987.50 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,878.15, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,911.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $62,513.77 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,676.85. The transfer capital threshold is the transfer adjustment factor * $4,676.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":68377.20},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($68,377.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $63,302.88, add-ons for qualifying new technology services are included. If operating cost exceeds $111,987.50 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,878.15, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,911.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $62,513.77 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,676.85. The transfer capital threshold is the transfer adjustment factor * $4,676.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":68377.20},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE [10230006]","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"ALTERNATE MEDI-CAL [2001]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE TRANSPLANT [11170001]","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"UCR PROMPT PAY PAYOR [8240]","plan_name":"UCSD CHARITY MEDICARE CONTRACT","standard_charge_algorithm":"Case rate ($68,377.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $63,302.88, add-ons for qualifying new technology services are included. If operating cost exceeds $111,987.50 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,878.15, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,911.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $62,513.77 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,676.85. The transfer capital threshold is the transfer adjustment factor * $4,676.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Medicare All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":68377.20},{"payer_name":"AETNA [1003]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":302668.36},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"IMPERIAL COUNTY PHYSICIAN MED GRP","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":54519.32},{"payer_name":"STERLING OPTION 1 [1083]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"USAA [1091]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"ALTERNATE AETNA [1004]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":302668.36},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":54519.32},{"payer_name":"ASTIVA HEALTH [2095]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($67,770.97). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $62,719.68, add-ons for qualifying new technology services are included. If operating cost exceeds $111,878.57 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,383.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,328.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $61,930.58 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,653.83. The transfer capital threshold is the transfer adjustment factor * $4,653.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":67770.97},{"payer_name":"ALTERNATE KAISER RAD ONC [2089]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":504447.27},{"payer_name":"MC HEALTHNET GENERIC PAYOR [164010]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"AMA - AMERICAN MEDICAL ASSOCIATION [1009]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"CIGNA [1023]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($67,770.97). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $62,719.68, add-ons for qualifying new technology services are included. If operating cost exceeds $111,878.57 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,383.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,328.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $61,930.58 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,653.83. The transfer capital threshold is the transfer adjustment factor * $4,653.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":67770.97},{"payer_name":"IMPERIAL HEALTH HOLDINGS [1132]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":117838.40,"10th_percentile":117838.40,"90th_percentile":117838.40,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":55631.96},{"payer_name":"MC CIGNA HMO [164003]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"AETNA [1003]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($55,493.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $51,102.39, add-ons for qualifying new technology services are included. If operating cost exceeds $100,261.28 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,723.08, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,710.76 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,313.28 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,993.75. The transfer capital threshold is the transfer adjustment factor * $3,993.75. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55493.60},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"CIGNA HMO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":253736.98},{"payer_name":"CLEVER CARE [2061]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"OLYMPUS MANAGED HEALTHCARE INC [11020001]","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":302668.36},{"payer_name":"ALTERNATE SCAN HEALTH [2088]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":52850.36},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($55,493.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $51,102.39, add-ons for qualifying new technology services are included. If operating cost exceeds $100,261.28 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,723.08, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,710.76 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,313.28 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,993.75. The transfer capital threshold is the transfer adjustment factor * $3,993.75. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55493.60},{"payer_name":"MC ANTHEM BLUE CROSS HMO [164002]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"TRANSAMERICA [1084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"ENCOMPASS MED GRP [1030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"CAREMORE [2028]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"DEPARTMENT OF LABOR [1028]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($68,377.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $63,302.88, add-ons for qualifying new technology services are included. If operating cost exceeds $111,987.50 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,878.15, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,911.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $62,513.77 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,676.85. The transfer capital threshold is the transfer adjustment factor * $4,676.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":88890.36},{"payer_name":"PRIMARY CARE ASSOCIATES OF CA [2067]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($68,377.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $63,302.88, add-ons for qualifying new technology services are included. If operating cost exceeds $111,987.50 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,878.15, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,911.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $62,513.77 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,676.85. The transfer capital threshold is the transfer adjustment factor * $4,676.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":68377.20},{"payer_name":"ALTERNATE VA - VETERANS ADMINISTRATION [1239]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($68,377.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $63,302.88, add-ons for qualifying new technology services are included. If operating cost exceeds $111,987.50 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,878.15, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,911.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $62,513.77 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,676.85. The transfer capital threshold is the transfer adjustment factor * $4,676.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":68377.20},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($68,377.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $63,302.88, add-ons for qualifying new technology services are included. If operating cost exceeds $111,987.50 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,878.15, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,911.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $62,513.77 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,676.85. The transfer capital threshold is the transfer adjustment factor * $4,676.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":68377.20},{"payer_name":"SDSM [2017]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"MC BRAND NEW DAY GENERIC PAYOR [164031]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"COMMUNITY HEALTH GROUP [1022]","plan_name":"COMMUNITY HEALTH GROUP MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 113%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":62864.11},{"payer_name":"BANKERS LIFE [1011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"VANTAGE [1092]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"SIMNSA HEALTH PLAN [2047]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"ADMAR [1001]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":327890.73},{"payer_name":"BPS - BENEFIT PLAN SERVICES [1015]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":327890.73},{"payer_name":"MC HEALTHNET HMO [164004]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNA PRIORITY SELECT","standard_charge_algorithm":"Per diem ($7,362).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":7362.00},{"payer_name":"ALPHACARE [2062]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD COVERED CA TRIO HMO","standard_charge_algorithm":"Per diem ($13,880). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":504447.27},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA COMMERCIAL","standard_charge_percentage":85.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":428780.18},{"payer_name":"MC HUMANA HMO [164013]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($55,493.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $51,102.39, add-ons for qualifying new technology services are included. If operating cost exceeds $100,261.28 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,723.08, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,710.76 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,313.28 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,993.75. The transfer capital threshold is the transfer adjustment factor * $3,993.75. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Pre\/Post or Other\/VAD Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55493.60},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDI-CAL","standard_charge_algorithm":"Case rate ($67,770.97). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $62,719.68, add-ons for qualifying new technology services are included. If operating cost exceeds $111,878.57 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,383.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,328.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $61,930.58 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,653.83. The transfer capital threshold is the transfer adjustment factor * $4,653.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 80%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Pre\/Post  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":54216.78},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"EASY ACCESS CARE [2077]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET ENHANCED CARE PPO","standard_charge_algorithm":"Case rate ($51,370.45). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $47,318.05, add-ons for qualifying new technology services are included. If operating cost exceeds $96,476.94 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,384.27, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $47,715.52. The transfer operating threshold is the transfer adjustment factor * $47,318.05 If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,654.93. The transfer capital threshold is the transfer adjustment factor * $3,654.93. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 281%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services (MSDRG no DSH GME IME) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":51370.45},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($67,770.97). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $62,719.68, add-ons for qualifying new technology services are included. If operating cost exceeds $111,878.57 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,383.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,328.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $61,930.58 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,653.83. The transfer capital threshold is the transfer adjustment factor * $4,653.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":67770.97},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":504447.27},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($55,493.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $51,102.39, add-ons for qualifying new technology services are included. If operating cost exceeds $100,261.28 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,723.08, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,710.76 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,313.28 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,993.75. The transfer capital threshold is the transfer adjustment factor * $3,993.75. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55493.60},{"payer_name":"ARCH HEALTH PARTNERS [2000]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"MC BLUE SHIELD HMO [164015]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED HMO NON CONTRACTED [10260001]","standard_charge_algorithm":"Case rate ($55,493.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $51,102.39, add-ons for qualifying new technology services are included. If operating cost exceeds $100,261.28 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,723.08, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,710.76 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,313.28 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,993.75. The transfer capital threshold is the transfer adjustment factor * $3,993.75. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55493.60},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED PPO NON CONTRACTED [10260002]","standard_charge_algorithm":"Case rate ($55,493.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $51,102.39, add-ons for qualifying new technology services are included. If operating cost exceeds $100,261.28 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,723.08, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,710.76 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,313.28 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,993.75. The transfer capital threshold is the transfer adjustment factor * $3,993.75. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55493.60},{"payer_name":"KAISER [1046]","plan_name":"KAISER MEDICARE ADVANTAGE","standard_charge_percentage":67.00,"methodology":"percent of total billed charges","median_amount":708131.17,"10th_percentile":708131.17,"90th_percentile":708131.17,"count":"1 through 10","additional_payer_notes":"undefined","standard_charge_dollar":337979.67},{"payer_name":"FIRST HEALTH [1032]","plan_name":"FIRST HEALTH","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":378335.45},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($67,770.97). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $62,719.68, add-ons for qualifying new technology services are included. If operating cost exceeds $111,878.57 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,383.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,328.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $61,930.58 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,653.83. The transfer capital threshold is the transfer adjustment factor * $4,653.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":67770.97},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"BLUE CROSS [1013]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($55,493.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $51,102.39, add-ons for qualifying new technology services are included. If operating cost exceeds $100,261.28 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,723.08, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,710.76 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,313.28 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,993.75. The transfer capital threshold is the transfer adjustment factor * $3,993.75. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55493.60},{"payer_name":"BLUE CROSS [1013]","plan_name":"UCSD STUDENT HEALTH INS PLAN - BC SHIP","standard_charge_percentage":26.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":134687.42},{"payer_name":"INTERPLAN [1045]","plan_name":"INTERPLAN","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":353113.09},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Per diem ($8,294). The outlier payment amount is calculated by taking the estimated cost amount, subtracting the threshold amount ($247,571), then multiplying the difference by the percent of outlier that is reimbursed (53%). If the calculated outlier amount is greater than $0, it is added to the reimbursement total. The estimated cost amount is the adjusted billed amount multiplied by the cost-to-charge ratio (1). The following revenue codes are excluded from the adjusted billed amount: RC 0274-0276, 0278, 0624, 0891.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":8294.00},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":504447.27},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET MEDICARE ADVANTAGE UC EMPLOYER GROUP","standard_charge_algorithm":"Fee schedule rate ($5.45). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":5.45},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"INTERNATIONAL EMBASSY OF KUWAIT","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":343024.14},{"payer_name":"UNLISTED MEDICARE ADVANTAGE (NON-CONTRACTED) [1051]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"CHRISTIAN HEALTHCARE MINISTRIES [2030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"ELIZABETH HOSPICE [2018]","plan_name":"ELIZABETH HOSPICE GIP","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay.","standard_charge_dollar":950.00},{"payer_name":"TRI-CITY [1085]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"CHESAPEAKE LIFE [1021]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"MUTUAL OF OMAHA [1059]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"CIGNA [1023]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":278454.89},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"UNLISTED HOSPICE [1035]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"MULTIPLAN [1058]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":327890.73},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"US BEHAVIORAL MENTAL\/EATING DISORDER","standard_charge_percentage":70.00,"standard_charge_algorithm":"70% of billed.","methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":353113.09},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($67,770.97). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $62,719.68, add-ons for qualifying new technology services are included. If operating cost exceeds $111,878.57 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,383.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,328.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $61,930.58 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,653.83. The transfer capital threshold is the transfer adjustment factor * $4,653.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":67770.97},{"payer_name":"SEDGWICK [1077]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($68,377.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $63,302.88, add-ons for qualifying new technology services are included. If operating cost exceeds $111,987.50 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,878.15, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,911.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $62,513.77 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,676.85. The transfer capital threshold is the transfer adjustment factor * $4,676.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":88890.36},{"payer_name":"TRIWEST [2003]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($68,377.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $63,302.88, add-ons for qualifying new technology services are included. If operating cost exceeds $111,987.50 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,878.15, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,911.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $62,513.77 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,676.85. The transfer capital threshold is the transfer adjustment factor * $4,676.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":68377.20},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($13,880). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","median_amount":468529.13,"10th_percentile":468529.13,"90th_percentile":468529.13,"count":"1 through 10","additional_payer_notes":"Oncology","standard_charge_dollar":504447.27},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Per diem ($13,880). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":504447.27},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA EPN\/IFP","standard_charge_algorithm":"Per diem ($10,826). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .468 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":504447.27},{"payer_name":"INTEGRATED HEALTH PARTNERS [2068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"PACIFIC FOUNDATION [1063]","plan_name":"PACIFIC FOUNDATION FOR MEDICAL CARE","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":378335.45},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE ST PAULS","standard_charge_algorithm":"Case rate ($68,377.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $63,302.88, add-ons for qualifying new technology services are included. If operating cost exceeds $111,987.50 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,878.15, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,911.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $62,513.77 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,676.85. The transfer capital threshold is the transfer adjustment factor * $4,676.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":71434.36,"10th_percentile":71434.36,"90th_percentile":71434.36,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":68377.20},{"payer_name":"MC SCAN GENERIC PAYOR [164034]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"GREATER NEWPORT PHYSICIANS [2096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"MVP HEALTHCARE [1060]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"MC UHC VEBA HMO [164033]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"MEDI-CAL [1048]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS HOUSE STAFF","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":133174.08},{"payer_name":"SCRIPPS COASTAL MED GRP [1074]","plan_name":"SCRIPPS COASTAL MED GRP [10740001]","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":327890.73},{"payer_name":"NATIONAL HEALTHCARE SOLUTIONS INC [1100]","plan_name":"NATIONAL HEALTHCARE SOLUTIONS INC [11000001]","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":403557.82},{"payer_name":"MC UNITED HEALTHCARE HMO [164005]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"SD PHYSICIANS MED GRP [1076]","plan_name":"SD PHYSICIANS MED GRP SR [10760002]","standard_charge_percentage":55.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":277446.00},{"payer_name":"UC AFF BLUE SHIELD SR\/SDSM [164037]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"MERCY PHYSICIANS MED GRP [1052]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"PRIVATE HEALTHCARE SYSTEM","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":327890.73},{"payer_name":"HEALTH NET [1039]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"VILLAGE HEALTH [1094]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"TRI-CITY MEDICAL CENTER [1129]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"MC UHC ALLIANCE HMO [164020]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"BLUE SHIELD TRANSPLANTS [1113]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($13,880). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":504447.27},{"payer_name":"MC SCAN HMO [164035]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"ALTERNATE BRAND NEW DAY [2079]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"INLAND FACULTY MEDICAL GROUP [2063]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"PREMIER PATIENT CARE IPA [2069]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"CARNIVAL CRUISES [1018]","plan_name":"CARNIVAL CRUISES [10180001]","standard_charge_percentage":90.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":454002.54},{"payer_name":"KERN HEALTH SYSTEMS [2033]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"MC UNITED HEALTHCARE GENERIC PAYOR [164011]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"ROYAL EMBASSY","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":353113.09},{"payer_name":"BEECH STREET [1012]","plan_name":"CAPPCARE\/BEECH STREET","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":378335.45},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":278454.89},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($13,880). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":504447.27},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Per diem ($13,880). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":504447.27},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":43641.00,"10th_percentile":43641.00,"90th_percentile":43641.00,"count":"1 through 10","additional_payer_notes":"Inpatient","standard_charge_dollar":55631.96},{"payer_name":"UNITED AMERICAN [1087]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"REDLANDS COMMUNITY HOSPITAL [2005]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"CALIFORNIA HEALTH & WELLNESS MEDI-CAL [1122]","plan_name":"CALIFORNIA HEALTH AND WELLNESS MEDI-CAL (no longer Medi-Cal plan as of 1\/1\/24)","standard_charge_algorithm":"Per diem ($2,600).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2600.00},{"payer_name":"INTER VALLEY HEALTH PLAN [2024]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"GLOBAL EXCEL [1036]","plan_name":"GLOBAL EXCEL","standard_charge_algorithm":"Case rate ($68,377.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $63,302.88, add-ons for qualifying new technology services are included. If operating cost exceeds $111,987.50 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,878.15, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,911.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $62,513.77 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,676.85. The transfer capital threshold is the transfer adjustment factor * $4,676.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 165%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":68377.20},{"payer_name":"SIERRA MEDICAL GROUP [2048]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"CAL OPTIMA [1016]","plan_name":"CalOptima Medicare","standard_charge_algorithm":"Case rate ($68,377.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $63,302.88, add-ons for qualifying new technology services are included. If operating cost exceeds $111,987.50 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,878.15, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,911.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $62,513.77 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,676.85. The transfer capital threshold is the transfer adjustment factor * $4,676.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":68377.20},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Per diem ($8,294). The outlier payment amount is calculated by taking the estimated cost amount, subtracting the threshold amount ($247,571), then multiplying the difference by the percent of outlier that is reimbursed (53%). If the calculated outlier amount is greater than $0, it is added to the reimbursement total. The estimated cost amount is the adjusted billed amount multiplied by the cost-to-charge ratio (1). The following revenue codes are excluded from the adjusted billed amount: RC 0274-0276, 0278, 0624, 0891.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":8294.00},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":504447.27},{"payer_name":"HERITAGE VICTOR VALLEY MEDICAL GROUP [2045]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($67,770.97). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $62,719.68, add-ons for qualifying new technology services are included. If operating cost exceeds $111,878.57 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,383.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,328.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $61,930.58 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,653.83. The transfer capital threshold is the transfer adjustment factor * $4,653.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":67770.97},{"payer_name":"CHAMPVA [1020]","plan_name":"VETERANS ADMINISTRATION - CHAMPVA","standard_charge_algorithm":"Case rate ($68,377.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $63,302.88, add-ons for qualifying new technology services are included. If operating cost exceeds $111,987.50 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,878.15, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,911.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $62,513.77 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,676.85. The transfer capital threshold is the transfer adjustment factor * $4,676.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":68377.20},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"EASY CHOICE [1029]","plan_name":"EASY CHOICE","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"WORKERS COMPENSATION [1097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($68,377.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $63,302.88, add-ons for qualifying new technology services are included. If operating cost exceeds $111,987.50 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,878.15, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,911.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $62,513.77 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,676.85. The transfer capital threshold is the transfer adjustment factor * $4,676.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":88890.36},{"payer_name":"MC UHC VEBA GENERIC HMO [164032]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"RIVERSIDE MEDICAL CLINIC [2064]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":54519.32},{"payer_name":"ETS - LIFETRAC NETWORK [1103]","plan_name":"LIFETRAC","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":327890.73},{"payer_name":"TRIWEST ALTERNATE [2036]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($68,377.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $63,302.88, add-ons for qualifying new technology services are included. If operating cost exceeds $111,987.50 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,878.15, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,911.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $62,513.77 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,676.85. The transfer capital threshold is the transfer adjustment factor * $4,676.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":68377.20},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":504447.27},{"payer_name":"BLUE SHIELD [1014]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($55,493.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $51,102.39, add-ons for qualifying new technology services are included. If operating cost exceeds $100,261.28 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,723.08, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,710.76 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,313.28 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,993.75. The transfer capital threshold is the transfer adjustment factor * $3,993.75. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55493.60},{"payer_name":"IMPERIAL HEALTH PLAN [2081]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":302668.36},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE PPO","standard_charge_percentage":49.55,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":249953.62},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UHC SELECT AND SELECT PLUS","standard_charge_algorithm":"Per diem ($14,996).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":14996.00},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($67,770.97). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $62,719.68, add-ons for qualifying new technology services are included. If operating cost exceeds $111,878.57 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,383.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,328.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $61,930.58 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,653.83. The transfer capital threshold is the transfer adjustment factor * $4,653.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":67770.97},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"AETNA TRANSPLANTS [1112]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":302668.36},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"PYRAMID LIFE [1068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"UC AFF HUMANA\/SDSM [164025]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"CIGNA [1023]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"MONARCH HEALTHCARE [2006]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"UC AFF MC HUMANA GENERIC PAYOR [164027]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"MC BRAND NEW DAY HMO [164030]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"SCRIPPS HEALTH PLAN SERVICES [1075]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":302668.36},{"payer_name":"CMN - CANADIAN MEDICAL NETWORK [1024]","plan_name":"CMN GLOBAL INC","standard_charge_algorithm":"Case rate ($68,377.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $63,302.88, add-ons for qualifying new technology services are included. If operating cost exceeds $111,987.50 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,878.15, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,911.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $62,513.77 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,676.85. The transfer capital threshold is the transfer adjustment factor * $4,676.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 170%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":116241.24},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($67,770.97). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $62,719.68, add-ons for qualifying new technology services are included. If operating cost exceeds $111,878.57 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,383.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,328.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $61,930.58 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,653.83. The transfer capital threshold is the transfer adjustment factor * $4,653.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":97659.58,"10th_percentile":97659.58,"90th_percentile":97659.58,"count":"1 through 10","additional_payer_notes":"All Other Inpatient Services","standard_charge_dollar":67770.97},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"EMBASSY OF STATE OF KUWAIT [11010001]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":343024.14},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($67,770.97). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $62,719.68, add-ons for qualifying new technology services are included. If operating cost exceeds $111,878.57 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,383.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,328.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $61,930.58 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,653.83. The transfer capital threshold is the transfer adjustment factor * $4,653.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":67770.97},{"payer_name":"HIGH DESERT MEDICAL GROUP [2053]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"STATE OF CALIFORNIA [1082]","plan_name":"California State Prison","standard_charge_algorithm":"Case rate ($68,377.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $63,302.88, add-ons for qualifying new technology services are included. If operating cost exceeds $111,987.50 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,878.15, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,911.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $62,513.77 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,676.85. The transfer capital threshold is the transfer adjustment factor * $4,676.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 250%.","methodology":"other","median_amount":224992.72,"10th_percentile":224992.72,"90th_percentile":224992.72,"count":"1 through 10","additional_payer_notes":"Inpatient","standard_charge_dollar":68377.20},{"payer_name":"SAN DIEGO SOCKERS [2015]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($68,377.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $63,302.88, add-ons for qualifying new technology services are included. If operating cost exceeds $111,987.50 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,878.15, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,911.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $62,513.77 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,676.85. The transfer capital threshold is the transfer adjustment factor * $4,676.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":88890.36},{"payer_name":"AMERICAN SPECIALTY HEALTH PLAN [2038]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"WELL CARE [1096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"IMMIGRATION HEALTH SERVICES [1043]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($68,377.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $63,302.88, add-ons for qualifying new technology services are included. If operating cost exceeds $111,987.50 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,878.15, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,911.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $62,513.77 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,676.85. The transfer capital threshold is the transfer adjustment factor * $4,676.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":67009.66},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"HEMET COMMUNITY MED GRP - PROMISECARE [1040]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"MC UHC HARMONY HMO [164026]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Per diem ($14,938).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":14938.00},{"payer_name":"BLUE SHIELD PROMISE [1017]","plan_name":"CARE 1ST HEALTHPLAN MEDICARE ADVANTAGE (BS PROMISE)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MA\/SDPMG","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":52850.36},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Per diem ($14,938).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":14938.00},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($67,770.97). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $62,719.68, add-ons for qualifying new technology services are included. If operating cost exceeds $111,878.57 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,383.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,328.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $61,930.58 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,653.83. The transfer capital threshold is the transfer adjustment factor * $4,653.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":67770.97},{"payer_name":"LA CARE HEALTH PLAN [2025]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":302668.36},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":66758.35},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"ST JOSEPH ST JUDE [2065]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"GOLDEN PHYSICIANS MEDICAL GROUP [2082]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","median_amount":351934.80,"10th_percentile":351934.80,"90th_percentile":351934.80,"count":"1 through 10","additional_payer_notes":"Surgery","standard_charge_dollar":504447.27},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CALIFORNIA UC CARE \/ HSP","standard_charge_percentage":26.66,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":134485.64},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"KUWAIT OIL COMPANY [11010005]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":343024.14},{"payer_name":"SCAN HEALTH [1072]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":52850.36},{"payer_name":"KEY MED GRP [2074]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"ADVANTRA FREEDOM [1002]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"EMPIRE PHYS MED GRP [2072]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE SAN DIEGO","standard_charge_algorithm":"Case rate ($67,770.97). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $62,719.68, add-ons for qualifying new technology services are included. If operating cost exceeds $111,878.57 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,383.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,328.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $61,930.58 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,653.83. The transfer capital threshold is the transfer adjustment factor * $4,653.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":67770.97},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":61195.16},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($67,770.97). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $62,719.68, add-ons for qualifying new technology services are included. If operating cost exceeds $111,878.57 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,383.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,328.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $61,930.58 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,653.83. The transfer capital threshold is the transfer adjustment factor * $4,653.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":67770.97},{"payer_name":"SCRIPPS HOSPICE [2008]","plan_name":"SCRIPPS HEALTH HOSPICE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay.","standard_charge_dollar":700.00},{"payer_name":"BEACON HEALTH STRATEGY [2039]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($67,770.97). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $62,719.68, add-ons for qualifying new technology services are included. If operating cost exceeds $111,878.57 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,383.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,328.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $61,930.58 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,653.83. The transfer capital threshold is the transfer adjustment factor * $4,653.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":67770.97},{"payer_name":"MGM RESORTS [1053]","plan_name":"MGM RESORT","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":378335.45},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"SALUDPOL Peru Police","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":353113.09},{"payer_name":"HUMANA [1042]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($55,493.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $51,102.39, add-ons for qualifying new technology services are included. If operating cost exceeds $100,261.28 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,723.08, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,710.76 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,313.28 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,993.75. The transfer capital threshold is the transfer adjustment factor * $3,993.75. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55493.60},{"payer_name":"MC HNET BLUE&GOLD ACO [164017]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"Community Care IPA Medi-Cal Managed Care","standard_charge_algorithm":"Includes a variable per diem for days 0-99999: RC 0100:0169 @ $1,750; RC 0200:0202 @ $1,750; RC 0208:0213 @ $1,750; RC 0219 @ $1,750; RC 0206 @ $2,300; RC 0207 @ $2,300.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":504447.27},{"payer_name":"HEALTH CARE SUPPORT [2011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"USOC - US OLYMPIC COMMITTEE [1123]","plan_name":"USOC VIK (BSC UC CARE)","standard_charge_percentage":43.10,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":217416.77},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"UC AFF ANTHEM\/SDSM HMO [164024]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"MC HUMANA GENERIC PAYOR [164014]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"UC AFF ANTHEM\/XIMED HMO [164022]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"BRAND NEW DAY [1089]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"AXA ASSISTANCE [1098]","plan_name":"AXA ASSISTANCE USA,INC","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":403557.82},{"payer_name":"AETNA [1003]","plan_name":"AETNA BEHAVIORAL EATING DISORDER","standard_charge_percentage":43.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":220443.46},{"payer_name":"FRESENIUS [1034]","plan_name":"FRESENIUS HEALTH PARTNERS, INC","standard_charge_algorithm":"Case rate ($55,493.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $51,102.39, add-ons for qualifying new technology services are included. If operating cost exceeds $100,261.28 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,723.08, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,710.76 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,313.28 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,993.75. The transfer capital threshold is the transfer adjustment factor * $3,993.75. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55493.60},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK","standard_charge_algorithm":"Per diem ($4,700). A payment threshold will be met when non-excluded charges is greater than 325000. For days after this threshold has been met, a per diem of (non-excluded charges for that day multiplied by .65) will be used instead of the standard payment for each day after the threshold.","methodology":"other","median_amount":291306.57,"10th_percentile":291306.57,"90th_percentile":291306.57,"count":"1 through 10","additional_payer_notes":"Oncology","standard_charge_dollar":504447.27},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($55,493.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $51,102.39, add-ons for qualifying new technology services are included. If operating cost exceeds $100,261.28 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,723.08, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,710.76 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,313.28 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,993.75. The transfer capital threshold is the transfer adjustment factor * $3,993.75. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55493.60},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":504447.27},{"payer_name":"HEALTHNET TRANSPLANTS [1114]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":504447.27},{"payer_name":"MC AETNA HMO [164001]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"MEDICARE [1050]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($68,377.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $63,302.88, add-ons for qualifying new technology services are included. If operating cost exceeds $111,987.50 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,878.15, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,911.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $62,513.77 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,676.85. The transfer capital threshold is the transfer adjustment factor * $4,676.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","median_amount":84349.23,"10th_percentile":65862.76,"90th_percentile":113486.30,"count":"1 through 10","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":67009.66},{"payer_name":"KAISER [1046]","plan_name":"KAISER","standard_charge_percentage":67.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":337979.67},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Per diem ($10,457).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":10457.00},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EPO [10130074]","standard_charge_algorithm":"Per diem ($14,938).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":14938.00},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EATING DISORDER","standard_charge_percentage":58.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":295807.88},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($67,770.97). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $62,719.68, add-ons for qualifying new technology services are included. If operating cost exceeds $111,878.57 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,383.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,328.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $61,930.58 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,653.83. The transfer capital threshold is the transfer adjustment factor * $4,653.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":67770.97},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Per diem ($10,457).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":10457.00},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($67,770.97). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $62,719.68, add-ons for qualifying new technology services are included. If operating cost exceeds $111,878.57 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,383.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,328.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $61,930.58 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,653.83. The transfer capital threshold is the transfer adjustment factor * $4,653.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":67770.97},{"payer_name":"CENTRAL HEALTH PLAN [2026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"CASSIDY MED GRP [1019]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":327890.73},{"payer_name":"AETNA [1003]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"MEDCARE PARTNERS [2084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS UC CARE","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":133174.08},{"payer_name":"MC AETNA GENERIC PAYOR [164008]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"CLIPPERS WORKERS COMPENSATION [2097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($68,377.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $63,302.88, add-ons for qualifying new technology services are included. If operating cost exceeds $111,987.50 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,878.15, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,911.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $62,513.77 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,676.85. The transfer capital threshold is the transfer adjustment factor * $4,676.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":88890.36},{"payer_name":"BEAVER MED GRP [2075]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"MC BLUE SHIELD GENERIC PAYOR [164016]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60533.67},{"payer_name":"HEALTHCARE PARTNERS [2073]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":504447.27},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($67,770.97). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $62,719.68, add-ons for qualifying new technology services are included. If operating cost exceeds $111,878.57 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,383.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,328.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $61,930.58 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,653.83. The transfer capital threshold is the transfer adjustment factor * $4,653.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":67770.97},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":66758.35},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"COMMUNITY ELDERCARE [1027]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"OPTUM CARE NETWORK - PCAMG [1064]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":327890.73},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA HMO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","median_amount":364983.85,"10th_percentile":364983.85,"90th_percentile":364983.85,"count":"1 through 10","additional_payer_notes":"undefined","standard_charge_dollar":253736.98},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA PPO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":253736.98},{"payer_name":"VA - VETERANS ADMINISTRATION [1093]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($68,377.20). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $63,302.88, add-ons for qualifying new technology services are included. If operating cost exceeds $111,987.50 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,878.15, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,911.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $62,513.77 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,676.85. The transfer capital threshold is the transfer adjustment factor * $4,676.85. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":68377.20},{"payer_name":"US MARSHAL SERVICES [1090]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($55,631.96). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $51,230.15, add-ons for qualifying new technology services are included. If operating cost exceeds $99,914.77 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,205.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $50,838.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $50,441.04 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,004.34. The transfer capital threshold is the transfer adjustment factor * $4,004.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55631.96},{"payer_name":"DESERT OASIS HEALTH CARE [2052]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($67,770.97). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $62,719.68, add-ons for qualifying new technology services are included. If operating cost exceeds $111,878.57 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,383.16, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 11.4. The base transfer operating payment is the transfer adjustment factor * $62,328.05 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $61,930.58 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,653.83. The transfer capital threshold is the transfer adjustment factor * $4,653.83. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":67770.97}]}]}
,{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"minimum":4.22,"maximum":103417.22,"gross_charge":381170.91,"discounted_cash":209644.00,"setting":"inpatient","payers_information":[{"payer_name":"DESERT OASIS HEALTH CARE [2052]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($52,565.86). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $48,661.23, add-ons for qualifying new technology services are included. If operating cost exceeds $97,820.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,326.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,179.36 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $47,872.12 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,597.39. The transfer capital threshold is the transfer adjustment factor * $3,597.39. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":52565.86},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Commercial","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 160%.","methodology":"other","count":"0","additional_payer_notes":"Oncology Care Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":69091.90},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Medicare","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"Oncology Care Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":51818.93},{"payer_name":"LAKESIDE MEDICAL GROUP [2054]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"MC CIGNA GENERIC PAYOR [164007]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"ALTERNATE HEALTH NET BH [2059]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":381170.91},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"ALTERNATE HEALTH NET BH [2059]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"HMSA - HAWAII MEDICAL SERVICE ASSOC MDCR [1041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"IMPERIAL COUNTY PHYSICIAN MED GRP","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":42318.79},{"payer_name":"ALTERNATE SHERIFF CUSTODY [1106]","plan_name":"SHERIFF COUNTY CONTRACT # 514250","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":247761.09},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH PLAN","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":228702.55},{"payer_name":"MENIFEE MED GRP [2076]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MARKET PLACE","standard_charge_algorithm":"Case rate ($43,075.49). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $39,681.10, add-ons for qualifying new technology services are included. If operating cost exceeds $88,839.99 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,199.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,891.99 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,087.15. The transfer capital threshold is the transfer adjustment factor * $3,087.15. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 180%.","methodology":"other","median_amount":205440.17,"10th_percentile":205440.17,"90th_percentile":205440.17,"count":"1 through 10","additional_payer_notes":"All Inpatient","standard_charge_dollar":43075.49},{"payer_name":"XIMED [2016]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"QUALITY HEALTH [1069]","plan_name":"QUALITY HEALTH MANAGEMENT","standard_charge_algorithm":"Case rate ($53,034.47). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $49,112.04, add-ons for qualifying new technology services are included. If operating cost exceeds $97,796.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,630.17 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $48,322.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,615.19. The transfer capital threshold is the transfer adjustment factor * $3,615.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 195%.","methodology":"other","count":"0","additional_payer_notes":"Oncology  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":103417.22},{"payer_name":"MC HUMANA GENERIC PAYOR [164014]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"AFFILIATED DOCTORS OF ORANGE COUNTY [2041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"RIVER CITY MEDICAL GROUP [2066]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA COMMERCIAL","standard_charge_percentage":85.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":323995.27},{"payer_name":"ALTERNATE MEDICARE [2007]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($53,034.47). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $49,112.04, add-ons for qualifying new technology services are included. If operating cost exceeds $97,796.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,630.17 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $48,322.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,615.19. The transfer capital threshold is the transfer adjustment factor * $3,615.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":51973.78},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($53,034.47). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $49,112.04, add-ons for qualifying new technology services are included. If operating cost exceeds $97,796.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,630.17 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $48,322.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,615.19. The transfer capital threshold is the transfer adjustment factor * $3,615.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":53034.47},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($53,034.47). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $49,112.04, add-ons for qualifying new technology services are included. If operating cost exceeds $97,796.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,630.17 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $48,322.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,615.19. The transfer capital threshold is the transfer adjustment factor * $3,615.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":53034.47},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE [10230006]","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE TRANSPLANT [11170001]","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"UCR PROMPT PAY PAYOR [8240]","plan_name":"UCSD CHARITY MEDICARE CONTRACT","standard_charge_algorithm":"Case rate ($53,034.47). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $49,112.04, add-ons for qualifying new technology services are included. If operating cost exceeds $97,796.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,630.17 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $48,322.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,615.19. The transfer capital threshold is the transfer adjustment factor * $3,615.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Medicare All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":53034.47},{"payer_name":"AETNA [1003]","plan_name":"AETNA","standard_charge_algorithm":"Payment is accumulated by procedure count, in order of descending billed amounts. Procedure 1, Case rate ($26,341). Procedures 2 - 9999, Per diem ($13,036).","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":381170.91},{"payer_name":"USAA [1091]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"STERLING OPTION 1 [1083]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"ALTERNATE AETNA [1004]","plan_name":"AETNA","standard_charge_algorithm":"Payment is accumulated by procedure count, in order of descending billed amounts. Procedure 1, Case rate ($26,341). Procedures 2 - 9999, Per diem ($13,036).","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":381170.91},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":42318.79},{"payer_name":"ALTERNATE KAISER RAD ONC [2089]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":381170.91},{"payer_name":"ASTIVA HEALTH [2095]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($52,565.86). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $48,661.23, add-ons for qualifying new technology services are included. If operating cost exceeds $97,820.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,326.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,179.36 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $47,872.12 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,597.39. The transfer capital threshold is the transfer adjustment factor * $3,597.39. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":52565.86},{"payer_name":"MC HEALTHNET GENERIC PAYOR [164010]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"AMA - AMERICAN MEDICAL ASSOCIATION [1009]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"IMPERIAL HEALTH HOLDINGS [1132]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"CIGNA [1023]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($52,565.86). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $48,661.23, add-ons for qualifying new technology services are included. If operating cost exceeds $97,820.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,326.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,179.36 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $47,872.12 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,597.39. The transfer capital threshold is the transfer adjustment factor * $3,597.39. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":52565.86},{"payer_name":"MC CIGNA HMO [164003]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"AETNA [1003]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($43,075.49). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $39,681.10, add-ons for qualifying new technology services are included. If operating cost exceeds $88,839.99 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,199.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,891.99 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,087.15. The transfer capital threshold is the transfer adjustment factor * $3,087.15. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43075.49},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"CIGNA HMO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":191728.97},{"payer_name":"SCRIPPS COASTAL MED GRP [1074]","plan_name":"SCRIPPS COASTAL MED GRP [10740001]","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":247761.09},{"payer_name":"CLEVER CARE [2061]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($43,075.49). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $39,681.10, add-ons for qualifying new technology services are included. If operating cost exceeds $88,839.99 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,199.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,891.99 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,087.15. The transfer capital threshold is the transfer adjustment factor * $3,087.15. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43075.49},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"OLYMPUS MANAGED HEALTHCARE INC [11020001]","standard_charge_algorithm":"Payment is accumulated by procedure count, in order of descending billed amounts. Procedure 1, Case rate ($26,341). Procedures 2 - 9999, Per diem ($13,036).","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":381170.91},{"payer_name":"ALTERNATE SCAN HEALTH [2088]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":41023.32},{"payer_name":"MC ANTHEM BLUE CROSS HMO [164002]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"TRANSAMERICA [1084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"ENCOMPASS MED GRP [1030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","median_amount":42337.69,"10th_percentile":42337.69,"90th_percentile":42337.69,"count":"1 through 10","additional_payer_notes":"All Inpatient","standard_charge_dollar":43182.44},{"payer_name":"DEPARTMENT OF LABOR [1028]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($53,034.47). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $49,112.04, add-ons for qualifying new technology services are included. If operating cost exceeds $97,796.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,630.17 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $48,322.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,615.19. The transfer capital threshold is the transfer adjustment factor * $3,615.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":68944.81},{"payer_name":"CAREMORE [2028]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"PRIMARY CARE ASSOCIATES OF CA [2067]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"ALTERNATE VA - VETERANS ADMINISTRATION [1239]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($53,034.47). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $49,112.04, add-ons for qualifying new technology services are included. If operating cost exceeds $97,796.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,630.17 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $48,322.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,615.19. The transfer capital threshold is the transfer adjustment factor * $3,615.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":53034.47},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($53,034.47). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $49,112.04, add-ons for qualifying new technology services are included. If operating cost exceeds $97,796.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,630.17 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $48,322.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,615.19. The transfer capital threshold is the transfer adjustment factor * $3,615.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":53034.47},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($53,034.47). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $49,112.04, add-ons for qualifying new technology services are included. If operating cost exceeds $97,796.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,630.17 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $48,322.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,615.19. The transfer capital threshold is the transfer adjustment factor * $3,615.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":53034.47},{"payer_name":"SDSM [2017]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"COMMUNITY HEALTH GROUP [1022]","plan_name":"COMMUNITY HEALTH GROUP MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 113%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":48796.16},{"payer_name":"BANKERS LIFE [1011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"UC AFF ANTHEM\/XIMED HMO [164022]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"VANTAGE [1092]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"SIMNSA HEALTH PLAN [2047]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"ADMAR [1001]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":247761.09},{"payer_name":"BPS - BENEFIT PLAN SERVICES [1015]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":247761.09},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MID-COUNTY PHYSICIANS NARROW NETWORK","standard_charge_algorithm":"Per diem ($17,123).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":17123.00},{"payer_name":"MC HEALTHNET HMO [164004]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"ALPHACARE [2062]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD COVERED CA TRIO HMO","standard_charge_algorithm":"Per diem ($13,880). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":381170.91},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA COMMERCIAL","standard_charge_percentage":85.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":323995.27},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($43,075.49). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $39,681.10, add-ons for qualifying new technology services are included. If operating cost exceeds $88,839.99 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,199.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,891.99 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,087.15. The transfer capital threshold is the transfer adjustment factor * $3,087.15. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Pre\/Post or Other\/VAD Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43075.49},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDI-CAL","standard_charge_algorithm":"Case rate ($52,565.86). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $48,661.23, add-ons for qualifying new technology services are included. If operating cost exceeds $97,820.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,326.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,179.36 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $47,872.12 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,597.39. The transfer capital threshold is the transfer adjustment factor * $3,597.39. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 80%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Pre\/Post  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":42052.69},{"payer_name":"EASY ACCESS CARE [2077]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":381170.91},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNA PRIORITY SELECT","standard_charge_algorithm":"Per diem ($7,362).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":7362.00},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET ENHANCED CARE PPO","standard_charge_algorithm":"Case rate ($39,709.18). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $36,576.69, add-ons for qualifying new technology services are included. If operating cost exceeds $85,735.58 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,554.59, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $36,883.93. The transfer operating threshold is the transfer adjustment factor * $36,576.69 If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,825.25. The transfer capital threshold is the transfer adjustment factor * $2,825.25. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 281%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services (MSDRG no DSH GME IME) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":39709.18},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($52,565.86). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $48,661.23, add-ons for qualifying new technology services are included. If operating cost exceeds $97,820.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,326.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,179.36 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $47,872.12 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,597.39. The transfer capital threshold is the transfer adjustment factor * $3,597.39. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":52565.86},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($43,075.49). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $39,681.10, add-ons for qualifying new technology services are included. If operating cost exceeds $88,839.99 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,199.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,891.99 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,087.15. The transfer capital threshold is the transfer adjustment factor * $3,087.15. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43075.49},{"payer_name":"MC UHC HARMONY HMO [164026]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"ARCH HEALTH PARTNERS [2000]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"MC BLUE SHIELD HMO [164015]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"KAISER [1046]","plan_name":"KAISER MEDICARE ADVANTAGE","standard_charge_percentage":67.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":255384.51},{"payer_name":"MC ANTHEM BLUE CROSS GENERIC PAYOR [164009]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED HMO NON CONTRACTED [10260001]","standard_charge_algorithm":"Case rate ($43,075.49). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $39,681.10, add-ons for qualifying new technology services are included. If operating cost exceeds $88,839.99 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,199.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,891.99 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,087.15. The transfer capital threshold is the transfer adjustment factor * $3,087.15. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43075.49},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED PPO NON CONTRACTED [10260002]","standard_charge_algorithm":"Case rate ($43,075.49). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $39,681.10, add-ons for qualifying new technology services are included. If operating cost exceeds $88,839.99 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,199.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,891.99 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,087.15. The transfer capital threshold is the transfer adjustment factor * $3,087.15. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43075.49},{"payer_name":"FIRST HEALTH [1032]","plan_name":"FIRST HEALTH","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":285878.18},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($52,565.86). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $48,661.23, add-ons for qualifying new technology services are included. If operating cost exceeds $97,820.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,326.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,179.36 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $47,872.12 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,597.39. The transfer capital threshold is the transfer adjustment factor * $3,597.39. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":52565.86},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"INTERPLAN [1045]","plan_name":"INTERPLAN","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":266819.64},{"payer_name":"BLUE CROSS [1013]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($43,075.49). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $39,681.10, add-ons for qualifying new technology services are included. If operating cost exceeds $88,839.99 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,199.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,891.99 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,087.15. The transfer capital threshold is the transfer adjustment factor * $3,087.15. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43075.49},{"payer_name":"BLUE CROSS [1013]","plan_name":"UCSD STUDENT HEALTH INS PLAN - BC SHIP","standard_charge_percentage":26.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":101772.63},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Per diem ($8,294). The outlier payment amount is calculated by taking the estimated cost amount, subtracting the threshold amount ($247,571), then multiplying the difference by the percent of outlier that is reimbursed (53%). If the calculated outlier amount is greater than $0, it is added to the reimbursement total. The estimated cost amount is the adjusted billed amount multiplied by the cost-to-charge ratio (1). The following revenue codes are excluded from the adjusted billed amount: RC 0274-0276, 0278, 0624, 0891.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":8294.00},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"INTERNATIONAL EMBASSY OF KUWAIT","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":259196.22},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":381170.91},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET MEDICARE ADVANTAGE UC EMPLOYER GROUP","standard_charge_algorithm":"Fee schedule rate ($4.22). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":4.22},{"payer_name":"UNLISTED MEDICARE ADVANTAGE (NON-CONTRACTED) [1051]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"ELIZABETH HOSPICE [2018]","plan_name":"ELIZABETH HOSPICE GIP","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay.","standard_charge_dollar":950.00},{"payer_name":"CHRISTIAN HEALTHCARE MINISTRIES [2030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"CHESAPEAKE LIFE [1021]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"TRI-CITY [1085]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS UC CARE","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":100629.12},{"payer_name":"MC AETNA HMO [164001]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"MUTUAL OF OMAHA [1059]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"CIGNA [1023]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":210406.34},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"UNLISTED HOSPICE [1035]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"MULTIPLAN [1058]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":247761.09},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"US BEHAVIORAL MENTAL\/EATING DISORDER","standard_charge_percentage":70.00,"standard_charge_algorithm":"70% of billed.","methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":266819.64},{"payer_name":"SEDGWICK [1077]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($53,034.47). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $49,112.04, add-ons for qualifying new technology services are included. If operating cost exceeds $97,796.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,630.17 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $48,322.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,615.19. The transfer capital threshold is the transfer adjustment factor * $3,615.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":68944.81},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($52,565.86). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $48,661.23, add-ons for qualifying new technology services are included. If operating cost exceeds $97,820.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,326.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,179.36 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $47,872.12 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,597.39. The transfer capital threshold is the transfer adjustment factor * $3,597.39. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":52565.86},{"payer_name":"TRIWEST [2003]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($53,034.47). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $49,112.04, add-ons for qualifying new technology services are included. If operating cost exceeds $97,796.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,630.17 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $48,322.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,615.19. The transfer capital threshold is the transfer adjustment factor * $3,615.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":53034.47},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($13,880). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":381170.91},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Per diem ($13,880). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":381170.91},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA EPN\/IFP","standard_charge_algorithm":"Per diem ($10,826). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .468 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":381170.91},{"payer_name":"INTEGRATED HEALTH PARTNERS [2068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"PACIFIC FOUNDATION [1063]","plan_name":"PACIFIC FOUNDATION FOR MEDICAL CARE","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":285878.18},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE ST PAULS","standard_charge_algorithm":"Case rate ($53,034.47). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $49,112.04, add-ons for qualifying new technology services are included. If operating cost exceeds $97,796.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,630.17 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $48,322.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,615.19. The transfer capital threshold is the transfer adjustment factor * $3,615.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":53034.47},{"payer_name":"MC SCAN GENERIC PAYOR [164034]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"GREATER NEWPORT PHYSICIANS [2096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"MC UHC VEBA HMO [164033]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"MVP HEALTHCARE [1060]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"MEDI-CAL [1048]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS HOUSE STAFF","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":100629.12},{"payer_name":"NATIONAL HEALTHCARE SOLUTIONS INC [1100]","plan_name":"NATIONAL HEALTHCARE SOLUTIONS INC [11000001]","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":304936.73},{"payer_name":"MC UNITED HEALTHCARE HMO [164005]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"SD PHYSICIANS MED GRP [1076]","plan_name":"SD PHYSICIANS MED GRP SR [10760002]","standard_charge_percentage":55.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":209644.00},{"payer_name":"UC AFF BLUE SHIELD SR\/SDSM [164037]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"MERCY PHYSICIANS MED GRP [1052]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"VILLAGE HEALTH [1094]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"TRI-CITY MEDICAL CENTER [1129]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"MC UHC ALLIANCE HMO [164020]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"PRIVATE HEALTHCARE SYSTEM","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":247761.09},{"payer_name":"HEALTH NET [1039]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"BLUE SHIELD TRANSPLANTS [1113]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($13,880). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":381170.91},{"payer_name":"MC SCAN HMO [164035]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"ALTERNATE BRAND NEW DAY [2079]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"INLAND FACULTY MEDICAL GROUP [2063]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"PREMIER PATIENT CARE IPA [2069]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"CARNIVAL CRUISES [1018]","plan_name":"CARNIVAL CRUISES [10180001]","standard_charge_percentage":90.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":343053.82},{"payer_name":"KERN HEALTH SYSTEMS [2033]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"MC UNITED HEALTHCARE GENERIC PAYOR [164011]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"ROYAL EMBASSY","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":266819.64},{"payer_name":"BEECH STREET [1012]","plan_name":"CAPPCARE\/BEECH STREET","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":285878.18},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($13,880). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":381170.91},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Per diem ($13,880). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":381170.91},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"REDLANDS COMMUNITY HOSPITAL [2005]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"UNITED AMERICAN [1087]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"CALIFORNIA HEALTH & WELLNESS MEDI-CAL [1122]","plan_name":"CALIFORNIA HEALTH AND WELLNESS MEDI-CAL (no longer Medi-Cal plan as of 1\/1\/24)","standard_charge_algorithm":"Per diem ($2,600).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2600.00},{"payer_name":"INTER VALLEY HEALTH PLAN [2024]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"GLOBAL EXCEL [1036]","plan_name":"GLOBAL EXCEL","standard_charge_algorithm":"Case rate ($53,034.47). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $49,112.04, add-ons for qualifying new technology services are included. If operating cost exceeds $97,796.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,630.17 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $48,322.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,615.19. The transfer capital threshold is the transfer adjustment factor * $3,615.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 165%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":53034.47},{"payer_name":"SIERRA MEDICAL GROUP [2048]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"HERITAGE VICTOR VALLEY MEDICAL GROUP [2045]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($52,565.86). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $48,661.23, add-ons for qualifying new technology services are included. If operating cost exceeds $97,820.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,326.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,179.36 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $47,872.12 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,597.39. The transfer capital threshold is the transfer adjustment factor * $3,597.39. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":52565.86},{"payer_name":"CHAMPVA [1020]","plan_name":"VETERANS ADMINISTRATION - CHAMPVA","standard_charge_algorithm":"Case rate ($53,034.47). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $49,112.04, add-ons for qualifying new technology services are included. If operating cost exceeds $97,796.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,630.17 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $48,322.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,615.19. The transfer capital threshold is the transfer adjustment factor * $3,615.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":53034.47},{"payer_name":"CAL OPTIMA [1016]","plan_name":"CalOptima Medicare","standard_charge_algorithm":"Case rate ($53,034.47). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $49,112.04, add-ons for qualifying new technology services are included. If operating cost exceeds $97,796.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,630.17 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $48,322.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,615.19. The transfer capital threshold is the transfer adjustment factor * $3,615.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":53034.47},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Per diem ($8,294). The outlier payment amount is calculated by taking the estimated cost amount, subtracting the threshold amount ($247,571), then multiplying the difference by the percent of outlier that is reimbursed (53%). If the calculated outlier amount is greater than $0, it is added to the reimbursement total. The estimated cost amount is the adjusted billed amount multiplied by the cost-to-charge ratio (1). The following revenue codes are excluded from the adjusted billed amount: RC 0274-0276, 0278, 0624, 0891.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":8294.00},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":381170.91},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"WORKERS COMPENSATION [1097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($53,034.47). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $49,112.04, add-ons for qualifying new technology services are included. If operating cost exceeds $97,796.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,630.17 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $48,322.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,615.19. The transfer capital threshold is the transfer adjustment factor * $3,615.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":68944.81},{"payer_name":"MC UHC VEBA GENERIC HMO [164032]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"EASY CHOICE [1029]","plan_name":"EASY CHOICE","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"RIVERSIDE MEDICAL CLINIC [2064]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"ETS - LIFETRAC NETWORK [1103]","plan_name":"LIFETRAC","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":247761.09},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":42318.79},{"payer_name":"TRIWEST ALTERNATE [2036]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($53,034.47). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $49,112.04, add-ons for qualifying new technology services are included. If operating cost exceeds $97,796.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,630.17 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $48,322.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,615.19. The transfer capital threshold is the transfer adjustment factor * $3,615.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":53034.47},{"payer_name":"MC BRAND NEW DAY GENERIC PAYOR [164031]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":381170.91},{"payer_name":"BLUE SHIELD [1014]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($43,075.49). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $39,681.10, add-ons for qualifying new technology services are included. If operating cost exceeds $88,839.99 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,199.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,891.99 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,087.15. The transfer capital threshold is the transfer adjustment factor * $3,087.15. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43075.49},{"payer_name":"IMPERIAL HEALTH PLAN [2081]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"AETNA","standard_charge_algorithm":"Payment is accumulated by procedure count, in order of descending billed amounts. Procedure 1, Case rate ($26,341). Procedures 2 - 9999, Per diem ($13,036).","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":381170.91},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE PPO","standard_charge_percentage":49.55,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":188870.19},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UHC SELECT AND SELECT PLUS","standard_charge_algorithm":"Per diem ($14,996).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":14996.00},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":228702.55},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($52,565.86). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $48,661.23, add-ons for qualifying new technology services are included. If operating cost exceeds $97,820.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,326.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,179.36 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $47,872.12 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,597.39. The transfer capital threshold is the transfer adjustment factor * $3,597.39. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":52565.86},{"payer_name":"AETNA TRANSPLANTS [1112]","plan_name":"AETNA","standard_charge_algorithm":"Payment is accumulated by procedure count, in order of descending billed amounts. Procedure 1, Case rate ($26,341). Procedures 2 - 9999, Per diem ($13,036).","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":381170.91},{"payer_name":"PYRAMID LIFE [1068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"UC AFF HUMANA\/SDSM [164025]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"CIGNA [1023]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"MONARCH HEALTHCARE [2006]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"UC AFF MC HUMANA GENERIC PAYOR [164027]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"MC BRAND NEW DAY HMO [164030]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($52,565.86). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $48,661.23, add-ons for qualifying new technology services are included. If operating cost exceeds $97,820.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,326.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,179.36 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $47,872.12 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,597.39. The transfer capital threshold is the transfer adjustment factor * $3,597.39. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":52565.86},{"payer_name":"CMN - CANADIAN MEDICAL NETWORK [1024]","plan_name":"CMN GLOBAL INC","standard_charge_algorithm":"Case rate ($53,034.47). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $49,112.04, add-ons for qualifying new technology services are included. If operating cost exceeds $97,796.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,630.17 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $48,322.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,615.19. The transfer capital threshold is the transfer adjustment factor * $3,615.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 170%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":90158.60},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"SCRIPPS HEALTH PLAN SERVICES [1075]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":228702.55},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($52,565.86). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $48,661.23, add-ons for qualifying new technology services are included. If operating cost exceeds $97,820.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,326.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,179.36 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $47,872.12 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,597.39. The transfer capital threshold is the transfer adjustment factor * $3,597.39. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":52565.86},{"payer_name":"STATE OF CALIFORNIA [1082]","plan_name":"California State Prison","standard_charge_algorithm":"Case rate ($53,034.47). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $49,112.04, add-ons for qualifying new technology services are included. If operating cost exceeds $97,796.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,630.17 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $48,322.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,615.19. The transfer capital threshold is the transfer adjustment factor * $3,615.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 250%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":53034.47},{"payer_name":"SAN DIEGO SOCKERS [2015]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($53,034.47). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $49,112.04, add-ons for qualifying new technology services are included. If operating cost exceeds $97,796.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,630.17 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $48,322.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,615.19. The transfer capital threshold is the transfer adjustment factor * $3,615.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":68944.81},{"payer_name":"AMERICAN SPECIALTY HEALTH PLAN [2038]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"HIGH DESERT MEDICAL GROUP [2053]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"IMMIGRATION HEALTH SERVICES [1043]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($53,034.47). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $49,112.04, add-ons for qualifying new technology services are included. If operating cost exceeds $97,796.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,630.17 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $48,322.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,615.19. The transfer capital threshold is the transfer adjustment factor * $3,615.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":51973.78},{"payer_name":"WELL CARE [1096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"HEMET COMMUNITY MED GRP - PROMISECARE [1040]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Per diem ($14,938).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":14938.00},{"payer_name":"BLUE SHIELD PROMISE [1017]","plan_name":"CARE 1ST HEALTHPLAN MEDICARE ADVANTAGE (BS PROMISE)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MA\/SDPMG","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":41023.32},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($52,565.86). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $48,661.23, add-ons for qualifying new technology services are included. If operating cost exceeds $97,820.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,326.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,179.36 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $47,872.12 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,597.39. The transfer capital threshold is the transfer adjustment factor * $3,597.39. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":52565.86},{"payer_name":"LA CARE HEALTH PLAN [2025]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":51818.93},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":381170.91},{"payer_name":"ST JOSEPH ST JUDE [2065]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"GOLDEN PHYSICIANS MEDICAL GROUP [2082]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CALIFORNIA UC CARE \/ HSP","standard_charge_percentage":26.66,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":101620.16},{"payer_name":"KEY MED GRP [2074]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"ADVANTRA FREEDOM [1002]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"SCAN HEALTH [1072]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":41023.32},{"payer_name":"SCRIPPS HOSPICE [2008]","plan_name":"SCRIPPS HEALTH HOSPICE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay.","standard_charge_dollar":700.00},{"payer_name":"EMPIRE PHYS MED GRP [2072]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE SAN DIEGO","standard_charge_algorithm":"Case rate ($52,565.86). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $48,661.23, add-ons for qualifying new technology services are included. If operating cost exceeds $97,820.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,326.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,179.36 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $47,872.12 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,597.39. The transfer capital threshold is the transfer adjustment factor * $3,597.39. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":52565.86},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","median_amount":108666.75,"10th_percentile":108666.75,"90th_percentile":108666.75,"count":"1 through 10","additional_payer_notes":"All Inpatient","standard_charge_dollar":47500.68},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($52,565.86). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $48,661.23, add-ons for qualifying new technology services are included. If operating cost exceeds $97,820.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,326.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,179.36 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $47,872.12 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,597.39. The transfer capital threshold is the transfer adjustment factor * $3,597.39. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":52565.86},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($52,565.86). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $48,661.23, add-ons for qualifying new technology services are included. If operating cost exceeds $97,820.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,326.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,179.36 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $47,872.12 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,597.39. The transfer capital threshold is the transfer adjustment factor * $3,597.39. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":52565.86},{"payer_name":"BEACON HEALTH STRATEGY [2039]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"MGM RESORTS [1053]","plan_name":"MGM RESORT","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":285878.18},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"EMBASSY OF STATE OF KUWAIT [11010001]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":259196.22},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"KUWAIT OIL COMPANY [11010005]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":259196.22},{"payer_name":"HUMANA [1042]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($43,075.49). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $39,681.10, add-ons for qualifying new technology services are included. If operating cost exceeds $88,839.99 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,199.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,891.99 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,087.15. The transfer capital threshold is the transfer adjustment factor * $3,087.15. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43075.49},{"payer_name":"MC HNET BLUE&GOLD ACO [164017]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"HEALTH CARE SUPPORT [2011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"USOC - US OLYMPIC COMMITTEE [1123]","plan_name":"USOC VIK (BSC UC CARE)","standard_charge_percentage":43.10,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":164284.66},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE QUALCOMM ","standard_charge_percentage":45.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":173966.40},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"Community Care IPA Medi-Cal Managed Care","standard_charge_algorithm":"Includes a variable per diem for days 0-99999: RC 0100:0169 @ $1,750; RC 0200:0202 @ $1,750; RC 0208:0213 @ $1,750; RC 0219 @ $1,750; RC 0206 @ $2,300; RC 0207 @ $2,300.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":381170.91},{"payer_name":"UC AFF ANTHEM\/SDSM HMO [164024]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"BRAND NEW DAY [1089]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"AXA ASSISTANCE [1098]","plan_name":"AXA ASSISTANCE USA,INC","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":304936.73},{"payer_name":"FRESENIUS [1034]","plan_name":"FRESENIUS HEALTH PARTNERS, INC","standard_charge_algorithm":"Case rate ($43,075.49). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $39,681.10, add-ons for qualifying new technology services are included. If operating cost exceeds $88,839.99 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,199.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,891.99 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,087.15. The transfer capital threshold is the transfer adjustment factor * $3,087.15. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43075.49},{"payer_name":"ALTERNATE MEDI-CAL [2001]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK","standard_charge_algorithm":"Per diem ($4,700). A payment threshold will be met when non-excluded charges is greater than 325000. For days after this threshold has been met, a per diem of (non-excluded charges for that day multiplied by .65) will be used instead of the standard payment for each day after the threshold.","methodology":"other","count":"0","additional_payer_notes":"Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":381170.91},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":381170.91},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($43,075.49). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $39,681.10, add-ons for qualifying new technology services are included. If operating cost exceeds $88,839.99 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,199.24 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,891.99 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,087.15. The transfer capital threshold is the transfer adjustment factor * $3,087.15. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43075.49},{"payer_name":"HEALTHNET TRANSPLANTS [1114]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":381170.91},{"payer_name":"MEDICARE [1050]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($53,034.47). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $49,112.04, add-ons for qualifying new technology services are included. If operating cost exceeds $97,796.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,630.17 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $48,322.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,615.19. The transfer capital threshold is the transfer adjustment factor * $3,615.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","median_amount":51096.28,"10th_percentile":51096.28,"90th_percentile":91546.65,"count":"1 through 10","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":51973.78},{"payer_name":"KAISER [1046]","plan_name":"KAISER","standard_charge_percentage":67.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":255384.51},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EPO [10130074]","standard_charge_algorithm":"Per diem ($14,938).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":14938.00},{"payer_name":"MC HUMANA HMO [164013]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EATING DISORDER","standard_charge_percentage":58.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":223518.62},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($52,565.86). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $48,661.23, add-ons for qualifying new technology services are included. If operating cost exceeds $97,820.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,326.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,179.36 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $47,872.12 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,597.39. The transfer capital threshold is the transfer adjustment factor * $3,597.39. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":52565.86},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Per diem ($10,457).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":10457.00},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($52,565.86). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $48,661.23, add-ons for qualifying new technology services are included. If operating cost exceeds $97,820.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,326.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,179.36 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $47,872.12 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,597.39. The transfer capital threshold is the transfer adjustment factor * $3,597.39. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":52565.86},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":210406.34},{"payer_name":"CENTRAL HEALTH PLAN [2026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"CASSIDY MED GRP [1019]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":247761.09},{"payer_name":"MEDCARE PARTNERS [2084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"AETNA [1003]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"CLIPPERS WORKERS COMPENSATION [2097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($53,034.47). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $49,112.04, add-ons for qualifying new technology services are included. If operating cost exceeds $97,796.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,630.17 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $48,322.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,615.19. The transfer capital threshold is the transfer adjustment factor * $3,615.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":68944.81},{"payer_name":"MC BLUE SHIELD GENERIC PAYOR [164016]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"BEAVER MED GRP [2075]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"MC AETNA GENERIC PAYOR [164008]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":45740.51},{"payer_name":"HEALTHCARE PARTNERS [2073]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":381170.91},{"payer_name":"AETNA [1003]","plan_name":"AETNA BEHAVIORAL EATING DISORDER","standard_charge_percentage":43.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":166571.69},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"SALUDPOL Peru Police","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":266819.64},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($52,565.86). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $48,661.23, add-ons for qualifying new technology services are included. If operating cost exceeds $97,820.12 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,326.73, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,179.36 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $47,872.12 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,597.39. The transfer capital threshold is the transfer adjustment factor * $3,597.39. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":52565.86},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Per diem ($10,457).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":10457.00},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":51818.93},{"payer_name":"OPTUM CARE NETWORK - PCAMG [1064]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":247761.09},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA HMO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":191728.97},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":110026.86,"10th_percentile":110026.86,"90th_percentile":110026.86,"count":"1 through 10","additional_payer_notes":"All Inptient Services","standard_charge_dollar":43182.44},{"payer_name":"COMMUNITY ELDERCARE [1027]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA PPO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":191728.97},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Per diem ($14,938).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 8 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":14938.00},{"payer_name":"VA - VETERANS ADMINISTRATION [1093]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($53,034.47). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $49,112.04, add-ons for qualifying new technology services are included. If operating cost exceeds $97,796.66 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,816.49, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $48,630.17 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $48,322.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,615.19. The transfer capital threshold is the transfer adjustment factor * $3,615.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":53034.47},{"payer_name":"US MARSHAL SERVICES [1090]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($43,182.44). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $39,779.86, add-ons for qualifying new technology services are included. If operating cost exceeds $88,464.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $6,296.64, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 8.6. The base transfer operating payment is the transfer adjustment factor * $39,297.99 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $38,990.75 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,095.34. The transfer capital threshold is the transfer adjustment factor * $3,095.34. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43182.44}]}]}
,{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc\/McC","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"minimum":2.88,"maximum":67526.55,"gross_charge":316034.50,"discounted_cash":173818.98,"setting":"inpatient","payers_information":[{"payer_name":"DESERT OASIS HEALTH CARE [2052]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($36,180.53). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $33,511.56, add-ons for qualifying new technology services are included. If operating cost exceeds $82,670.45 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,188.30, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $32,932.47 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $32,722.45 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,458.96. The transfer capital threshold is the transfer adjustment factor * $2,458.96. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36180.53},{"payer_name":"LAKESIDE MEDICAL GROUP [2054]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Commercial","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 150%.","methodology":"other","count":"0","additional_payer_notes":"General Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":44649.90},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Medicare","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"General Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":32743.26},{"payer_name":"ALTERNATE HEALTH NET BH [2059]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"ALTERNATE HEALTH NET BH [2059]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"HMSA - HAWAII MEDICAL SERVICE ASSOC MDCR [1041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"IMPERIAL COUNTY PHYSICIAN MED GRP","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29171.27},{"payer_name":"MC UNITED HEALTHCARE GENERIC PAYOR [164011]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"MENIFEE MED GRP [2076]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"ALTERNATE SHERIFF CUSTODY [1106]","plan_name":"SHERIFF COUNTY CONTRACT # 514250","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":205422.43},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MARKET PLACE","standard_charge_algorithm":"Case rate ($29,693.50). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $27,373.30, add-ons for qualifying new technology services are included. If operating cost exceeds $76,532.19 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $4,839.53, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,794.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,584.19 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,110.19. The transfer capital threshold is the transfer adjustment factor * $2,110.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 180%.","methodology":"other","median_amount":38000.00,"10th_percentile":38000.00,"90th_percentile":38000.00,"count":"1 through 10","additional_payer_notes":"All Inpatient","standard_charge_dollar":29693.50},{"payer_name":"XIMED [2016]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"CIGNA [1023]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":174451.04},{"payer_name":"QUALITY HEALTH [1069]","plan_name":"QUALITY HEALTH MANAGEMENT","standard_charge_algorithm":"Case rate ($36,500.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $33,819.71, add-ons for qualifying new technology services are included. If operating cost exceeds $82,504.33 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,672.42, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $33,240.61 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $33,030.60 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,471.12. The transfer capital threshold is the transfer adjustment factor * $2,471.12. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 185%.","methodology":"other","count":"0","additional_payer_notes":"Surgery  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":67526.55},{"payer_name":"MC HUMANA GENERIC PAYOR [164014]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"AFFILIATED DOCTORS OF ORANGE COUNTY [2041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"RIVER CITY MEDICAL GROUP [2066]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA COMMERCIAL","standard_charge_percentage":85.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":268629.33},{"payer_name":"ALTERNATE MEDICARE [2007]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($36,500.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $33,819.71, add-ons for qualifying new technology services are included. If operating cost exceeds $82,504.33 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,672.42, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $33,240.61 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $33,030.60 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,471.12. The transfer capital threshold is the transfer adjustment factor * $2,471.12. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35770.82},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE [10230006]","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($36,500.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $33,819.71, add-ons for qualifying new technology services are included. If operating cost exceeds $82,504.33 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,672.42, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $33,240.61 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $33,030.60 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,471.12. The transfer capital threshold is the transfer adjustment factor * $2,471.12. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36500.84},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE TRANSPLANT [11170001]","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"AETNA [1003]","plan_name":"AETNA","standard_charge_algorithm":"Payment is accumulated by procedure count, in order of descending billed amounts. Procedure 1, Case rate ($39,923). Procedures 2 - 9999, Per diem ($13,036).","methodology":"other","count":"0","additional_payer_notes":"Bronchoscopy Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"MEDI-CAL [1048]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"UCR PROMPT PAY PAYOR [8240]","plan_name":"UCSD CHARITY MEDICARE CONTRACT","standard_charge_algorithm":"Case rate ($36,500.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $33,819.71, add-ons for qualifying new technology services are included. If operating cost exceeds $82,504.33 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,672.42, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $33,240.61 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $33,030.60 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,471.12. The transfer capital threshold is the transfer adjustment factor * $2,471.12. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Medicare All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36500.84},{"payer_name":"STERLING OPTION 1 [1083]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"USAA [1091]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"ALTERNATE AETNA [1004]","plan_name":"AETNA","standard_charge_algorithm":"Payment is accumulated by procedure count, in order of descending billed amounts. Procedure 1, Case rate ($39,923). Procedures 2 - 9999, Per diem ($13,036).","methodology":"other","count":"0","additional_payer_notes":"Bronchoscopy Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"ALTERNATE KAISER RAD ONC [2089]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29171.27},{"payer_name":"ASTIVA HEALTH [2095]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($36,180.53). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $33,511.56, add-ons for qualifying new technology services are included. If operating cost exceeds $82,670.45 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,188.30, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $32,932.47 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $32,722.45 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,458.96. The transfer capital threshold is the transfer adjustment factor * $2,458.96. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36180.53},{"payer_name":"MC HEALTHNET GENERIC PAYOR [164010]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"AMA - AMERICAN MEDICAL ASSOCIATION [1009]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"MC HNET BLUE&GOLD ACO [164017]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"CIGNA [1023]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($36,180.53). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $33,511.56, add-ons for qualifying new technology services are included. If operating cost exceeds $82,670.45 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,188.30, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $32,932.47 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $32,722.45 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,458.96. The transfer capital threshold is the transfer adjustment factor * $2,458.96. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36180.53},{"payer_name":"IMPERIAL HEALTH HOLDINGS [1132]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"NATIONAL HEALTHCARE SOLUTIONS INC [1100]","plan_name":"NATIONAL HEALTHCARE SOLUTIONS INC [11000001]","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":252827.60},{"payer_name":"MC CIGNA HMO [164003]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"MC HEALTHNET HMO [164004]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Per diem ($11,022).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":11022.00},{"payer_name":"AETNA [1003]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($29,693.50). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $27,373.30, add-ons for qualifying new technology services are included. If operating cost exceeds $76,532.19 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $4,839.53, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,794.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,584.19 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,110.19. The transfer capital threshold is the transfer adjustment factor * $2,110.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29693.50},{"payer_name":"UC AFF ANTHEM\/SDSM HMO [164024]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"CARNIVAL CRUISES [1018]","plan_name":"CARNIVAL CRUISES [10180001]","standard_charge_percentage":90.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":284431.05},{"payer_name":"SCRIPPS COASTAL MED GRP [1074]","plan_name":"SCRIPPS COASTAL MED GRP [10740001]","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":205422.43},{"payer_name":"CLEVER CARE [2061]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"SD PHYSICIANS MED GRP [1076]","plan_name":"SD PHYSICIANS MED GRP SR [10760002]","standard_charge_percentage":55.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":173818.98},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"OLYMPUS MANAGED HEALTHCARE INC [11020001]","standard_charge_algorithm":"Payment is accumulated by procedure count, in order of descending billed amounts. Procedure 1, Case rate ($39,923). Procedures 2 - 9999, Per diem ($13,036).","methodology":"other","count":"0","additional_payer_notes":"Bronchoscopy Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"ALTERNATE SCAN HEALTH [2088]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":28278.27},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($29,693.50). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $27,373.30, add-ons for qualifying new technology services are included. If operating cost exceeds $76,532.19 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $4,839.53, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,794.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,584.19 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,110.19. The transfer capital threshold is the transfer adjustment factor * $2,110.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29693.50},{"payer_name":"MC ANTHEM BLUE CROSS HMO [164002]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"MC BLUE SHIELD GENERIC PAYOR [164016]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"TRANSAMERICA [1084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"ENCOMPASS MED GRP [1030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS HOUSE STAFF","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":83433.11},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"CAREMORE [2028]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"DEPARTMENT OF LABOR [1028]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($36,500.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $33,819.71, add-ons for qualifying new technology services are included. If operating cost exceeds $82,504.33 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,672.42, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $33,240.61 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $33,030.60 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,471.12. The transfer capital threshold is the transfer adjustment factor * $2,471.12. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47451.09},{"payer_name":"PRIMARY CARE ASSOCIATES OF CA [2067]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"ALTERNATE VA - VETERANS ADMINISTRATION [1239]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($36,500.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $33,819.71, add-ons for qualifying new technology services are included. If operating cost exceeds $82,504.33 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,672.42, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $33,240.61 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $33,030.60 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,471.12. The transfer capital threshold is the transfer adjustment factor * $2,471.12. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36500.84},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($36,500.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $33,819.71, add-ons for qualifying new technology services are included. If operating cost exceeds $82,504.33 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,672.42, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $33,240.61 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $33,030.60 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,471.12. The transfer capital threshold is the transfer adjustment factor * $2,471.12. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36500.84},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($36,500.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $33,819.71, add-ons for qualifying new technology services are included. If operating cost exceeds $82,504.33 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,672.42, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $33,240.61 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $33,030.60 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,471.12. The transfer capital threshold is the transfer adjustment factor * $2,471.12. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36500.84},{"payer_name":"SDSM [2017]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"COMMUNITY HEALTH GROUP [1022]","plan_name":"COMMUNITY HEALTH GROUP MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 113%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":33636.26},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Per diem ($15,746).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":15746.00},{"payer_name":"BANKERS LIFE [1011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"UC AFF ANTHEM\/XIMED HMO [164022]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"VANTAGE [1092]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"ADMAR [1001]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":205422.43},{"payer_name":"SIMNSA HEALTH PLAN [2047]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"BPS - BENEFIT PLAN SERVICES [1015]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":205422.43},{"payer_name":"ALPHACARE [2062]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"MC CIGNA GENERIC PAYOR [164007]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD COVERED CA TRIO HMO","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA COMMERCIAL","standard_charge_percentage":85.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":268629.33},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"EASY ACCESS CARE [2077]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($29,693.50). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $27,373.30, add-ons for qualifying new technology services are included. If operating cost exceeds $76,532.19 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $4,839.53, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,794.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,584.19 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,110.19. The transfer capital threshold is the transfer adjustment factor * $2,110.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Pre\/Post or Other\/VAD Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29693.50},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDI-CAL","standard_charge_algorithm":"Case rate ($36,180.53). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $33,511.56, add-ons for qualifying new technology services are included. If operating cost exceeds $82,670.45 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,188.30, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $32,932.47 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $32,722.45 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,458.96. The transfer capital threshold is the transfer adjustment factor * $2,458.96. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 80%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Pre\/Post  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":28944.42},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($29,693.50). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $27,373.30, add-ons for qualifying new technology services are included. If operating cost exceeds $76,532.19 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $4,839.53, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,794.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,584.19 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,110.19. The transfer capital threshold is the transfer adjustment factor * $2,110.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29693.50},{"payer_name":"MC UHC HARMONY HMO [164026]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNA PRIORITY SELECT","standard_charge_algorithm":"Per diem ($7,746).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":7746.00},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET ENHANCED CARE PPO","standard_charge_algorithm":"Case rate ($27,142.77). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $25,001.59, add-ons for qualifying new technology services are included. If operating cost exceeds $74,160.48 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $4,660.51, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $25,211.60. The transfer operating threshold is the transfer adjustment factor * $25,001.59 If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $1,931.17. The transfer capital threshold is the transfer adjustment factor * $1,931.17. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 281%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services (MSDRG no DSH GME IME) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":27142.77},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($36,180.53). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $33,511.56, add-ons for qualifying new technology services are included. If operating cost exceeds $82,670.45 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,188.30, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $32,932.47 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $32,722.45 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,458.96. The transfer capital threshold is the transfer adjustment factor * $2,458.96. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36180.53},{"payer_name":"ARCH HEALTH PARTNERS [2000]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"KAISER [1046]","plan_name":"KAISER MEDICARE ADVANTAGE","standard_charge_percentage":63.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":199101.74},{"payer_name":"MC ANTHEM BLUE CROSS GENERIC PAYOR [164009]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED HMO NON CONTRACTED [10260001]","standard_charge_algorithm":"Case rate ($29,693.50). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $27,373.30, add-ons for qualifying new technology services are included. If operating cost exceeds $76,532.19 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $4,839.53, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,794.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,584.19 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,110.19. The transfer capital threshold is the transfer adjustment factor * $2,110.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29693.50},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED PPO NON CONTRACTED [10260002]","standard_charge_algorithm":"Case rate ($29,693.50). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $27,373.30, add-ons for qualifying new technology services are included. If operating cost exceeds $76,532.19 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $4,839.53, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,794.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,584.19 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,110.19. The transfer capital threshold is the transfer adjustment factor * $2,110.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29693.50},{"payer_name":"FIRST HEALTH [1032]","plan_name":"FIRST HEALTH","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":237025.88},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"US BEHAVIORAL MENTAL\/EATING DISORDER","standard_charge_percentage":70.00,"standard_charge_algorithm":"70% of billed.","methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":221224.15},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"UC AFF MC HUMANA GENERIC PAYOR [164027]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($36,180.53). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $33,511.56, add-ons for qualifying new technology services are included. If operating cost exceeds $82,670.45 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,188.30, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $32,932.47 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $32,722.45 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,458.96. The transfer capital threshold is the transfer adjustment factor * $2,458.96. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36180.53},{"payer_name":"MC UNITED HEALTHCARE HMO [164005]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET MEDICARE ADVANTAGE UC EMPLOYER GROUP","standard_charge_algorithm":"Fee schedule rate ($2.88). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2.88},{"payer_name":"INTERPLAN [1045]","plan_name":"INTERPLAN","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":221224.15},{"payer_name":"BLUE CROSS [1013]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($29,693.50). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $27,373.30, add-ons for qualifying new technology services are included. If operating cost exceeds $76,532.19 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $4,839.53, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,794.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,584.19 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,110.19. The transfer capital threshold is the transfer adjustment factor * $2,110.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29693.50},{"payer_name":"BLUE CROSS [1013]","plan_name":"UCSD STUDENT HEALTH INS PLAN - BC SHIP","standard_charge_percentage":26.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":84381.21},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Per diem ($8,294). The outlier payment amount is calculated by taking the estimated cost amount, subtracting the threshold amount ($247,571), then multiplying the difference by the percent of outlier that is reimbursed (53%). If the calculated outlier amount is greater than $0, it is added to the reimbursement total. The estimated cost amount is the adjusted billed amount multiplied by the cost-to-charge ratio (1). The following revenue codes are excluded from the adjusted billed amount: RC 0274-0276, 0278, 0624, 0891.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":8294.00},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"MC SCAN GENERIC PAYOR [164034]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"UNLISTED MEDICARE ADVANTAGE (NON-CONTRACTED) [1051]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"UC AFF BLUE SHIELD SR\/SDSM [164037]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"ELIZABETH HOSPICE [2018]","plan_name":"ELIZABETH HOSPICE GIP","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay.","standard_charge_dollar":950.00},{"payer_name":"CHRISTIAN HEALTHCARE MINISTRIES [2030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"TRI-CITY [1085]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"MC AETNA HMO [164001]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"CHESAPEAKE LIFE [1021]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"MUTUAL OF OMAHA [1059]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"GREATER NEWPORT PHYSICIANS [2096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"UNLISTED HOSPICE [1035]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"MULTIPLAN [1058]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":205422.43},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS UC CARE","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":83433.11},{"payer_name":"SEDGWICK [1077]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($36,500.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $33,819.71, add-ons for qualifying new technology services are included. If operating cost exceeds $82,504.33 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,672.42, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $33,240.61 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $33,030.60 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,471.12. The transfer capital threshold is the transfer adjustment factor * $2,471.12. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47451.09},{"payer_name":"TRIWEST [2003]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($36,500.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $33,819.71, add-ons for qualifying new technology services are included. If operating cost exceeds $82,504.33 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,672.42, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $33,240.61 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $33,030.60 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,471.12. The transfer capital threshold is the transfer adjustment factor * $2,471.12. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36500.84},{"payer_name":"BEECH STREET [1012]","plan_name":"CAPPCARE\/BEECH STREET","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":237025.88},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA EPN\/IFP","standard_charge_algorithm":"Per diem ($7,687). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .468 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"INLAND FACULTY MEDICAL GROUP [2063]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"INTEGRATED HEALTH PARTNERS [2068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"PACIFIC FOUNDATION [1063]","plan_name":"PACIFIC FOUNDATION FOR MEDICAL CARE","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":237025.88},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"INTERNATIONAL EMBASSY OF KUWAIT","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214903.46},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE ST PAULS","standard_charge_algorithm":"Case rate ($36,500.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $33,819.71, add-ons for qualifying new technology services are included. If operating cost exceeds $82,504.33 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,672.42, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $33,240.61 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $33,030.60 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,471.12. The transfer capital threshold is the transfer adjustment factor * $2,471.12. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36500.84},{"payer_name":"MVP HEALTHCARE [1060]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"MERCY PHYSICIANS MED GRP [1052]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($36,180.53). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $33,511.56, add-ons for qualifying new technology services are included. If operating cost exceeds $82,670.45 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,188.30, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $32,932.47 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $32,722.45 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,458.96. The transfer capital threshold is the transfer adjustment factor * $2,458.96. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36180.53},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"PRIVATE HEALTHCARE SYSTEM","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":205422.43},{"payer_name":"HEALTH NET [1039]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"VILLAGE HEALTH [1094]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"TRI-CITY MEDICAL CENTER [1129]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"BLUE SHIELD TRANSPLANTS [1113]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"ALTERNATE BRAND NEW DAY [2079]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"PREMIER PATIENT CARE IPA [2069]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"KERN HEALTH SYSTEMS [2033]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"ROYAL EMBASSY","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":221224.15},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Per diem ($9,855). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"MC SCAN HMO [164035]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"TRIWEST ALTERNATE [2036]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($36,500.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $33,819.71, add-ons for qualifying new technology services are included. If operating cost exceeds $82,504.33 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,672.42, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $33,240.61 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $33,030.60 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,471.12. The transfer capital threshold is the transfer adjustment factor * $2,471.12. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36500.84},{"payer_name":"UNITED AMERICAN [1087]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"REDLANDS COMMUNITY HOSPITAL [2005]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"CALIFORNIA HEALTH & WELLNESS MEDI-CAL [1122]","plan_name":"CALIFORNIA HEALTH AND WELLNESS MEDI-CAL (no longer Medi-Cal plan as of 1\/1\/24)","standard_charge_algorithm":"Per diem ($2,600).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2600.00},{"payer_name":"USOC - US OLYMPIC COMMITTEE [1123]","plan_name":"USOC VIK (BSC UC CARE)","standard_charge_percentage":43.10,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":136210.87},{"payer_name":"INTER VALLEY HEALTH PLAN [2024]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"GLOBAL EXCEL [1036]","plan_name":"GLOBAL EXCEL","standard_charge_algorithm":"Case rate ($36,500.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $33,819.71, add-ons for qualifying new technology services are included. If operating cost exceeds $82,504.33 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,672.42, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $33,240.61 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $33,030.60 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,471.12. The transfer capital threshold is the transfer adjustment factor * $2,471.12. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 165%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36500.84},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($36,180.53). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $33,511.56, add-ons for qualifying new technology services are included. If operating cost exceeds $82,670.45 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,188.30, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $32,932.47 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $32,722.45 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,458.96. The transfer capital threshold is the transfer adjustment factor * $2,458.96. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36180.53},{"payer_name":"CIGNA [1023]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"CAL OPTIMA [1016]","plan_name":"CalOptima Medicare","standard_charge_algorithm":"Case rate ($36,500.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $33,819.71, add-ons for qualifying new technology services are included. If operating cost exceeds $82,504.33 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,672.42, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $33,240.61 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $33,030.60 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,471.12. The transfer capital threshold is the transfer adjustment factor * $2,471.12. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36500.84},{"payer_name":"HERITAGE VICTOR VALLEY MEDICAL GROUP [2045]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($36,180.53). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $33,511.56, add-ons for qualifying new technology services are included. If operating cost exceeds $82,670.45 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,188.30, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $32,932.47 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $32,722.45 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,458.96. The transfer capital threshold is the transfer adjustment factor * $2,458.96. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36180.53},{"payer_name":"SIERRA MEDICAL GROUP [2048]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"CHAMPVA [1020]","plan_name":"VETERANS ADMINISTRATION - CHAMPVA","standard_charge_algorithm":"Case rate ($36,500.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $33,819.71, add-ons for qualifying new technology services are included. If operating cost exceeds $82,504.33 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,672.42, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $33,240.61 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $33,030.60 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,471.12. The transfer capital threshold is the transfer adjustment factor * $2,471.12. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36500.84},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Per diem ($8,294). The outlier payment amount is calculated by taking the estimated cost amount, subtracting the threshold amount ($247,571), then multiplying the difference by the percent of outlier that is reimbursed (53%). If the calculated outlier amount is greater than $0, it is added to the reimbursement total. The estimated cost amount is the adjusted billed amount multiplied by the cost-to-charge ratio (1). The following revenue codes are excluded from the adjusted billed amount: RC 0274-0276, 0278, 0624, 0891.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":8294.00},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"EASY CHOICE [1029]","plan_name":"EASY CHOICE","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"WORKERS COMPENSATION [1097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($36,500.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $33,819.71, add-ons for qualifying new technology services are included. If operating cost exceeds $82,504.33 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,672.42, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $33,240.61 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $33,030.60 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,471.12. The transfer capital threshold is the transfer adjustment factor * $2,471.12. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47451.09},{"payer_name":"RIVERSIDE MEDICAL CLINIC [2064]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"ETS - LIFETRAC NETWORK [1103]","plan_name":"LIFETRAC","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":205422.43},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29171.27},{"payer_name":"MC UHC VEBA HMO [164033]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"MC BRAND NEW DAY GENERIC PAYOR [164031]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"BLUE SHIELD [1014]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($29,693.50). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $27,373.30, add-ons for qualifying new technology services are included. If operating cost exceeds $76,532.19 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $4,839.53, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,794.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,584.19 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,110.19. The transfer capital threshold is the transfer adjustment factor * $2,110.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29693.50},{"payer_name":"UC AFF HUMANA\/SDSM [164025]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"IMPERIAL HEALTH PLAN [2081]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"AETNA","standard_charge_algorithm":"Payment is accumulated by procedure count, in order of descending billed amounts. Procedure 1, Case rate ($39,923). Procedures 2 - 9999, Per diem ($13,036).","methodology":"other","count":"0","additional_payer_notes":"Bronchoscopy Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE PPO","standard_charge_percentage":49.55,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":156595.09},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($36,180.53). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $33,511.56, add-ons for qualifying new technology services are included. If operating cost exceeds $82,670.45 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,188.30, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $32,932.47 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $32,722.45 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,458.96. The transfer capital threshold is the transfer adjustment factor * $2,458.96. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36180.53},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 4, Case rate ($25,000). Procedures 5 - 9999, Per diem ($5,100).","methodology":"other","count":"0","additional_payer_notes":"Ortho Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"AETNA TRANSPLANTS [1112]","plan_name":"AETNA","standard_charge_algorithm":"Payment is accumulated by procedure count, in order of descending billed amounts. Procedure 1, Case rate ($39,923). Procedures 2 - 9999, Per diem ($13,036).","methodology":"other","count":"0","additional_payer_notes":"Bronchoscopy Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"PYRAMID LIFE [1068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"MC UHC VEBA GENERIC HMO [164032]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"MONARCH HEALTHCARE [2006]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"MC BRAND NEW DAY HMO [164030]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CALIFORNIA UC CARE \/ HSP","standard_charge_percentage":26.66,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":84254.80},{"payer_name":"CMN - CANADIAN MEDICAL NETWORK [1024]","plan_name":"CMN GLOBAL INC","standard_charge_algorithm":"Case rate ($36,500.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $33,819.71, add-ons for qualifying new technology services are included. If operating cost exceeds $82,504.33 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,672.42, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $33,240.61 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $33,030.60 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,471.12. The transfer capital threshold is the transfer adjustment factor * $2,471.12. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 170%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":62051.43},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($36,180.53). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $33,511.56, add-ons for qualifying new technology services are included. If operating cost exceeds $82,670.45 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,188.30, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $32,932.47 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $32,722.45 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,458.96. The transfer capital threshold is the transfer adjustment factor * $2,458.96. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36180.53},{"payer_name":"HIGH DESERT MEDICAL GROUP [2053]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"STATE OF CALIFORNIA [1082]","plan_name":"California State Prison","standard_charge_algorithm":"Case rate ($36,500.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $33,819.71, add-ons for qualifying new technology services are included. If operating cost exceeds $82,504.33 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,672.42, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $33,240.61 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $33,030.60 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,471.12. The transfer capital threshold is the transfer adjustment factor * $2,471.12. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 250%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36500.84},{"payer_name":"SAN DIEGO SOCKERS [2015]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($36,500.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $33,819.71, add-ons for qualifying new technology services are included. If operating cost exceeds $82,504.33 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,672.42, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $33,240.61 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $33,030.60 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,471.12. The transfer capital threshold is the transfer adjustment factor * $2,471.12. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47451.09},{"payer_name":"AMERICAN SPECIALTY HEALTH PLAN [2038]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"WELL CARE [1096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"CIGNA HMO","standard_charge_percentage":83.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263572.77},{"payer_name":"IMMIGRATION HEALTH SERVICES [1043]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($36,500.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $33,819.71, add-ons for qualifying new technology services are included. If operating cost exceeds $82,504.33 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,672.42, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $33,240.61 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $33,030.60 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,471.12. The transfer capital threshold is the transfer adjustment factor * $2,471.12. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35770.82},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"HEMET COMMUNITY MED GRP - PROMISECARE [1040]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"BLUE SHIELD PROMISE [1017]","plan_name":"CARE 1ST HEALTHPLAN MEDICARE ADVANTAGE (BS PROMISE)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MA\/SDPMG","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":28278.27},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Per diem ($15,746).","methodology":"per diem","median_amount":160620.00,"10th_percentile":160620.00,"90th_percentile":160620.00,"count":"1 through 10","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay.","standard_charge_dollar":15746.00},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($36,180.53). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $33,511.56, add-ons for qualifying new technology services are included. If operating cost exceeds $82,670.45 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,188.30, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $32,932.47 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $32,722.45 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,458.96. The transfer capital threshold is the transfer adjustment factor * $2,458.96. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36180.53},{"payer_name":"LA CARE HEALTH PLAN [2025]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"MC UHC ALLIANCE HMO [164020]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"ST JOSEPH ST JUDE [2065]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"GOLDEN PHYSICIANS MEDICAL GROUP [2082]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35719.92},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"SCAN HEALTH [1072]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":28278.27},{"payer_name":"KEY MED GRP [2074]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"ADVANTRA FREEDOM [1002]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"SCRIPPS HOSPICE [2008]","plan_name":"SCRIPPS HEALTH HOSPICE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay.","standard_charge_dollar":700.00},{"payer_name":"EMPIRE PHYS MED GRP [2072]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE SAN DIEGO","standard_charge_algorithm":"Case rate ($36,180.53). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $33,511.56, add-ons for qualifying new technology services are included. If operating cost exceeds $82,670.45 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,188.30, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $32,932.47 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $32,722.45 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,458.96. The transfer capital threshold is the transfer adjustment factor * $2,458.96. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36180.53},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":32743.26},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($36,180.53). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $33,511.56, add-ons for qualifying new technology services are included. If operating cost exceeds $82,670.45 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,188.30, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $32,932.47 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $32,722.45 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,458.96. The transfer capital threshold is the transfer adjustment factor * $2,458.96. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36180.53},{"payer_name":"BEACON HEALTH STRATEGY [2039]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($36,180.53). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $33,511.56, add-ons for qualifying new technology services are included. If operating cost exceeds $82,670.45 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,188.30, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $32,932.47 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $32,722.45 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,458.96. The transfer capital threshold is the transfer adjustment factor * $2,458.96. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36180.53},{"payer_name":"MGM RESORTS [1053]","plan_name":"MGM RESORT","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":237025.88},{"payer_name":"HUMANA [1042]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($29,693.50). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $27,373.30, add-ons for qualifying new technology services are included. If operating cost exceeds $76,532.19 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $4,839.53, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,794.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,584.19 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,110.19. The transfer capital threshold is the transfer adjustment factor * $2,110.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29693.50},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"Community Care IPA Medi-Cal Managed Care","standard_charge_algorithm":"Includes a variable per diem for days 0-99999: RC 0100:0169 @ $1,750; RC 0200:0202 @ $1,750; RC 0208:0213 @ $1,750; RC 0219 @ $1,750; RC 0206 @ $2,300; RC 0207 @ $2,300.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"HEALTH CARE SUPPORT [2011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MID-COUNTY PHYSICIANS NARROW NETWORK","standard_charge_algorithm":"Per diem ($17,123).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":17123.00},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"AXA ASSISTANCE [1098]","plan_name":"AXA ASSISTANCE USA,INC","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":252827.60},{"payer_name":"MC BLUE SHIELD HMO [164015]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"BRAND NEW DAY [1089]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"FRESENIUS [1034]","plan_name":"FRESENIUS HEALTH PARTNERS, INC","standard_charge_algorithm":"Case rate ($29,693.50). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $27,373.30, add-ons for qualifying new technology services are included. If operating cost exceeds $76,532.19 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $4,839.53, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,794.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,584.19 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,110.19. The transfer capital threshold is the transfer adjustment factor * $2,110.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29693.50},{"payer_name":"ALTERNATE MEDI-CAL [2001]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK","standard_charge_algorithm":"Per diem ($3,800).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":3800.00},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($29,693.50). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $27,373.30, add-ons for qualifying new technology services are included. If operating cost exceeds $76,532.19 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $4,839.53, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,794.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,584.19 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,110.19. The transfer capital threshold is the transfer adjustment factor * $2,110.19. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29693.50},{"payer_name":"HEALTHNET TRANSPLANTS [1114]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($11,247). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgical Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE QUALCOMM ","standard_charge_percentage":45.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":144238.15},{"payer_name":"MEDICARE [1050]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($36,500.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $33,819.71, add-ons for qualifying new technology services are included. If operating cost exceeds $82,504.33 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,672.42, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $33,240.61 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $33,030.60 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,471.12. The transfer capital threshold is the transfer adjustment factor * $2,471.12. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35770.82},{"payer_name":"KAISER [1046]","plan_name":"KAISER","standard_charge_percentage":63.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":199101.74},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UHC SELECT AND SELECT PLUS","standard_charge_algorithm":"Per diem ($14,996).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":14996.00},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"EMBASSY OF STATE OF KUWAIT [11010001]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214903.46},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"KUWAIT OIL COMPANY [11010005]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":214903.46},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EPO [10130074]","standard_charge_algorithm":"Per diem ($15,746).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":15746.00},{"payer_name":"MC HUMANA HMO [164013]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Per diem ($11,022).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 9 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":11022.00},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($36,180.53). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $33,511.56, add-ons for qualifying new technology services are included. If operating cost exceeds $82,670.45 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,188.30, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $32,932.47 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $32,722.45 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,458.96. The transfer capital threshold is the transfer adjustment factor * $2,458.96. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36180.53},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($36,180.53). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $33,511.56, add-ons for qualifying new technology services are included. If operating cost exceeds $82,670.45 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,188.30, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $32,932.47 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $32,722.45 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,458.96. The transfer capital threshold is the transfer adjustment factor * $2,458.96. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36180.53},{"payer_name":"CASSIDY MED GRP [1019]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":205422.43},{"payer_name":"CENTRAL HEALTH PLAN [2026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"AETNA [1003]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EATING DISORDER","standard_charge_percentage":58.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":185322.63},{"payer_name":"MEDCARE PARTNERS [2084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"CLIPPERS WORKERS COMPENSATION [2097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($36,500.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $33,819.71, add-ons for qualifying new technology services are included. If operating cost exceeds $82,504.33 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,672.42, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $33,240.61 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $33,030.60 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,471.12. The transfer capital threshold is the transfer adjustment factor * $2,471.12. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":47451.09},{"payer_name":"BEAVER MED GRP [2075]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":174451.04},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($36,500.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $33,819.71, add-ons for qualifying new technology services are included. If operating cost exceeds $82,504.33 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,672.42, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $33,240.61 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $33,030.60 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,471.12. The transfer capital threshold is the transfer adjustment factor * $2,471.12. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36500.84},{"payer_name":"MC AETNA GENERIC PAYOR [164008]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":37924.14},{"payer_name":"SCRIPPS HEALTH PLAN SERVICES [1075]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 4, Case rate ($25,000). Procedures 5 - 9999, Per diem ($5,100).","methodology":"other","count":"0","additional_payer_notes":"Ortho Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($3,210). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Surgery Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":316034.50},{"payer_name":"AETNA [1003]","plan_name":"AETNA BEHAVIORAL EATING DISORDER","standard_charge_percentage":43.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":138107.08},{"payer_name":"HEALTHCARE PARTNERS [2073]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH PLAN","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":189620.70},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"SALUDPOL Peru Police","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":221224.15},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($36,180.53). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $33,511.56, add-ons for qualifying new technology services are included. If operating cost exceeds $82,670.45 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $5,188.30, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $32,932.47 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $32,722.45 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,458.96. The transfer capital threshold is the transfer adjustment factor * $2,458.96. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36180.53},{"payer_name":"OPTUM CARE NETWORK - PCAMG [1064]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":205422.43},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35719.92},{"payer_name":"COMMUNITY ELDERCARE [1027]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA HMO","standard_charge_percentage":83.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263572.77},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA PPO","standard_charge_percentage":83.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263572.77},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60},{"payer_name":"VA - VETERANS ADMINISTRATION [1093]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($36,500.84). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $33,819.71, add-ons for qualifying new technology services are included. If operating cost exceeds $82,504.33 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,672.42, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $33,240.61 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $33,030.60 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,471.12. The transfer capital threshold is the transfer adjustment factor * $2,471.12. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":36500.84},{"payer_name":"US MARSHAL SERVICES [1090]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($29,766.60). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $27,440.80, add-ons for qualifying new technology services are included. If operating cost exceeds $76,125.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $5,317.09, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 6.5. The base transfer operating payment is the transfer adjustment factor * $26,861.71 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $26,651.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $2,115.79. The transfer capital threshold is the transfer adjustment factor * $2,115.79. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":29766.60}]}]}
,{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"minimum":15.50,"maximum":291947.90,"gross_charge":525081.65,"discounted_cash":288794.91,"setting":"inpatient","payers_information":[{"payer_name":"DESERT OASIS HEALTH CARE [2052]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($148,381.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $137,250.76, add-ons for qualifying new technology services are included. If operating cost exceeds $186,409.65 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,983.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $137,337.46 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $136,461.65 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,254.53. The transfer capital threshold is the transfer adjustment factor * $10,254.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":148381.09},{"payer_name":"MC HUMANA GENERIC PAYOR [164014]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"QUALITY HEALTH [1069]","plan_name":"QUALITY HEALTH MANAGEMENT","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 195%.","methodology":"other","count":"0","additional_payer_notes":"Oncology  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":291947.90},{"payer_name":"LAKESIDE MEDICAL GROUP [2054]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Commercial","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 160%.","methodology":"other","count":"0","additional_payer_notes":"Oncology Care Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":194613.18},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Medicare","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"Oncology Care Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":145959.89},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"ALTERNATE HEALTH NET BH [2059]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 195%.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic Unrelated BMT (Optum 1\/24) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":237184.82},{"payer_name":"HMSA - HAWAII MEDICAL SERVICE ASSOC MDCR [1041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"MC UNITED HEALTHCARE GENERIC PAYOR [164011]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"IMPERIAL COUNTY PHYSICIAN MED GRP","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":119200.58},{"payer_name":"ALTERNATE SHERIFF CUSTODY [1106]","plan_name":"SHERIFF COUNTY CONTRACT # 514250","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":341303.07},{"payer_name":"MENIFEE MED GRP [2076]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":289845.07},{"payer_name":"SCRIPPS HOSPICE [2008]","plan_name":"SCRIPPS HEALTH HOSPICE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay.","standard_charge_dollar":700.00},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MARKET PLACE","standard_charge_algorithm":"Case rate ($121,328.37). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $111,652.50, add-ons for qualifying new technology services are included. If operating cost exceeds $160,811.39 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,529.40, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $111,739.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $110,863.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,800.06. The transfer capital threshold is the transfer adjustment factor * $8,800.06. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 180%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121328.37},{"payer_name":"XIMED [2016]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"CIGNA [1023]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":289845.07},{"payer_name":"AFFILIATED DOCTORS OF ORANGE COUNTY [2041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"RIVER CITY MEDICAL GROUP [2066]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA COMMERCIAL","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 140%.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":209603.62},{"payer_name":"ALTERNATE MEDICARE [2007]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","median_amount":161434.23,"10th_percentile":161434.23,"90th_percentile":161434.23,"count":"1 through 10","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":146722.53},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE [10230006]","standard_charge_algorithm":"Case rate ($221,722). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 642026. For days after this threshold has been met, a payment of (non-excluded charges minus 642026) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic Non-Related BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"BLUE CROSS TRANSPLANT [1116]","plan_name":"BLUE DISTINCTION ","standard_charge_algorithm":"Case rate ($229,627). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 746286. For days after this threshold has been met, a payment of (non-excluded charges minus 746286) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic Unrelated BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE TRANSPLANT [11170001]","standard_charge_algorithm":"Case rate ($221,722). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 642026. For days after this threshold has been met, a payment of (non-excluded charges minus 642026) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic Non-Related BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"AETNA [1003]","plan_name":"AETNA BEHAVIORAL EATING DISORDER","standard_charge_percentage":43.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":229460.68},{"payer_name":"AETNA [1003]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($279,808). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 886128. For days after this threshold has been met, a payment of (non-excluded charges minus 886128) multiplied by .60 will be used instead of the standard payment.","methodology":"other","median_amount":398534.00,"10th_percentile":398534.00,"90th_percentile":398924.89,"count":"1 through 10","additional_payer_notes":"Allo Non Related BMT","standard_charge_dollar":525081.65},{"payer_name":"MEDI-CAL [1048]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"UCR PROMPT PAY PAYOR [8240]","plan_name":"UCSD CHARITY MEDICARE CONTRACT","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Medicare All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":149716.87},{"payer_name":"USAA [1091]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"ALTERNATE AETNA [1004]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($279,808). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 886128. For days after this threshold has been met, a payment of (non-excluded charges minus 886128) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allo Non Related BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"STERLING OPTION 1 [1083]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":119200.58},{"payer_name":"ALTERNATE KAISER RAD ONC [2089]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"ASTIVA HEALTH [2095]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"EMBASSY OF STATE OF KUWAIT [11010001]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":357055.52},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"KUWAIT OIL COMPANY [11010005]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":357055.52},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($148,381.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $137,250.76, add-ons for qualifying new technology services are included. If operating cost exceeds $186,409.65 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,983.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $137,337.46 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $136,461.65 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,254.53. The transfer capital threshold is the transfer adjustment factor * $10,254.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":148381.09},{"payer_name":"MC HEALTHNET GENERIC PAYOR [164010]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"MC HNET BLUE&GOLD ACO [164017]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"AMA - AMERICAN MEDICAL ASSOCIATION [1009]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"IMPERIAL HEALTH HOLDINGS [1132]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"NATIONAL HEALTHCARE SOLUTIONS INC [1100]","plan_name":"NATIONAL HEALTHCARE SOLUTIONS INC [11000001]","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":420065.32},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"CIGNA [1023]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($220,016). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 733000. For days after this threshold has been met, a payment of (non-excluded charges minus 733000) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allo Unrelate BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"MC CIGNA HMO [164003]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"MC HEALTHNET HMO [164004]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"AETNA [1003]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($121,328.37). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $111,652.50, add-ons for qualifying new technology services are included. If operating cost exceeds $160,811.39 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,529.40, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $111,739.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $110,863.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,800.06. The transfer capital threshold is the transfer adjustment factor * $8,800.06. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121328.37},{"payer_name":"UC AFF ANTHEM\/SDSM HMO [164024]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"CARNIVAL CRUISES [1018]","plan_name":"CARNIVAL CRUISES [10180001]","standard_charge_percentage":90.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":472573.49},{"payer_name":"CLEVER CARE [2061]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"SD PHYSICIANS MED GRP [1076]","plan_name":"SD PHYSICIANS MED GRP SR [10760002]","standard_charge_percentage":55.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":288794.91},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"OLYMPUS MANAGED HEALTHCARE INC [11020001]","standard_charge_algorithm":"Case rate ($279,808). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 886128. For days after this threshold has been met, a payment of (non-excluded charges minus 886128) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allo Non Related BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($121,328.37). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $111,652.50, add-ons for qualifying new technology services are included. If operating cost exceeds $160,811.39 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,529.40, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $111,739.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $110,863.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,800.06. The transfer capital threshold is the transfer adjustment factor * $8,800.06. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121328.37},{"payer_name":"ALTERNATE SCAN HEALTH [2088]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":115551.58},{"payer_name":"MC BLUE SHIELD GENERIC PAYOR [164016]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"TRANSAMERICA [1084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS HOUSE STAFF","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":138621.56},{"payer_name":"ENCOMPASS MED GRP [1030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"DEPARTMENT OF LABOR [1028]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","median_amount":263896.09,"10th_percentile":263896.09,"90th_percentile":263896.09,"count":"1 through 10","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":194631.93},{"payer_name":"CAREMORE [2028]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"SCRIPPS HEALTH PLAN SERVICES [1075]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":315048.99},{"payer_name":"PRIMARY CARE ASSOCIATES OF CA [2067]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"ALTERNATE VA - VETERANS ADMINISTRATION [1239]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":149716.87},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":149716.87},{"payer_name":"SDSM [2017]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":149716.87},{"payer_name":"COMMUNITY HEALTH GROUP [1022]","plan_name":"COMMUNITY HEALTH GROUP MEDICARE ADVANTAGE","standard_charge_algorithm":"Fee schedule rate ($12.02). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","median_amount":1020244.15,"10th_percentile":1020244.15,"90th_percentile":1020244.15,"count":"1 through 10","additional_payer_notes":"Transplants","standard_charge_dollar":15.50},{"payer_name":"KAISER [1046]","plan_name":"KAISER MEDICARE ADVANTAGE","standard_charge_percentage":67.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":351804.71},{"payer_name":"BANKERS LIFE [1011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"ADMAR [1001]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":341303.07},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA PPO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","median_amount":221722.00,"10th_percentile":221722.00,"90th_percentile":221722.00,"count":"1 through 10","additional_payer_notes":"undefined","standard_charge_dollar":264116.07},{"payer_name":"VANTAGE [1092]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"SIMNSA HEALTH PLAN [2047]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"BPS - BENEFIT PLAN SERVICES [1015]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":341303.07},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNA PRIORITY SELECT","standard_charge_algorithm":"Case rate ($327,600). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1335600. For days after this threshold has been met, a payment of (non-excluded charges minus 1335600) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic BMT Unrelated Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE MEDI-CAL TRANSPLANT [11260001]","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 35, Case rate ($170,828). Procedures 36 - 9999, Per diem ($9,091).","methodology":"other","count":"0","additional_payer_notes":"Allo Stem Cell Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"ALPHACARE [2062]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"MC CIGNA GENERIC PAYOR [164007]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD COVERED CA TRIO HMO","standard_charge_algorithm":"Case rate ($236,155). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 543900. For days after this threshold has been met, a payment of (non-excluded charges minus 543900) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA COMMERCIAL","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 140%.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":209603.62},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"EASY ACCESS CARE [2077]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($121,328.37). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $111,652.50, add-ons for qualifying new technology services are included. If operating cost exceeds $160,811.39 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,529.40, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $111,739.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $110,863.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,800.06. The transfer capital threshold is the transfer adjustment factor * $8,800.06. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 195%.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic Unrelated BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":236590.32},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDI-CAL","standard_charge_algorithm":"Case rate ($346,408). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1085888. For days after this threshold has been met, a payment of (non-excluded charges minus 1085888) multiplied by .445 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic Unrelated BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"MC AETNA GENERIC PAYOR [164008]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"ALTERNATE MEDI-CAL [2001]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($121,328.37). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $111,652.50, add-ons for qualifying new technology services are included. If operating cost exceeds $160,811.39 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,529.40, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $111,739.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $110,863.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,800.06. The transfer capital threshold is the transfer adjustment factor * $8,800.06. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121328.37},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET ENHANCED CARE PPO","standard_charge_algorithm":"Case rate ($113,192.82). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $104,263.51, add-ons for qualifying new technology services are included. If operating cost exceeds $153,422.40 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $10,782.84, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $105,139.32. The transfer operating threshold is the transfer adjustment factor * $104,263.51 If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,053.50. The transfer capital threshold is the transfer adjustment factor * $8,053.50. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 281%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services (MSDRG no DSH GME IME) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":113192.82},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($148,381.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $137,250.76, add-ons for qualifying new technology services are included. If operating cost exceeds $186,409.65 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,983.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $137,337.46 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $136,461.65 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,254.53. The transfer capital threshold is the transfer adjustment factor * $10,254.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":148381.09},{"payer_name":"ARCH HEALTH PARTNERS [2000]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MID-COUNTY PHYSICIANS NARROW NETWORK","standard_charge_algorithm":"Per diem ($17,123).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":17123.00},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE QUALCOMM ","standard_charge_percentage":45.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":239647.27},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED HMO NON CONTRACTED [10260001]","standard_charge_algorithm":"Case rate ($121,328.37). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $111,652.50, add-ons for qualifying new technology services are included. If operating cost exceeds $160,811.39 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,529.40, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $111,739.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $110,863.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,800.06. The transfer capital threshold is the transfer adjustment factor * $8,800.06. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121328.37},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED PPO NON CONTRACTED [10260002]","standard_charge_algorithm":"Case rate ($121,328.37). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $111,652.50, add-ons for qualifying new technology services are included. If operating cost exceeds $160,811.39 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,529.40, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $111,739.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $110,863.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,800.06. The transfer capital threshold is the transfer adjustment factor * $8,800.06. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121328.37},{"payer_name":"FIRST HEALTH [1032]","plan_name":"FIRST HEALTH","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":393811.24},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($313,343). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1161872. For days after this threshold has been met, a payment of (non-excluded charges minus 1161872) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic BMT Unrelated Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE","standard_charge_algorithm":"Case rate ($221,722). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 642026. For days after this threshold has been met, a payment of (non-excluded charges minus 642026) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic Non-Related BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"BLUE CROSS [1013]","plan_name":"UCSD STUDENT HEALTH INS PLAN - BC SHIP","standard_charge_percentage":26.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":140196.80},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE","standard_charge_algorithm":"Case rate ($221,722). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 642026. For days after this threshold has been met, a payment of (non-excluded charges minus 642026) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic Non-Related BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"UC AFF MC HUMANA GENERIC PAYOR [164027]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($220,016). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 733000. For days after this threshold has been met, a payment of (non-excluded charges minus 733000) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allo Unrelate BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"MC AETNA HMO [164001]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"MC UNITED HEALTHCARE HMO [164005]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"INTERPLAN [1045]","plan_name":"INTERPLAN","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":367557.16},{"payer_name":"BLUE CROSS [1013]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($121,328.37). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $111,652.50, add-ons for qualifying new technology services are included. If operating cost exceeds $160,811.39 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,529.40, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $111,739.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $110,863.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,800.06. The transfer capital threshold is the transfer adjustment factor * $8,800.06. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121328.37},{"payer_name":"MC BRAND NEW DAY HMO [164030]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"MC SCAN GENERIC PAYOR [164034]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Pricing is calculated over two periods plus stop loss reimbursement. The first period consists of the days from admission to 2 days before the relevant ICD Procedure date. If multiple relevant ICD Procedures are present, the first relevant ICD Procedure date on the claim is used. The reimbursement for this period is calculated as a per diem rate of $4,345. The second period consists of the days from the end of the first period to claim end. The reimbursement for this period is calculated as a case rate ($143,401). The stop loss period consists of the days from the day after the stop loss threshold ($397,080) is met to claim end. Only charges after the start of period two are considered for stop loss calculation. The reimbursement for this period is calculated as 42.2% of billed charges during the period after non-excluded charges exceed the threshold of $397,080. Only charges above the threshold on the day the threshold is met are reimbursed.","methodology":"other","count":"0","additional_payer_notes":"Allogenic BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET MEDICARE ADVANTAGE UC EMPLOYER GROUP","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 195%.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic Unrelated BMT (Optum 1\/24) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":237184.82},{"payer_name":"UNLISTED MEDICARE ADVANTAGE (NON-CONTRACTED) [1051]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"UC AFF BLUE SHIELD SR\/SDSM [164037]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"CHRISTIAN HEALTHCARE MINISTRIES [2030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"ALTERNATE MOLINA [1240]","plan_name":"MOLINA MEDI-CAL","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 35, Case rate ($170,828). Procedures 36 - 9999, Per diem ($9,091).","methodology":"other","count":"0","additional_payer_notes":"Allo Stem Cell Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"CHESAPEAKE LIFE [1021]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"TRI-CITY [1085]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"MUTUAL OF OMAHA [1059]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($313,343). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1161872. For days after this threshold has been met, a payment of (non-excluded charges minus 1161872) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic BMT Unrelated Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"GREATER NEWPORT PHYSICIANS [2096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"UNLISTED HOSPICE [1035]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"MULTIPLAN [1058]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":341303.07},{"payer_name":"MC ANTHEM BLUE CROSS HMO [164002]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS UC CARE","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":138621.56},{"payer_name":"SEDGWICK [1077]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":194631.93},{"payer_name":"BEECH STREET [1012]","plan_name":"CAPPCARE\/BEECH STREET","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":393811.24},{"payer_name":"TRIWEST [2003]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","median_amount":190565.51,"10th_percentile":190565.51,"90th_percentile":194110.62,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":149716.87},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Case rate ($236,155). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 543900. For days after this threshold has been met, a payment of (non-excluded charges minus 543900) multiplied by .526 will be used instead of the standard payment.","methodology":"other","median_amount":416400.00,"10th_percentile":416400.00,"90th_percentile":416400.00,"count":"1 through 10","additional_payer_notes":"Allogeneic BMT","standard_charge_dollar":525081.65},{"payer_name":"PACIFIC FOUNDATION [1063]","plan_name":"PACIFIC FOUNDATION FOR MEDICAL CARE","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":393811.24},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"INTERNATIONAL EMBASSY OF KUWAIT","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":357055.52},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Case rate ($236,155). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 543900. For days after this threshold has been met, a payment of (non-excluded charges minus 543900) multiplied by .526 will be used instead of the standard payment.","methodology":"other","median_amount":279545.00,"10th_percentile":279545.00,"90th_percentile":279545.00,"count":"1 through 10","additional_payer_notes":"Allogeneic BMT","standard_charge_dollar":525081.65},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA EPN\/IFP","standard_charge_algorithm":"Case rate ($236,155). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 543900. For days after this threshold has been met, a payment of (non-excluded charges minus 543900) multiplied by .526 will be used instead of the standard payment.","methodology":"other","median_amount":283675.00,"10th_percentile":283675.00,"90th_percentile":283675.00,"count":"1 through 10","additional_payer_notes":"Allogeneic BMT","standard_charge_dollar":525081.65},{"payer_name":"INLAND FACULTY MEDICAL GROUP [2063]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"INTEGRATED HEALTH PARTNERS [2068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE ST PAULS","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":149716.87},{"payer_name":"MVP HEALTHCARE [1060]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"US BEHAVIORAL MENTAL\/EATING DISORDER","standard_charge_percentage":70.00,"standard_charge_algorithm":"70% of billed.","methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":367557.16},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($220,016). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 733000. For days after this threshold has been met, a payment of (non-excluded charges minus 733000) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allo Unrelate BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"PRIVATE HEALTHCARE SYSTEM","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":341303.07},{"payer_name":"MERCY PHYSICIANS MED GRP [1052]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"VILLAGE HEALTH [1094]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"TRI-CITY MEDICAL CENTER [1129]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"HEALTH NET [1039]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"BLUE SHIELD TRANSPLANTS [1113]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Case rate ($236,155). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 543900. For days after this threshold has been met, a payment of (non-excluded charges minus 543900) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"ALTERNATE BRAND NEW DAY [2079]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"SHARP HEALTHCARE TRANSPLANT [1119]","plan_name":"SHARP HEALTHCARE TRANSPLANT [11190001]","standard_charge_algorithm":"Per diem ($3,550).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":3550.00},{"payer_name":"PREMIER PATIENT CARE IPA [2069]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"KERN HEALTH SYSTEMS [2033]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"ROYAL EMBASSY","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":367557.16},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Case rate ($346,408). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1085888. For days after this threshold has been met, a payment of (non-excluded charges minus 1085888) multiplied by .445 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic Unrelated BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"ELIZABETH HOSPICE [2018]","plan_name":"ELIZABETH HOSPICE GIP","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay.","standard_charge_dollar":950.00},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"MC SCAN HMO [164035]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Case rate ($236,155). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 543900. For days after this threshold has been met, a payment of (non-excluded charges minus 543900) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Case rate ($236,155). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 543900. For days after this threshold has been met, a payment of (non-excluded charges minus 543900) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"REDLANDS COMMUNITY HOSPITAL [2005]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"TRIWEST ALTERNATE [2036]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":149716.87},{"payer_name":"UNITED AMERICAN [1087]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"MC UHC HARMONY HMO [164026]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"CALIFORNIA HEALTH & WELLNESS MEDI-CAL [1122]","plan_name":"CALIFORNIA HEALTH AND WELLNESS MEDI-CAL (no longer Medi-Cal plan as of 1\/1\/24)","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 35, Case rate ($164,743.46). Procedures 36 - 9999, Per diem ($8,766.79).","methodology":"other","count":"0","additional_payer_notes":"Allo Stem Cell Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"USOC - US OLYMPIC COMMITTEE [1123]","plan_name":"USOC VIK (BSC UC CARE)","standard_charge_percentage":43.10,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":226310.19},{"payer_name":"INTER VALLEY HEALTH PLAN [2024]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"GLOBAL EXCEL [1036]","plan_name":"GLOBAL EXCEL","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 165%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":149716.87},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($220,016). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 733000. For days after this threshold has been met, a payment of (non-excluded charges minus 733000) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allo Unrelate BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"CIGNA [1023]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"HERITAGE VICTOR VALLEY MEDICAL GROUP [2045]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($148,381.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $137,250.76, add-ons for qualifying new technology services are included. If operating cost exceeds $186,409.65 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,983.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $137,337.46 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $136,461.65 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,254.53. The transfer capital threshold is the transfer adjustment factor * $10,254.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":148381.09},{"payer_name":"CHAMPVA [1020]","plan_name":"VETERANS ADMINISTRATION - CHAMPVA","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":149716.87},{"payer_name":"CAL OPTIMA [1016]","plan_name":"CalOptima Medicare","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":149716.87},{"payer_name":"SIERRA MEDICAL GROUP [2048]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"WORKERS COMPENSATION [1097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","median_amount":352156.18,"10th_percentile":352156.18,"90th_percentile":352156.18,"count":"1 through 10","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":194631.93},{"payer_name":"EASY CHOICE [1029]","plan_name":"EASY CHOICE","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"RIVERSIDE MEDICAL CLINIC [2064]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"ETS - LIFETRAC NETWORK [1103]","plan_name":"LIFETRAC","standard_charge_algorithm":"Case rate ($192,500). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic Non Related BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":192500.00},{"payer_name":"MC UHC VEBA HMO [164033]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":119200.58},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($2,140). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"All other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"MC BRAND NEW DAY GENERIC PAYOR [164031]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"BLUE SHIELD [1014]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($121,328.37). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $111,652.50, add-ons for qualifying new technology services are included. If operating cost exceeds $160,811.39 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,529.40, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $111,739.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $110,863.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,800.06. The transfer capital threshold is the transfer adjustment factor * $8,800.06. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121328.37},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDI-CAL ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 35, Case rate ($170,828). Procedures 36 - 9999, Per diem ($9,091).","methodology":"other","count":"0","additional_payer_notes":"Allo Stem Cell Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"UC AFF HUMANA\/SDSM [164025]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"IMPERIAL HEALTH PLAN [2081]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($279,808). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 886128. For days after this threshold has been met, a payment of (non-excluded charges minus 886128) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allo Non Related BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"UC AFF ANTHEM\/XIMED HMO [164022]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE PPO","standard_charge_percentage":49.55,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":260177.96},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UHC SELECT AND SELECT PLUS","standard_charge_algorithm":"Per diem ($14,996).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":14996.00},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Case rate ($346,408). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1085888. For days after this threshold has been met, a payment of (non-excluded charges minus 1085888) multiplied by .445 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic Unrelated BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($148,381.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $137,250.76, add-ons for qualifying new technology services are included. If operating cost exceeds $186,409.65 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,983.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $137,337.46 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $136,461.65 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,254.53. The transfer capital threshold is the transfer adjustment factor * $10,254.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":148381.09},{"payer_name":"AETNA TRANSPLANTS [1112]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($279,808). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 886128. For days after this threshold has been met, a payment of (non-excluded charges minus 886128) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allo Non Related BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"PYRAMID LIFE [1068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"MC UHC VEBA GENERIC HMO [164032]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"MONARCH HEALTHCARE [2006]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"KAISER [1046]","plan_name":"KAISER","standard_charge_percentage":67.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":351804.71},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CALIFORNIA UC CARE \/ HSP","standard_charge_percentage":26.66,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":139986.77},{"payer_name":"CMN - CANADIAN MEDICAL NETWORK [1024]","plan_name":"CMN GLOBAL INC","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 170%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":254518.68},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($220,016). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 733000. For days after this threshold has been met, a payment of (non-excluded charges minus 733000) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allo Unrelate BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"STATE OF CALIFORNIA [1082]","plan_name":"California State Prison","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 250%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":149716.87},{"payer_name":"SAN DIEGO SOCKERS [2015]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":194631.93},{"payer_name":"AMERICAN SPECIALTY HEALTH PLAN [2038]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"HIGH DESERT MEDICAL GROUP [2053]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"CIGNA HMO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":264116.07},{"payer_name":"IMMIGRATION HEALTH SERVICES [1043]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":146722.53},{"payer_name":"WELL CARE [1096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Pricing is calculated over two periods plus stop loss reimbursement. The first period consists of the days from admission to 2 days before the relevant ICD Procedure date. If multiple relevant ICD Procedures are present, the first relevant ICD Procedure date on the claim is used. The reimbursement for this period is calculated as a per diem rate of $4,345. The second period consists of the days from the end of the first period to claim end. The reimbursement for this period is calculated as a case rate ($143,401). The stop loss period consists of the days from the day after the stop loss threshold ($397,080) is met to claim end. Only charges after the start of period two are considered for stop loss calculation. The reimbursement for this period is calculated as 42.2% of billed charges during the period after non-excluded charges exceed the threshold of $397,080. Only charges above the threshold on the day the threshold is met are reimbursed.","methodology":"other","count":"0","additional_payer_notes":"Allogenic BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 195%.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic Unrelated BMT (Optum 1\/24) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":237184.82},{"payer_name":"HEMET COMMUNITY MED GRP - PROMISECARE [1040]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Case rate ($327,600). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1335600. For days after this threshold has been met, a payment of (non-excluded charges minus 1335600) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic BMT Unrelated Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"BLUE SHIELD PROMISE [1017]","plan_name":"CARE 1ST HEALTHPLAN MEDICARE ADVANTAGE (BS PROMISE)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MA\/SDPMG","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":115551.58},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Case rate ($327,600). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1335600. For days after this threshold has been met, a payment of (non-excluded charges minus 1335600) multiplied by .62 will be used instead of the standard payment.","methodology":"other","median_amount":315000.00,"10th_percentile":242002.00,"90th_percentile":315000.00,"count":"12","additional_payer_notes":"Allogeneic BMT Unrelated Transplant","standard_charge_dollar":525081.65},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($220,016). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 733000. For days after this threshold has been met, a payment of (non-excluded charges minus 733000) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allo Unrelate BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"LA CARE HEALTH PLAN [2025]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"MC UHC ALLIANCE HMO [164020]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($2,140). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","median_amount":353184.34,"10th_percentile":353184.34,"90th_percentile":353184.34,"count":"1 through 10","additional_payer_notes":"All other Inpatient Services","standard_charge_dollar":525081.65},{"payer_name":"ST JOSEPH ST JUDE [2065]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"GOLDEN PHYSICIANS MEDICAL GROUP [2082]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":145959.89},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EATING DISORDER","standard_charge_percentage":58.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":307907.88},{"payer_name":"KEY MED GRP [2074]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"ADVANTRA FREEDOM [1002]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"SCAN HEALTH [1072]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":115551.58},{"payer_name":"EMPIRE PHYS MED GRP [2072]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE SAN DIEGO","standard_charge_algorithm":"Case rate ($148,381.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $137,250.76, add-ons for qualifying new technology services are included. If operating cost exceeds $186,409.65 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,983.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $137,337.46 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $136,461.65 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,254.53. The transfer capital threshold is the transfer adjustment factor * $10,254.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":148381.09},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Case rate ($346,408). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1085888. For days after this threshold has been met, a payment of (non-excluded charges minus 1085888) multiplied by .445 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic Unrelated BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":133796.56},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($148,381.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $137,250.76, add-ons for qualifying new technology services are included. If operating cost exceeds $186,409.65 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,983.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $137,337.46 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $136,461.65 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,254.53. The transfer capital threshold is the transfer adjustment factor * $10,254.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":148381.09},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($148,381.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $137,250.76, add-ons for qualifying new technology services are included. If operating cost exceeds $186,409.65 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,983.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $137,337.46 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $136,461.65 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,254.53. The transfer capital threshold is the transfer adjustment factor * $10,254.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":148381.09},{"payer_name":"BEACON HEALTH STRATEGY [2039]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"MGM RESORTS [1053]","plan_name":"MGM RESORT","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":393811.24},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"SALUDPOL Peru Police","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":367557.16},{"payer_name":"HUMANA [1042]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($121,328.37). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $111,652.50, add-ons for qualifying new technology services are included. If operating cost exceeds $160,811.39 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,529.40, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $111,739.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $110,863.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,800.06. The transfer capital threshold is the transfer adjustment factor * $8,800.06. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121328.37},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"Community Care IPA Medi-Cal Managed Care","standard_charge_algorithm":"Includes a variable per diem for days 0-99999: RC 0100:0169 @ $1,750; RC 0200:0202 @ $1,750; RC 0208:0213 @ $1,750; RC 0219 @ $1,750; RC 0206 @ $2,300; RC 0207 @ $2,300.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"HEALTH CARE SUPPORT [2011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"ALTERNATE MOLINA [1240]","plan_name":"MOLINA MEDI-CAL [12400001]","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 35, Case rate ($170,828). Procedures 36 - 9999, Per diem ($9,091).","methodology":"other","count":"0","additional_payer_notes":"Allo Stem Cell Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"AXA ASSISTANCE [1098]","plan_name":"AXA ASSISTANCE USA,INC","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":420065.32},{"payer_name":"MC BLUE SHIELD HMO [164015]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"BRAND NEW DAY [1089]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"FRESENIUS [1034]","plan_name":"FRESENIUS HEALTH PARTNERS, INC","standard_charge_algorithm":"Case rate ($121,328.37). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $111,652.50, add-ons for qualifying new technology services are included. If operating cost exceeds $160,811.39 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,529.40, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $111,739.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $110,863.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,800.06. The transfer capital threshold is the transfer adjustment factor * $8,800.06. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121328.37},{"payer_name":"SCRIPPS COASTAL MED GRP [1074]","plan_name":"SCRIPPS COASTAL MED GRP [10740001]","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":341303.07},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($2,140). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"All other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":110931.14,"10th_percentile":110931.14,"90th_percentile":110931.14,"count":"1 through 10","additional_payer_notes":"Transplants","standard_charge_dollar":121633.24},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE DISTINCTION ","standard_charge_algorithm":"Case rate ($229,627). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 746286. For days after this threshold has been met, a payment of (non-excluded charges minus 746286) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic Unrelated BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK","standard_charge_algorithm":"Per diem ($4,700). A payment threshold will be met when non-excluded charges is greater than 325000. For days after this threshold has been met, a per diem of (non-excluded charges for that day multiplied by .65) will be used instead of the standard payment for each day after the threshold.","methodology":"other","count":"0","additional_payer_notes":"Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"MEDICARE [1050]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","median_amount":161434.23,"10th_percentile":158799.08,"90th_percentile":397881.85,"count":"1 through 10","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":146722.53},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Case rate ($327,600). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1335600. For days after this threshold has been met, a payment of (non-excluded charges minus 1335600) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic BMT Unrelated Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EPO [10130074]","standard_charge_algorithm":"Case rate ($327,600). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1335600. For days after this threshold has been met, a payment of (non-excluded charges minus 1335600) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic BMT Unrelated Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"MC HUMANA HMO [164013]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($121,328.37). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $111,652.50, add-ons for qualifying new technology services are included. If operating cost exceeds $160,811.39 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $11,529.40, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $111,739.20 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $110,863.39 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,800.06. The transfer capital threshold is the transfer adjustment factor * $8,800.06. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121328.37},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($220,016). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 733000. For days after this threshold has been met, a payment of (non-excluded charges minus 733000) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allo Unrelate BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Case rate ($327,600). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 1335600. For days after this threshold has been met, a payment of (non-excluded charges minus 1335600) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Allogeneic BMT Unrelated Transplant Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525081.65},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":181508.61,"10th_percentile":181508.61,"90th_percentile":181508.61,"count":"1 through 10","additional_payer_notes":"Inpatient","standard_charge_dollar":121633.24},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($148,381.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $137,250.76, add-ons for qualifying new technology services are included. If operating cost exceeds $186,409.65 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,983.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $137,337.46 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $136,461.65 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,254.53. The transfer capital threshold is the transfer adjustment factor * $10,254.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":148381.09},{"payer_name":"CASSIDY MED GRP [1019]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":341303.07},{"payer_name":"CENTRAL HEALTH PLAN [2026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"MEDCARE PARTNERS [2084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"AETNA [1003]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":315048.99},{"payer_name":"CLIPPERS WORKERS COMPENSATION [2097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":194631.93},{"payer_name":"BEAVER MED GRP [2075]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":149716.87},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":149716.87},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($2,140). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","median_amount":379613.19,"10th_percentile":379613.19,"90th_percentile":379613.19,"count":"1 through 10","additional_payer_notes":"All other Inpatient Services","standard_charge_dollar":525081.65},{"payer_name":"HEALTHCARE PARTNERS [2073]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH PLAN","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":315048.99},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 25 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($148,381.09). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $137,250.76, add-ons for qualifying new technology services are included. If operating cost exceeds $186,409.65 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $12,983.86, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $137,337.46 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $136,461.65 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,254.53. The transfer capital threshold is the transfer adjustment factor * $10,254.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":148381.09},{"payer_name":"OPTUM CARE NETWORK - PCAMG [1064]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":341303.07},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA HMO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":264116.07},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":145959.89},{"payer_name":"COMMUNITY ELDERCARE [1027]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24},{"payer_name":"MC ANTHEM BLUE CROSS GENERIC PAYOR [164009]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":63009.80},{"payer_name":"VA - VETERANS ADMINISTRATION [1093]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($149,716.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $138,535.80, add-ons for qualifying new technology services are included. If operating cost exceeds $187,220.42 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $13,506.56, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $138,622.51 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $137,746.69 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $10,305.26. The transfer capital threshold is the transfer adjustment factor * $10,305.26. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":149716.87},{"payer_name":"US MARSHAL SERVICES [1090]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($121,633.24). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $111,934.01, add-ons for qualifying new technology services are included. If operating cost exceeds $160,618.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $12,024.72, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 25.7. The base transfer operating payment is the transfer adjustment factor * $112,020.72 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $111,144.90 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $8,823.42. The transfer capital threshold is the transfer adjustment factor * $8,823.42. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":121633.24}]}]}
,{"description":"Autologous Bone Marrow Transplant With Cc\/McC","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"minimum":7.65,"maximum":160050.00,"gross_charge":293147.59,"discounted_cash":161231.17,"setting":"inpatient","payers_information":[{"payer_name":"US MARSHAL SERVICES [1090]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($73,611.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $68,120.06, add-ons for qualifying new technology services are included. If operating cost exceeds $117,278.95 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,788.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $67,763.08 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,330.95 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,059.64. The transfer capital threshold is the transfer adjustment factor * $5,059.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":73611.83},{"payer_name":"DESERT OASIS HEALTH CARE [2052]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($73,611.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $68,120.06, add-ons for qualifying new technology services are included. If operating cost exceeds $117,278.95 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,788.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $67,763.08 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,330.95 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,059.64. The transfer capital threshold is the transfer adjustment factor * $5,059.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":73611.83},{"payer_name":"MC HUMANA GENERIC PAYOR [164014]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"LAKESIDE MEDICAL GROUP [2054]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"QUALITY HEALTH [1069]","plan_name":"QUALITY HEALTH MANAGEMENT","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 195%.","methodology":"other","count":"0","additional_payer_notes":"Oncology  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":144828.29},{"payer_name":"MC CIGNA GENERIC PAYOR [164007]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Commercial","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 160%.","methodology":"other","count":"0","additional_payer_notes":"Oncology Care Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":96662.86},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Medicare","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"Oncology Care Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":72497.15},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"ALTERNATE HEALTH NET BH [2059]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 195%.","methodology":"other","count":"0","additional_payer_notes":"Auto\/Auto BMT Tandem (Optum 1\/24) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":117807.87},{"payer_name":"HMSA - HAWAII MEDICAL SERVICE ASSOC MDCR [1041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"IMPERIAL COUNTY PHYSICIAN MED GRP","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":59206.00},{"payer_name":"MC UNITED HEALTHCARE GENERIC PAYOR [164011]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"UC AFF ANTHEM\/SDSM HMO [164024]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"ALTERNATE SHERIFF CUSTODY [1106]","plan_name":"SHERIFF COUNTY CONTRACT # 514250","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":190545.93},{"payer_name":"MENIFEE MED GRP [2076]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":161817.47},{"payer_name":"SCRIPPS HOSPICE [2008]","plan_name":"SCRIPPS HEALTH HOSPICE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay.","standard_charge_dollar":700.00},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MARKET PLACE","standard_charge_algorithm":"Case rate ($60,263.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $55,489.74, add-ons for qualifying new technology services are included. If operating cost exceeds $104,648.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,071.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,132.76 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,700.63 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,342.00. The transfer capital threshold is the transfer adjustment factor * $4,342.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 180%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60263.87},{"payer_name":"XIMED [2016]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"BEECH STREET [1012]","plan_name":"CAPPCARE\/BEECH STREET","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":219860.69},{"payer_name":"MEDI-CAL [1048]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA COMMERCIAL","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 140%.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":103979.29},{"payer_name":"AFFILIATED DOCTORS OF ORANGE COUNTY [2041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"RIVER CITY MEDICAL GROUP [2066]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"ALTERNATE MEDICARE [2007]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":72785.50},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE [10230006]","standard_charge_algorithm":"Case rate ($113,394). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 320436. For days after this threshold has been met, a payment of (non-excluded charges minus 320436) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Autologous BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"BLUE CROSS TRANSPLANT [1116]","plan_name":"BLUE DISTINCTION ","standard_charge_algorithm":"Case rate ($113,677). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 369449. For days after this threshold has been met, a payment of (non-excluded charges minus 369449) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Auto\/Auto BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE TRANSPLANT [11170001]","standard_charge_algorithm":"Case rate ($113,394). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 320436. For days after this threshold has been met, a payment of (non-excluded charges minus 320436) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Autologous BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"AETNA [1003]","plan_name":"AETNA BEHAVIORAL EATING DISORDER","standard_charge_percentage":43.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":128105.50},{"payer_name":"AETNA [1003]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($148,484). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 577411. For days after this threshold has been met, a payment of (non-excluded charges minus 577411) multiplied by .60 will be used instead of the standard payment.","methodology":"other","median_amount":218407.51,"10th_percentile":218407.51,"90th_percentile":218407.51,"count":"1 through 10","additional_payer_notes":"Autologous BMT","standard_charge_dollar":293147.59},{"payer_name":"UCR PROMPT PAY PAYOR [8240]","plan_name":"UCSD CHARITY MEDICARE CONTRACT","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Medicare All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":74270.92},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MID-COUNTY PHYSICIANS NARROW NETWORK","standard_charge_algorithm":"Per diem ($17,123).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":17123.00},{"payer_name":"STERLING OPTION 1 [1083]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"ALTERNATE AETNA [1004]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($148,484). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 577411. For days after this threshold has been met, a payment of (non-excluded charges minus 577411) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Autologous BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"ALTERNATE KAISER RAD ONC [2089]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":59206.00},{"payer_name":"ASTIVA HEALTH [2095]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"EMBASSY OF STATE OF KUWAIT [11010001]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":199340.36},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($73,611.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $68,120.06, add-ons for qualifying new technology services are included. If operating cost exceeds $117,278.95 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,788.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $67,763.08 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,330.95 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,059.64. The transfer capital threshold is the transfer adjustment factor * $5,059.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":73611.83},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"KUWAIT OIL COMPANY [11010005]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":199340.36},{"payer_name":"AMA - AMERICAN MEDICAL ASSOCIATION [1009]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"CIGNA [1023]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($171,689). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 554273. For days after this threshold has been met, a payment of (non-excluded charges minus 554273) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Auto\/Auto BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"IMPERIAL HEALTH HOLDINGS [1132]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"MC UHC ALLIANCE HMO [164020]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS UC CARE","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":77390.96},{"payer_name":"AETNA [1003]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($60,263.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $55,489.74, add-ons for qualifying new technology services are included. If operating cost exceeds $104,648.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,071.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,132.76 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,700.63 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,342.00. The transfer capital threshold is the transfer adjustment factor * $4,342.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60263.87},{"payer_name":"USAA [1091]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"CARNIVAL CRUISES [1018]","plan_name":"CARNIVAL CRUISES [10180001]","standard_charge_percentage":90.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":263832.83},{"payer_name":"MC HEALTHNET HMO [164004]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"CLEVER CARE [2061]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"OLYMPUS MANAGED HEALTHCARE INC [11020001]","standard_charge_algorithm":"Case rate ($148,484). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 577411. For days after this threshold has been met, a payment of (non-excluded charges minus 577411) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Autologous BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"ALTERNATE SCAN HEALTH [2088]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":57393.58},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($60,263.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $55,489.74, add-ons for qualifying new technology services are included. If operating cost exceeds $104,648.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,071.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,132.76 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,700.63 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,342.00. The transfer capital threshold is the transfer adjustment factor * $4,342.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60263.87},{"payer_name":"TRANSAMERICA [1084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"ENCOMPASS MED GRP [1030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"CAREMORE [2028]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"DEPARTMENT OF LABOR [1028]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":96552.20},{"payer_name":"PRIMARY CARE ASSOCIATES OF CA [2067]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE QUALCOMM ","standard_charge_percentage":45.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":133792.56},{"payer_name":"ALTERNATE VA - VETERANS ADMINISTRATION [1239]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":74270.92},{"payer_name":"EASY ACCESS CARE [2077]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"MC HEALTHNET GENERIC PAYOR [164010]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":74270.92},{"payer_name":"SDSM [2017]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"COMMUNITY HEALTH GROUP [1022]","plan_name":"COMMUNITY HEALTH GROUP MEDICARE ADVANTAGE","standard_charge_algorithm":"Fee schedule rate ($5.93). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","median_amount":68575.20,"10th_percentile":68575.20,"90th_percentile":68575.20,"count":"1 through 10","additional_payer_notes":"Transplants","standard_charge_dollar":7.65},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":74270.92},{"payer_name":"KAISER [1046]","plan_name":"KAISER MEDICARE ADVANTAGE","standard_charge_percentage":67.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":196408.89},{"payer_name":"BANKERS LIFE [1011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"ADMAR [1001]","plan_name":"MULTIPLAN","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":219860.69},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA HMO","standard_charge_algorithm":"Per diem ($19,450).","methodology":"per diem","median_amount":112386.10,"10th_percentile":112386.10,"90th_percentile":112386.10,"count":"1 through 10","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay.","standard_charge_dollar":19450.00},{"payer_name":"VANTAGE [1092]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"MC UHC VEBA GENERIC HMO [164032]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"SIMNSA HEALTH PLAN [2047]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"BPS - BENEFIT PLAN SERVICES [1015]","plan_name":"MULTIPLAN","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":219860.69},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNA PRIORITY SELECT","standard_charge_algorithm":"Case rate ($153,920). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 644480. For days after this threshold has been met, a payment of (non-excluded charges minus 644480) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Autologous BMT Stem Cell Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"CHRISTIAN HEALTHCARE MINISTRIES [2030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE MEDI-CAL TRANSPLANT [11260001]","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 20, Case rate ($136,084). Procedures 21 - 9999, Per diem ($4,903).","methodology":"other","median_amount":136084.00,"10th_percentile":136084.00,"90th_percentile":136084.00,"count":"1 through 10","additional_payer_notes":"Auto Stem Cell","standard_charge_dollar":293147.59},{"payer_name":"ALPHACARE [2062]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD COVERED CA TRIO HMO","standard_charge_algorithm":"Case rate ($226,275). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 500850. For days after this threshold has been met, a payment of (non-excluded charges minus 500850) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Auto\/Allo BMT (tandem) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"SEDGWICK [1077]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":96552.20},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA COMMERCIAL","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 140%.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":103979.29},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"MC AETNA GENERIC PAYOR [164008]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($60,263.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $55,489.74, add-ons for qualifying new technology services are included. If operating cost exceeds $104,648.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,071.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,132.76 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,700.63 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,342.00. The transfer capital threshold is the transfer adjustment factor * $4,342.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 195%.","methodology":"other","median_amount":121029.36,"10th_percentile":121029.36,"90th_percentile":121104.48,"count":"1 through 10","additional_payer_notes":"Auto\/Auto BMT Tandem","standard_charge_dollar":117514.55},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDI-CAL","standard_charge_algorithm":"Case rate ($287,165). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 844878. For days after this threshold has been met, a payment of (non-excluded charges minus 844878) multiplied by .445 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Auto\/Auto BMT Tandem Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"ALTERNATE MEDI-CAL [2001]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($60,263.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $55,489.74, add-ons for qualifying new technology services are included. If operating cost exceeds $104,648.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,071.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,132.76 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,700.63 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,342.00. The transfer capital threshold is the transfer adjustment factor * $4,342.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60263.87},{"payer_name":"ARCH HEALTH PARTNERS [2000]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"FIRST HEALTH [1032]","plan_name":"FIRST HEALTH","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":219860.69},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UHC SELECT AND SELECT PLUS","standard_charge_algorithm":"Per diem ($14,996).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":14996.00},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED HMO NON CONTRACTED [10260001]","standard_charge_algorithm":"Case rate ($60,263.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $55,489.74, add-ons for qualifying new technology services are included. If operating cost exceeds $104,648.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,071.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,132.76 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,700.63 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,342.00. The transfer capital threshold is the transfer adjustment factor * $4,342.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60263.87},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED PPO NON CONTRACTED [10260002]","standard_charge_algorithm":"Case rate ($60,263.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $55,489.74, add-ons for qualifying new technology services are included. If operating cost exceeds $104,648.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,071.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,132.76 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,700.63 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,342.00. The transfer capital threshold is the transfer adjustment factor * $4,342.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60263.87},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($144,469). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 538407. For days after this threshold has been met, a payment of (non-excluded charges minus 538407) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Autologous BMT Stem Cell Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE","standard_charge_algorithm":"Case rate ($113,394). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 320436. For days after this threshold has been met, a payment of (non-excluded charges minus 320436) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Autologous BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($171,689). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 554273. For days after this threshold has been met, a payment of (non-excluded charges minus 554273) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Auto\/Auto BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE","standard_charge_algorithm":"Case rate ($113,394). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 320436. For days after this threshold has been met, a payment of (non-excluded charges minus 320436) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Autologous BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"MC AETNA HMO [164001]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 4, Case rate ($25,000). Procedures 5 - 9999, Per diem ($5,100).","methodology":"other","count":"0","additional_payer_notes":"Ortho Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"INTERPLAN [1045]","plan_name":"INTERPLAN","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":205203.31},{"payer_name":"MC BRAND NEW DAY HMO [164030]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"BLUE CROSS [1013]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($60,263.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $55,489.74, add-ons for qualifying new technology services are included. If operating cost exceeds $104,648.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,071.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,132.76 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,700.63 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,342.00. The transfer capital threshold is the transfer adjustment factor * $4,342.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60263.87},{"payer_name":"BLUE CROSS [1013]","plan_name":"UCSD STUDENT HEALTH INS PLAN - BC SHIP","standard_charge_percentage":26.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":78270.41},{"payer_name":"MC SCAN GENERIC PAYOR [164034]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"MC UNITED HEALTHCARE HMO [164005]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Pricing is calculated over two periods plus stop loss reimbursement. The first period consists of the days from admission to 2 days before the relevant ICD Procedure date. If multiple relevant ICD Procedures are present, the first relevant ICD Procedure date on the claim is used. The reimbursement for this period is calculated as a per diem rate of $4,345. The second period consists of the days from the end of the first period to claim end. The reimbursement for this period is calculated as a case rate ($63,698). The stop loss period consists of the days from the day after the stop loss threshold ($224,762) is met to claim end. Only charges after the start of period two are considered for stop loss calculation. The reimbursement for this period is calculated as 42.2% of billed charges during the period after non-excluded charges exceed the threshold of $224,762. Only charges above the threshold on the day the threshold is met are reimbursed.","methodology":"other","median_amount":70417.32,"10th_percentile":70417.32,"90th_percentile":70417.32,"count":"1 through 10","additional_payer_notes":"Autollogous BMT","standard_charge_dollar":293147.59},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET MEDICARE ADVANTAGE UC EMPLOYER GROUP","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 195%.","methodology":"other","count":"0","additional_payer_notes":"Auto\/Auto BMT Tandem (Optum 1\/24) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":117807.87},{"payer_name":"UNLISTED MEDICARE ADVANTAGE (NON-CONTRACTED) [1051]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"TRI-CITY [1085]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"ALTERNATE MOLINA [1240]","plan_name":"MOLINA MEDI-CAL","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 20, Case rate ($136,084). Procedures 21 - 9999, Per diem ($4,903).","methodology":"other","count":"0","additional_payer_notes":"Auto Stem Cell Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"CHESAPEAKE LIFE [1021]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"MUTUAL OF OMAHA [1059]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($144,469). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 538407. For days after this threshold has been met, a payment of (non-excluded charges minus 538407) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Autologous BMT Stem Cell Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"GREATER NEWPORT PHYSICIANS [2096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"MC SCAN HMO [164035]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"UNLISTED HOSPICE [1035]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"MULTIPLAN [1058]","plan_name":"MULTIPLAN","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":219860.69},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS HOUSE STAFF","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":77390.96},{"payer_name":"MC ANTHEM BLUE CROSS HMO [164002]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"UC AFF BLUE SHIELD SR\/SDSM [164037]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"TRIWEST [2003]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","median_amount":74270.92,"10th_percentile":74270.92,"90th_percentile":74270.92,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":74270.92},{"payer_name":"MC CIGNA HMO [164003]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Case rate ($226,275). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 500850. For days after this threshold has been met, a payment of (non-excluded charges minus 500850) multiplied by .526 will be used instead of the standard payment.","methodology":"other","median_amount":149215.00,"10th_percentile":149215.00,"90th_percentile":149215.00,"count":"1 through 10","additional_payer_notes":"Auto\/Allo BMT (tandem)","standard_charge_dollar":293147.59},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Case rate ($226,275). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 500850. For days after this threshold has been met, a payment of (non-excluded charges minus 500850) multiplied by .526 will be used instead of the standard payment.","methodology":"other","median_amount":81000.00,"10th_percentile":81000.00,"90th_percentile":81000.00,"count":"1 through 10","additional_payer_notes":"Auto\/Allo BMT (tandem)","standard_charge_dollar":293147.59},{"payer_name":"INLAND FACULTY MEDICAL GROUP [2063]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"INTEGRATED HEALTH PARTNERS [2068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"PACIFIC FOUNDATION [1063]","plan_name":"PACIFIC FOUNDATION FOR MEDICAL CARE","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":219860.69},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"INTERNATIONAL EMBASSY OF KUWAIT","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":199340.36},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA EPN\/IFP","standard_charge_algorithm":"Case rate ($226,275). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 500850. For days after this threshold has been met, a payment of (non-excluded charges minus 500850) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Auto\/Allo BMT (tandem) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE ST PAULS","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":74270.92},{"payer_name":"MVP HEALTHCARE [1060]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET ENHANCED CARE PPO","standard_charge_algorithm":"Case rate ($55,849.98). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $51,444.21, add-ons for qualifying new technology services are included. If operating cost exceeds $100,603.10 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $6,702.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $51,876.34. The transfer operating threshold is the transfer adjustment factor * $51,444.21 If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $3,973.64. The transfer capital threshold is the transfer adjustment factor * $3,973.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 281%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services (MSDRG no DSH GME IME) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":55849.98},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($73,611.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $68,120.06, add-ons for qualifying new technology services are included. If operating cost exceeds $117,278.95 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,788.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $67,763.08 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,330.95 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,059.64. The transfer capital threshold is the transfer adjustment factor * $5,059.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":73611.83},{"payer_name":"NATIONAL HEALTHCARE SOLUTIONS INC [1100]","plan_name":"NATIONAL HEALTHCARE SOLUTIONS INC [11000001]","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":234518.07},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"US BEHAVIORAL MENTAL\/EATING DISORDER","standard_charge_percentage":70.00,"standard_charge_algorithm":"70% of billed.","methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":205203.31},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"PRIVATE HEALTHCARE SYSTEM","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":219860.69},{"payer_name":"MERCY PHYSICIANS MED GRP [1052]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($171,689). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 554273. For days after this threshold has been met, a payment of (non-excluded charges minus 554273) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Auto\/Auto BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"HEALTH NET [1039]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"VILLAGE HEALTH [1094]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"BLUE SHIELD TRANSPLANTS [1113]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Case rate ($226,275). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 500850. For days after this threshold has been met, a payment of (non-excluded charges minus 500850) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Auto\/Allo BMT (tandem) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"SHARP HEALTHCARE TRANSPLANT [1119]","plan_name":"SHARP HEALTHCARE TRANSPLANT [11190001]","standard_charge_algorithm":"Per diem ($3,550).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":3550.00},{"payer_name":"ALTERNATE BRAND NEW DAY [2079]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"UC AFF MC HUMANA GENERIC PAYOR [164027]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"PREMIER PATIENT CARE IPA [2069]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"ROYAL EMBASSY","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":205203.31},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Case rate ($186,529). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 584707. For days after this threshold has been met, a payment of (non-excluded charges minus 584707) multiplied by .445 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Autologous BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"KERN HEALTH SYSTEMS [2033]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"ELIZABETH HOSPICE [2018]","plan_name":"ELIZABETH HOSPICE GIP","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay.","standard_charge_dollar":950.00},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Case rate ($226,275). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 500850. For days after this threshold has been met, a payment of (non-excluded charges minus 500850) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Auto\/Allo BMT (tandem) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Case rate ($226,275). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 500850. For days after this threshold has been met, a payment of (non-excluded charges minus 500850) multiplied by .526 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Auto\/Allo BMT (tandem) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":61921.90,"10th_percentile":61921.90,"90th_percentile":61921.90,"count":"1 through 10","additional_payer_notes":"Inpatient","standard_charge_dollar":60414.29},{"payer_name":"TRIWEST ALTERNATE [2036]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":74270.92},{"payer_name":"UNITED AMERICAN [1087]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"MC UHC HARMONY HMO [164026]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"CALIFORNIA HEALTH & WELLNESS MEDI-CAL [1122]","plan_name":"CALIFORNIA HEALTH AND WELLNESS MEDI-CAL (no longer Medi-Cal plan as of 1\/1\/24)","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 20, Case rate ($131,237.18). Procedures 21 - 9999, Per diem ($4,728.01).","methodology":"other","count":"0","additional_payer_notes":"Auto Stem Cell Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"INTER VALLEY HEALTH PLAN [2024]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"GLOBAL EXCEL [1036]","plan_name":"GLOBAL EXCEL","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 165%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":74270.92},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($171,689). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 554273. For days after this threshold has been met, a payment of (non-excluded charges minus 554273) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Auto\/Auto BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"CIGNA [1023]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"CAL OPTIMA [1016]","plan_name":"CalOptima Medicare","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":74270.92},{"payer_name":"HERITAGE VICTOR VALLEY MEDICAL GROUP [2045]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($73,611.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $68,120.06, add-ons for qualifying new technology services are included. If operating cost exceeds $117,278.95 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,788.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $67,763.08 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,330.95 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,059.64. The transfer capital threshold is the transfer adjustment factor * $5,059.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":73611.83},{"payer_name":"SIERRA MEDICAL GROUP [2048]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"CHAMPVA [1020]","plan_name":"VETERANS ADMINISTRATION - CHAMPVA","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":74270.92},{"payer_name":"EASY CHOICE [1029]","plan_name":"EASY CHOICE","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"WORKERS COMPENSATION [1097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":96552.20},{"payer_name":"RIVERSIDE MEDICAL CLINIC [2064]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"BLUE CROSS [1013]","plan_name":"STRATEGIC HEALTH","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 44, Case rate ($78,200). Procedures 45 - 9999, 70% of billed.","methodology":"other","count":"0","additional_payer_notes":"Autologous BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"ETS - LIFETRAC NETWORK [1103]","plan_name":"LIFETRAC","standard_charge_algorithm":"The days more than 1 days before the primary service date are reimbursed at 65% of charges. The next 25 days are considered inlier days and are reimbursed at a case rate amount of $160,050. The remaining days after the inlier period are reimbursed at 50% of charges. ","methodology":"other","count":"0","additional_payer_notes":"Auto\/Auto BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":160050.00},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":59206.00},{"payer_name":"REDLANDS COMMUNITY HOSPITAL [2005]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"WELL CARE [1096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"ALTERNATE MOLINA [1240]","plan_name":"MOLINA MEDI-CAL [12400001]","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 20, Case rate ($136,084). Procedures 21 - 9999, Per diem ($4,903).","methodology":"other","count":"0","additional_payer_notes":"Auto Stem Cell Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($2,140). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"All other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"MC BRAND NEW DAY GENERIC PAYOR [164031]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"MGM RESORTS [1053]","plan_name":"MGM RESORT","standard_charge_algorithm":"Case rate ($132,000). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 240400. For days after this threshold has been met, a payment of (non-excluded charges minus 240400) multiplied by .70 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"AUTO\/AUTO BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"BLUE SHIELD [1014]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($60,263.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $55,489.74, add-ons for qualifying new technology services are included. If operating cost exceeds $104,648.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,071.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,132.76 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,700.63 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,342.00. The transfer capital threshold is the transfer adjustment factor * $4,342.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60263.87},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDI-CAL ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 20, Case rate ($136,084). Procedures 21 - 9999, Per diem ($4,903).","methodology":"other","median_amount":136084.00,"10th_percentile":136084.00,"90th_percentile":136084.00,"count":"1 through 10","additional_payer_notes":"Auto Stem Cell","standard_charge_dollar":293147.59},{"payer_name":"SCRIPPS HEALTH PLAN SERVICES [1075]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 4, Case rate ($25,000). Procedures 5 - 9999, Per diem ($5,100).","methodology":"other","count":"0","additional_payer_notes":"Ortho Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"IMPERIAL HEALTH PLAN [2081]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"UC AFF ANTHEM\/XIMED HMO [164022]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($148,484). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 577411. For days after this threshold has been met, a payment of (non-excluded charges minus 577411) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Autologous BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE PPO","standard_charge_percentage":49.55,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":145254.63},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($73,611.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $68,120.06, add-ons for qualifying new technology services are included. If operating cost exceeds $117,278.95 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,788.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $67,763.08 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,330.95 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,059.64. The transfer capital threshold is the transfer adjustment factor * $5,059.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":73611.83},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Case rate ($186,529). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 584707. For days after this threshold has been met, a payment of (non-excluded charges minus 584707) multiplied by .445 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Autologous BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"AETNA TRANSPLANTS [1112]","plan_name":"AETNA","standard_charge_algorithm":"Case rate ($148,484). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 577411. For days after this threshold has been met, a payment of (non-excluded charges minus 577411) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Autologous BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"PYRAMID LIFE [1068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"KAISER [1046]","plan_name":"KAISER","standard_charge_percentage":67.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":196408.89},{"payer_name":"MONARCH HEALTHCARE [2006]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"CMN - CANADIAN MEDICAL NETWORK [1024]","plan_name":"CMN GLOBAL INC","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 170%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":126260.56},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE SAN DIEGO","standard_charge_algorithm":"Case rate ($73,611.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $68,120.06, add-ons for qualifying new technology services are included. If operating cost exceeds $117,278.95 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,788.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $67,763.08 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,330.95 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,059.64. The transfer capital threshold is the transfer adjustment factor * $5,059.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":73611.83},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($171,689). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 554273. For days after this threshold has been met, a payment of (non-excluded charges minus 554273) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Auto\/Auto BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"HIGH DESERT MEDICAL GROUP [2053]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"CIGNA HMO","standard_charge_algorithm":"Per diem ($19,450).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":19450.00},{"payer_name":"UC AFF HUMANA\/SDSM [164025]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"STATE OF CALIFORNIA [1082]","plan_name":"California State Prison","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 250%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":74270.92},{"payer_name":"AMERICAN SPECIALTY HEALTH PLAN [2038]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"IMMIGRATION HEALTH SERVICES [1043]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":72785.50},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Pricing is calculated over two periods plus stop loss reimbursement. The first period consists of the days from admission to 2 days before the relevant ICD Procedure date. If multiple relevant ICD Procedures are present, the first relevant ICD Procedure date on the claim is used. The reimbursement for this period is calculated as a per diem rate of $4,345. The second period consists of the days from the end of the first period to claim end. The reimbursement for this period is calculated as a case rate ($63,698). The stop loss period consists of the days from the day after the stop loss threshold ($224,762) is met to claim end. Only charges after the start of period two are considered for stop loss calculation. The reimbursement for this period is calculated as 42.2% of billed charges during the period after non-excluded charges exceed the threshold of $224,762. Only charges above the threshold on the day the threshold is met are reimbursed.","methodology":"other","median_amount":77549.88,"10th_percentile":77549.88,"90th_percentile":77549.88,"count":"1 through 10","additional_payer_notes":"Autollogous BMT","standard_charge_dollar":293147.59},{"payer_name":"HEMET COMMUNITY MED GRP - PROMISECARE [1040]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Case rate ($153,920). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 644480. For days after this threshold has been met, a payment of (non-excluded charges minus 644480) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Autologous BMT Stem Cell Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 195%.","methodology":"other","count":"0","additional_payer_notes":"Auto\/Auto BMT Tandem (Optum 1\/24) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":117807.87},{"payer_name":"MC BLUE SHIELD GENERIC PAYOR [164016]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"BLUE SHIELD PROMISE [1017]","plan_name":"CARE 1ST HEALTHPLAN MEDICARE ADVANTAGE (BS PROMISE)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MA\/SDPMG","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":57393.58},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Case rate ($153,920). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 644480. For days after this threshold has been met, a payment of (non-excluded charges minus 644480) multiplied by .62 will be used instead of the standard payment.","methodology":"other","median_amount":148000.00,"10th_percentile":148000.00,"90th_percentile":148000.00,"count":"1 through 10","additional_payer_notes":"Autologous BMT Stem Cell","standard_charge_dollar":293147.59},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($171,689). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 554273. For days after this threshold has been met, a payment of (non-excluded charges minus 554273) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Auto\/Auto BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"LA CARE HEALTH PLAN [2025]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($2,140). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"All other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"GOLDEN PHYSICIANS MEDICAL GROUP [2082]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":72497.15},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"SAN DIEGO SOCKERS [2015]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":96552.20},{"payer_name":"MC UHC VEBA HMO [164033]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EATING DISORDER","standard_charge_percentage":58.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":171901.75},{"payer_name":"SCAN HEALTH [1072]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":57393.58},{"payer_name":"ADVANTRA FREEDOM [1002]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"EMPIRE PHYS MED GRP [2072]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Case rate ($186,529). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 584707. For days after this threshold has been met, a payment of (non-excluded charges minus 584707) multiplied by .445 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Autologous BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":66455.72},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($73,611.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $68,120.06, add-ons for qualifying new technology services are included. If operating cost exceeds $117,278.95 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,788.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $67,763.08 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,330.95 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,059.64. The transfer capital threshold is the transfer adjustment factor * $5,059.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":73611.83},{"payer_name":"BEACON HEALTH STRATEGY [2039]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"SALUDPOL Peru Police","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":205203.31},{"payer_name":"TRI-CITY MEDICAL CENTER [1129]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"KEY MED GRP [2074]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"HUMANA [1042]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($60,263.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $55,489.74, add-ons for qualifying new technology services are included. If operating cost exceeds $104,648.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,071.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,132.76 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,700.63 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,342.00. The transfer capital threshold is the transfer adjustment factor * $4,342.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60263.87},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"Community Care IPA Medi-Cal Managed Care","standard_charge_algorithm":"Includes a variable per diem for days 0-99999: RC 0100:0169 @ $1,750; RC 0200:0202 @ $1,750; RC 0208:0213 @ $1,750; RC 0219 @ $1,750; RC 0206 @ $2,300; RC 0207 @ $2,300.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"HEALTH CARE SUPPORT [2011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"USOC - US OLYMPIC COMMITTEE [1123]","plan_name":"USOC VIK (BSC UC CARE)","standard_charge_percentage":43.10,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":126346.61},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"AXA ASSISTANCE [1098]","plan_name":"AXA ASSISTANCE USA,INC","standard_charge_algorithm":"Case rate ($120,225). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 240450. For days after this threshold has been met, a payment of (non-excluded charges minus 240450) multiplied by .65 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Auto\/Auto BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"MC BLUE SHIELD HMO [164015]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"BRAND NEW DAY [1089]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($73,611.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $68,120.06, add-ons for qualifying new technology services are included. If operating cost exceeds $117,278.95 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,788.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $67,763.08 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,330.95 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,059.64. The transfer capital threshold is the transfer adjustment factor * $5,059.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":73611.83},{"payer_name":"CIGNA [1023]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":161817.47},{"payer_name":"MC HNET BLUE&GOLD ACO [164017]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"FRESENIUS [1034]","plan_name":"FRESENIUS HEALTH PARTNERS, INC","standard_charge_algorithm":"Case rate ($60,263.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $55,489.74, add-ons for qualifying new technology services are included. If operating cost exceeds $104,648.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,071.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,132.76 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,700.63 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,342.00. The transfer capital threshold is the transfer adjustment factor * $4,342.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60263.87},{"payer_name":"SCRIPPS COASTAL MED GRP [1074]","plan_name":"SCRIPPS COASTAL MED GRP [10740001]","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":190545.93},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Transplants Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($2,140). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"All other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"ST JOSEPH ST JUDE [2065]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE DISTINCTION ","standard_charge_algorithm":"Case rate ($113,677). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 369449. For days after this threshold has been met, a payment of (non-excluded charges minus 369449) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Auto\/Auto BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"MEDICARE [1050]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","median_amount":74795.63,"10th_percentile":72819.93,"90th_percentile":74798.19,"count":"11","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":72785.50},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Case rate ($153,920). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 644480. For days after this threshold has been met, a payment of (non-excluded charges minus 644480) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Autologous BMT Stem Cell Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EPO [10130074]","standard_charge_algorithm":"Case rate ($153,920). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 644480. For days after this threshold has been met, a payment of (non-excluded charges minus 644480) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Autologous BMT Stem Cell Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"MC HUMANA HMO [164013]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK","standard_charge_algorithm":"Per diem ($4,700). A payment threshold will be met when non-excluded charges is greater than 325000. For days after this threshold has been met, a per diem of (non-excluded charges for that day multiplied by .65) will be used instead of the standard payment for each day after the threshold.","methodology":"other","count":"0","additional_payer_notes":"Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($171,689). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 554273. For days after this threshold has been met, a payment of (non-excluded charges minus 554273) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Auto\/Auto BMT Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($60,263.87). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $55,489.74, add-ons for qualifying new technology services are included. If operating cost exceeds $104,648.63 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,071.34, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,132.76 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,700.63 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,342.00. The transfer capital threshold is the transfer adjustment factor * $4,342.00. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60263.87},{"payer_name":"SD PHYSICIANS MED GRP [1076]","plan_name":"SD PHYSICIANS MED GRP SR [10760002]","standard_charge_percentage":55.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":161231.17},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Case rate ($153,920). Paid as a per diem or percent of billed for days before transplant, a case rate or percent of billed for the transplant period, and a per diem or percent of billed for the post-procedure period. A payment threshold will be met when non-excluded charges is greater than 644480. For days after this threshold has been met, a payment of (non-excluded charges minus 644480) multiplied by .62 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Autologous BMT Stem Cell Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":293147.59},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($73,611.83). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $68,120.06, add-ons for qualifying new technology services are included. If operating cost exceeds $117,278.95 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $7,788.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $67,763.08 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,330.95 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,059.64. The transfer capital threshold is the transfer adjustment factor * $5,059.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":73611.83},{"payer_name":"CASSIDY MED GRP [1019]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":190545.93},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA PPO","standard_charge_algorithm":"Per diem ($19,450).","methodology":"per diem","median_amount":145950.23,"10th_percentile":145950.23,"90th_percentile":249003.63,"count":"1 through 10","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay.","standard_charge_dollar":19450.00},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CALIFORNIA UC CARE \/ HSP","standard_charge_percentage":26.66,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":78153.15},{"payer_name":"CENTRAL HEALTH PLAN [2026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"AETNA [1003]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"MEDCARE PARTNERS [2084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"CLIPPERS WORKERS COMPENSATION [2097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":96552.20},{"payer_name":"BEAVER MED GRP [2075]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 15 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":74270.92},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":74270.92},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($2,140). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","median_amount":226951.23,"10th_percentile":154519.01,"90th_percentile":292074.29,"count":"1 through 10","additional_payer_notes":"All other Inpatient Services","standard_charge_dollar":293147.59},{"payer_name":"HEALTHCARE PARTNERS [2073]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH PLAN","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":199340.36},{"payer_name":"OPTUM CARE NETWORK - PCAMG [1064]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":190545.93},{"payer_name":"COMMUNITY ELDERCARE [1027]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":72497.15},{"payer_name":"MC ANTHEM BLUE CROSS GENERIC PAYOR [164009]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":35177.71},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($60,414.29). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $55,628.64, add-ons for qualifying new technology services are included. If operating cost exceeds $104,313.26 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $7,554.82, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $55,271.66 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $54,839.53 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $4,353.53. The transfer capital threshold is the transfer adjustment factor * $4,353.53. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":60414.29},{"payer_name":"VA - VETERANS ADMINISTRATION [1093]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($74,270.92). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $68,754.12, add-ons for qualifying new technology services are included. If operating cost exceeds $117,438.74 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $8,285.97, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 16.1. The base transfer operating payment is the transfer adjustment factor * $68,397.13 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $67,965.00 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $5,084.68. The transfer capital threshold is the transfer adjustment factor * $5,084.68. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":74270.92}]}]}
,{"description":"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","code_information":[{"code":"018","type":"TRIS-DRG"},{"code":"018","type":"MS-DRG"}],"standard_charges":[{"minimum":43.18,"maximum":1045038.91,"gross_charge":3027234.46,"discounted_cash":1664978.95,"setting":"inpatient","payers_information":[{"payer_name":"ALTERNATE AETNA [1004]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1816340.68},{"payer_name":"MC BLUE SHIELD HMO [164015]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($531,117.65). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $491,124.03, add-ons for qualifying new technology services are included. If operating cost exceeds $540,282.92 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $39,575.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $493,481.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $490,334.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $36,846.64. The transfer capital threshold is the transfer adjustment factor * $36,846.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":531117.65},{"payer_name":"TRI-CITY MEDICAL CENTER [1129]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"EMPIRE PHYS MED GRP [2072]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":3027234.46},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Per diem ($14,938).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":14938.00},{"payer_name":"OPTUM CARE NETWORK - PCAMG [1064]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1967702.40},{"payer_name":"CLIPPERS WORKERS COMPENSATION [2097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($535,917.39). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $495,741.47, add-ons for qualifying new technology services are included. If operating cost exceeds $544,426.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $40,230.24, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $498,099.34 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $494,952.36 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $37,028.95. The transfer capital threshold is the transfer adjustment factor * $37,028.95. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":696692.61},{"payer_name":"MEDICARE [1050]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($535,917.39). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $495,741.47, add-ons for qualifying new technology services are included. If operating cost exceeds $544,426.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $40,230.24, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $498,099.34 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $494,952.36 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $37,028.95. The transfer capital threshold is the transfer adjustment factor * $37,028.95. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","median_amount":628591.32,"10th_percentile":153409.00,"90th_percentile":667720.57,"count":"25","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":525199.04},{"payer_name":"LAKESIDE MEDICAL GROUP [2054]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"MC CIGNA HMO [164003]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"KAISER [1046]","plan_name":"KAISER","standard_charge_percentage":67.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2028247.09},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Per diem ($14,938).","methodology":"per diem","median_amount":687055.50,"10th_percentile":656730.02,"90th_percentile":774658.83,"count":"1 through 10","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay.","standard_charge_dollar":14938.00},{"payer_name":"ALTERNATE SHERIFF CUSTODY [1106]","plan_name":"SHERIFF COUNTY CONTRACT # 514250","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1967702.40},{"payer_name":"ST JOSEPH ST JUDE [2065]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"TRICARE [1086]","plan_name":"TRICARE ","standard_charge_algorithm":"If the length of stay is greater than 4, the reimbursement is as follows: Case rate ($567,795.36). For stays with a transfer discharge disposition of 02 or 82, the transfer payment is a per diem payment of $48,947.87, and the first day is paid a rate of $97,895.75. The transfer payment is capped at $433,332.34. Billed amount less exclusions adjusted by a cost-to-charge ratio of 0.2348 that exceeds an outlier threshold of $620,466.53 is considered a cost outlier and adds an additional payment of 80% of the excess amount. For stays with a transfer discharge disposition, the outlier threshold is multiplied by (LOS \/ 11.6000003814697). Includes reimbursement from new technology add-ons. If the length of stay is less than or equal to 4, the reimbursement is as follows: Per diem ($86,686.31), capped at $433,332.34. For stays with a transfer discharge disposition of 02 or 82, the transfer payment is a per diem payment of $48,947.87, and the first day is paid a rate of $97,895.75. The transfer payment is capped at $433,332.34. Billed amount less exclusions adjusted by a cost-to-charge ratio of 0.2348 that exceeds an outlier threshold of $620,466.53 is considered a cost outlier and adds an additional payment of 80% of the excess amount. For stays with a transfer discharge disposition, the outlier threshold is multiplied by (LOS \/ 11.6000003814697). Includes reimbursement from new technology add-ons.","methodology":"other","median_amount":633026.38,"10th_percentile":633026.38,"90th_percentile":633026.38,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":332086.99},{"payer_name":"AETNA [1003]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"US MARSHAL SERVICES [1090]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"BEACON HEALTH STRATEGY [2039]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($531,117.65). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $491,124.03, add-ons for qualifying new technology services are included. If operating cost exceeds $540,282.92 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $39,575.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $493,481.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $490,334.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $36,846.64. The transfer capital threshold is the transfer adjustment factor * $36,846.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":531117.65},{"payer_name":"DESERT OASIS HEALTH CARE [2052]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($531,117.65). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $491,124.03, add-ons for qualifying new technology services are included. If operating cost exceeds $540,282.92 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $39,575.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $493,481.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $490,334.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $36,846.64. The transfer capital threshold is the transfer adjustment factor * $36,846.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":531117.65},{"payer_name":"CENTRAL HEALTH PLAN [2026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"COMMUNITY ELDERCARE [1027]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"HEALTH CARE SUPPORT [2011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":570658.75,"10th_percentile":570658.75,"90th_percentile":570658.75,"count":"1 through 10","additional_payer_notes":"Inpatient","standard_charge_dollar":435007.08},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MARKET PLACE","standard_charge_algorithm":"Fee schedule rate ($43.18). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","median_amount":1111389.67,"10th_percentile":1111389.67,"90th_percentile":1111389.67,"count":"1 through 10","additional_payer_notes":"All Inpatient","standard_charge_dollar":43.18},{"payer_name":"HMSA - HAWAII MEDICAL SERVICE ASSOC MDCR [1041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA COMMERCIAL","standard_charge_percentage":85.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2573149.29},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"BEECH STREET [1012]","plan_name":"CAPPCARE\/BEECH STREET","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2270425.85},{"payer_name":"MC HEALTHNET GENERIC PAYOR [164010]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($531,117.65). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $491,124.03, add-ons for qualifying new technology services are included. If operating cost exceeds $540,282.92 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $39,575.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $493,481.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $490,334.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $36,846.64. The transfer capital threshold is the transfer adjustment factor * $36,846.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":531117.65},{"payer_name":"BEAVER MED GRP [2075]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"ALTERNATE KAISER RAD ONC [2089]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":3027234.46},{"payer_name":"RIVER CITY MEDICAL GROUP [2066]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"MC HNET BLUE&GOLD ACO [164017]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"FRESENIUS [1034]","plan_name":"FRESENIUS HEALTH PARTNERS, INC","standard_charge_algorithm":"Case rate ($433,911.63). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $399,144.20, add-ons for qualifying new technology services are included. If operating cost exceeds $448,303.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $34,349.79, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $401,502.07 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $398,355.09 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,620.45. The transfer capital threshold is the transfer adjustment factor * $31,620.45. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":433911.63},{"payer_name":"AFFILIATED DOCTORS OF ORANGE COUNTY [2041]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"UCR PROMPT PAY PAYOR [8240]","plan_name":"UCSD CHARITY MEDICARE CONTRACT","standard_charge_algorithm":"Case rate ($535,917.39). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $495,741.47, add-ons for qualifying new technology services are included. If operating cost exceeds $544,426.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $40,230.24, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $498,099.34 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $494,952.36 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $37,028.95. The transfer capital threshold is the transfer adjustment factor * $37,028.95. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Medicare All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":535917.39},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":426306.94},{"payer_name":"STERLING OPTION 1 [1083]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"XIMED [2016]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"AMA - AMERICAN MEDICAL ASSOCIATION [1009]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Commercial","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 165%.","methodology":"other","count":"0","additional_payer_notes":"IP Car-T Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":717761.68},{"payer_name":"UC AFF ANTHEM\/SDSM HMO [164024]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"QUALITY HEALTH [1069]","plan_name":"QUALITY HEALTH MANAGEMENT","standard_charge_algorithm":"Case rate ($535,917.39). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $495,741.47, add-ons for qualifying new technology services are included. If operating cost exceeds $544,426.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $40,230.24, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $498,099.34 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $494,952.36 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $37,028.95. The transfer capital threshold is the transfer adjustment factor * $37,028.95. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 195%.","methodology":"other","count":"0","additional_payer_notes":"Oncology  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1045038.91},{"payer_name":"TRIVALLEY MEDICAL GROUP [2086]","plan_name":"Guidant - Tri Valley Medical Group Medicare","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"IP Car-T Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":565509.20},{"payer_name":"MEDCARE PARTNERS [2084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK","standard_charge_algorithm":"Per diem ($4,700). A payment threshold will be met when non-excluded charges is greater than 325000. For days after this threshold has been met, a per diem of (non-excluded charges for that day multiplied by .65) will be used instead of the standard payment for each day after the threshold.","methodology":"other","count":"0","additional_payer_notes":"Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":3027234.46},{"payer_name":"OPTUM CARE NETWORK - PRIMECARE MED GRP [1065]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($433,911.63). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $399,144.20, add-ons for qualifying new technology services are included. If operating cost exceeds $448,303.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $34,349.79, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $401,502.07 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $398,355.09 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,620.45. The transfer capital threshold is the transfer adjustment factor * $31,620.45. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":433911.63},{"payer_name":"ALTERNATE HEALTH NET BH [2059]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($7,660). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Post ICU\/CCU Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":3027234.46},{"payer_name":"ALTERNATE HEALTH NET BH [2059]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"IMPERIAL COUNTY PHYSICIAN MED GRP","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":426306.94},{"payer_name":"ALTERNATE MEDICARE [2007]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($535,917.39). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $495,741.47, add-ons for qualifying new technology services are included. If operating cost exceeds $544,426.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $40,230.24, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $498,099.34 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $494,952.36 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $37,028.95. The transfer capital threshold is the transfer adjustment factor * $37,028.95. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","median_amount":153375.48,"10th_percentile":153375.48,"90th_percentile":153375.48,"count":"1 through 10","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":525199.04},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS HOUSE STAFF","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":799189.90},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($433,911.63). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $399,144.20, add-ons for qualifying new technology services are included. If operating cost exceeds $448,303.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $34,349.79, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $401,502.07 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $398,355.09 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,620.45. The transfer capital threshold is the transfer adjustment factor * $31,620.45. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":433911.63},{"payer_name":"MC BLUE SHIELD GENERIC PAYOR [164016]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"OLYMPUS MANAGED HEALTHCARE INC [11020001]","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1816340.68},{"payer_name":"HEALTHCARE PARTNERS [2073]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"CIGNA [1023]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($531,117.65). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $491,124.03, add-ons for qualifying new technology services are included. If operating cost exceeds $540,282.92 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $39,575.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $493,481.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $490,334.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $36,846.64. The transfer capital threshold is the transfer adjustment factor * $36,846.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":531117.65},{"payer_name":"IMPERIAL COUNTY MED GRP [1044]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"MC UNITED HEALTHCARE HMO [164005]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Fee schedule rate ($43.18). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43.18},{"payer_name":"CLEVER CARE [2061]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"MENIFEE MED GRP [2076]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"INLAND EMPIRE HEALTH PLAN [1121]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($433,911.63). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $399,144.20, add-ons for qualifying new technology services are included. If operating cost exceeds $448,303.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $34,349.79, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $401,502.07 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $398,355.09 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,620.45. The transfer capital threshold is the transfer adjustment factor * $31,620.45. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":433911.63},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Fee schedule rate ($43.18). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43.18},{"payer_name":"VA - VETERANS ADMINISTRATION [1093]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($535,917.39). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $495,741.47, add-ons for qualifying new technology services are included. If operating cost exceeds $544,426.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $40,230.24, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $498,099.34 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $494,952.36 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $37,028.95. The transfer capital threshold is the transfer adjustment factor * $37,028.95. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":535917.39},{"payer_name":"ADMAR [1001]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1967702.40},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Fee schedule rate ($43.18). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43.18},{"payer_name":"AETNA [1003]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($433,911.63). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $399,144.20, add-ons for qualifying new technology services are included. If operating cost exceeds $448,303.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $34,349.79, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $401,502.07 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $398,355.09 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,620.45. The transfer capital threshold is the transfer adjustment factor * $31,620.45. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":433911.63},{"payer_name":"UC AFF ANTHEM\/XIMED HMO [164022]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNA PRIORITY SELECT","standard_charge_algorithm":"Per diem ($7,362).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":7362.00},{"payer_name":"NATIONAL HEALTHCARE SOLUTIONS INC [1100]","plan_name":"NATIONAL HEALTHCARE SOLUTIONS INC [11000001]","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2421787.57},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA COMMERCIAL","standard_charge_percentage":85.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2573149.29},{"payer_name":"MC CIGNA GENERIC PAYOR [164007]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"MC HEALTHNET HMO [164004]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"BPS - BENEFIT PLAN SERVICES [1015]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1967702.40},{"payer_name":"USAA [1091]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE QUALCOMM ","standard_charge_percentage":45.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1381629.81},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD COVERED CA TRIO HMO","standard_charge_algorithm":"Per diem ($13,880). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":3027234.46},{"payer_name":"CAREMORE [2028]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"ALTERNATE VA - VETERANS ADMINISTRATION [1239]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($535,917.39). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $495,741.47, add-ons for qualifying new technology services are included. If operating cost exceeds $544,426.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $40,230.24, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $498,099.34 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $494,952.36 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $37,028.95. The transfer capital threshold is the transfer adjustment factor * $37,028.95. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":535917.39},{"payer_name":"MERCY PHYSICIANS MED GRP [1052]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"PRIMARY CARE ASSOCIATES OF CA [2067]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"MC UHC HARMONY HMO [164026]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"ENCOMPASS MED GRP [1030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","median_amount":652455.86,"10th_percentile":652455.86,"90th_percentile":652455.86,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":522008.50},{"payer_name":"PALOMAR HEALTH [1128]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"DEPARTMENT OF LABOR [1028]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($535,917.39). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $495,741.47, add-ons for qualifying new technology services are included. If operating cost exceeds $544,426.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $40,230.24, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $498,099.34 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $494,952.36 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $37,028.95. The transfer capital threshold is the transfer adjustment factor * $37,028.95. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":696692.61},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS UC CARE","standard_charge_percentage":26.40,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":799189.90},{"payer_name":"MOLINA [1055]","plan_name":"MOLINA MEDICARE ADVANTAGE","standard_charge_algorithm":"Fee schedule rate ($43.18). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","median_amount":3794.06,"10th_percentile":3794.06,"90th_percentile":3794.06,"count":"1 through 10","additional_payer_notes":"All Inpatient","standard_charge_dollar":43.18},{"payer_name":"SIMNSA HEALTH PLAN [2047]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"COMMUNITY HEALTH GROUP [1022]","plan_name":"COMMUNITY HEALTH GROUP MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 113%.","methodology":"other","median_amount":3438033.38,"10th_percentile":3438033.38,"90th_percentile":3438033.38,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":491558.00},{"payer_name":"FIRST HEALTH [1032]","plan_name":"FIRST HEALTH","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2270425.85},{"payer_name":"ASTIVA HEALTH [2095]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"ELIZABETH HOSPICE [2018]","plan_name":"ELIZABETH HOSPICE GIP","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay.","standard_charge_dollar":950.00},{"payer_name":"BANKERS LIFE [1011]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"KAISER [1046]","plan_name":"KAISER MEDICARE ADVANTAGE","standard_charge_percentage":67.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2028247.09},{"payer_name":"ALTERNATE SCAN HEALTH [2088]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":413256.73},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($433,911.63). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $399,144.20, add-ons for qualifying new technology services are included. If operating cost exceeds $448,303.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $34,349.79, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $401,502.07 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $398,355.09 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,620.45. The transfer capital threshold is the transfer adjustment factor * $31,620.45. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":553545.97,"10th_percentile":553545.97,"90th_percentile":553545.97,"count":"1 through 10","additional_payer_notes":"Inpatient Pre\/Post or Other\/VAD","standard_charge_dollar":433911.63},{"payer_name":"INTERPLAN [1045]","plan_name":"INTERPLAN","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2119064.12},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM TRANSPLANT MEDI-CAL","standard_charge_algorithm":"Case rate ($531,117.65). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $491,124.03, add-ons for qualifying new technology services are included. If operating cost exceeds $540,282.92 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $39,575.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $493,481.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $490,334.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $36,846.64. The transfer capital threshold is the transfer adjustment factor * $36,846.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 80%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Pre\/Post  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":424894.12},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($531,117.65). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $491,124.03, add-ons for qualifying new technology services are included. If operating cost exceeds $540,282.92 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $39,575.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $493,481.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $490,334.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $36,846.64. The transfer capital threshold is the transfer adjustment factor * $36,846.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":531117.65},{"payer_name":"TRANSAMERICA [1084]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"MC ANTHEM BLUE CROSS HMO [164002]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"UNLISTED MEDICARE ADVANTAGE (NON-CONTRACTED) [1051]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"MULTIPLAN [1058]","plan_name":"MULTIPLAN","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1967702.40},{"payer_name":"IMPERIAL HEALTH HOLDINGS [1132]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"VANTAGE [1092]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"INLAND EMPIRE HEALTH PLAN TRANSPLANT [1126]","plan_name":"INLAND EMPIRE HEALTHPLAN MEDICARE ADVANTAGE","standard_charge_algorithm":"Fee schedule rate ($43.18). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43.18},{"payer_name":"UC AFF MC HUMANA GENERIC PAYOR [164027]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"MUTUAL OF OMAHA [1059]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"CHRISTIAN HEALTHCARE MINISTRIES [2030]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"SD PHYSICIANS MED GRP [1076]","plan_name":"SD PHYSICIANS MED GRP SR [10760002]","standard_charge_percentage":55.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1664978.95},{"payer_name":"UNLISTED HOSPICE [1035]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"MC BRAND NEW DAY HMO [164030]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"SDSM [2017]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"ARCH HEALTH PARTNERS [2000]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"AETNA TRANSPLANTS [1112]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1816340.68},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($13,880). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","median_amount":629640.52,"10th_percentile":394097.28,"90th_percentile":686980.00,"count":"1 through 10","additional_payer_notes":"Oncology","standard_charge_dollar":3027234.46},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Per diem ($13,880). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":3027234.46},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CA EPN\/IFP","standard_charge_algorithm":"Per diem ($10,826). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .468 will be used instead of the standard payment.","methodology":"other","median_amount":667708.44,"10th_percentile":667708.44,"90th_percentile":712549.52,"count":"1 through 10","additional_payer_notes":"Oncology","standard_charge_dollar":3027234.46},{"payer_name":"PACIFIC FOUNDATION [1063]","plan_name":"PACIFIC FOUNDATION FOR MEDICAL CARE","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2270425.85},{"payer_name":"TRIWEST [2003]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($535,917.39). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $495,741.47, add-ons for qualifying new technology services are included. If operating cost exceeds $544,426.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $40,230.24, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $498,099.34 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $494,952.36 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $37,028.95. The transfer capital threshold is the transfer adjustment factor * $37,028.95. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","median_amount":714870.16,"10th_percentile":714870.16,"90th_percentile":714870.16,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":535917.39},{"payer_name":"MC AETNA HMO [164001]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"GREATER NEWPORT PHYSICIANS [2096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"CIGNA HMO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1522698.93},{"payer_name":"EASY ACCESS CARE [2077]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"MC UHC VEBA GENERIC HMO [164032]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED HMO NON CONTRACTED [10260001]","standard_charge_algorithm":"Case rate ($433,911.63). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $399,144.20, add-ons for qualifying new technology services are included. If operating cost exceeds $448,303.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $34,349.79, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $401,502.07 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $398,355.09 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,620.45. The transfer capital threshold is the transfer adjustment factor * $31,620.45. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":433911.63},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UNLISTED PPO NON CONTRACTED [10260002]","standard_charge_algorithm":"Case rate ($433,911.63). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $399,144.20, add-ons for qualifying new technology services are included. If operating cost exceeds $448,303.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $34,349.79, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $401,502.07 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $398,355.09 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,620.45. The transfer capital threshold is the transfer adjustment factor * $31,620.45. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":433911.63},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE ST PAULS","standard_charge_algorithm":"Fee schedule rate ($43.18). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43.18},{"payer_name":"MC UHC VEBA HMO [164033]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"MC BRAND NEW DAY GENERIC PAYOR [164031]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"PRIVATE HEALTHCARE SYSTEM","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1967702.40},{"payer_name":"SEDGWICK [1077]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($535,917.39). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $495,741.47, add-ons for qualifying new technology services are included. If operating cost exceeds $544,426.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $40,230.24, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $498,099.34 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $494,952.36 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $37,028.95. The transfer capital threshold is the transfer adjustment factor * $37,028.95. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":696692.61},{"payer_name":"BLUE CROSS [1013]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($433,911.63). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $399,144.20, add-ons for qualifying new technology services are included. If operating cost exceeds $448,303.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $34,349.79, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $401,502.07 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $398,355.09 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,620.45. The transfer capital threshold is the transfer adjustment factor * $31,620.45. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":433911.63},{"payer_name":"BLUE CROSS [1013]","plan_name":"UCSD STUDENT HEALTH INS PLAN - BC SHIP","standard_charge_percentage":26.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":808271.60},{"payer_name":"BLUE SHIELD TRANSPLANTS [1113]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($13,880). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":3027234.46},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"KUWAIT OIL COMPANY [11010005]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2058519.43},{"payer_name":"MC SCAN HMO [164035]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"ROYAL EMBASSY","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2119064.12},{"payer_name":"OLYMPUS MANAGED HEALTHCARE INC [1102]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1816340.68},{"payer_name":"MC UNITED HEALTHCARE GENERIC PAYOR [164011]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"ALPHACARE [2062]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Per diem ($5,388). The outlier payment amount is calculated by taking the estimated cost amount, subtracting the threshold amount ($247,571), then multiplying the difference by the percent of outlier that is reimbursed (53%). If the calculated outlier amount is greater than $0, it is added to the reimbursement total. The estimated cost amount is the adjusted billed amount multiplied by the cost-to-charge ratio (1). The following revenue codes are excluded from the adjusted billed amount: RC 0274-0276, 0278, 0624, 0891.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":5388.00},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($7,660). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","median_amount":1518303.93,"10th_percentile":1518303.93,"90th_percentile":1518303.93,"count":"1 through 10","additional_payer_notes":"Post ICU\/CCU","standard_charge_dollar":3027234.46},{"payer_name":"ALTERNATE HEALTHNET [1007]","plan_name":"HEALTH NET MEDICARE ADVANTAGE UC EMPLOYER GROUP","standard_charge_algorithm":"Fee schedule rate ($43.18). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43.18},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"US BEHAVIORAL MENTAL\/EATING DISORDER","standard_charge_percentage":70.00,"standard_charge_algorithm":"70% of billed.","methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2119064.12},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($531,117.65). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $491,124.03, add-ons for qualifying new technology services are included. If operating cost exceeds $540,282.92 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $39,575.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $493,481.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $490,334.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $36,846.64. The transfer capital threshold is the transfer adjustment factor * $36,846.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":531117.65},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($531,117.65). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $491,124.03, add-ons for qualifying new technology services are included. If operating cost exceeds $540,282.92 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $39,575.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $493,481.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $490,334.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $36,846.64. The transfer capital threshold is the transfer adjustment factor * $36,846.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":531117.65},{"payer_name":"MVP HEALTHCARE [1060]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA HMO","standard_charge_algorithm":"Per diem ($13,880). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":3027234.46},{"payer_name":"ALTERNATE BLUE SHIELD [2002]","plan_name":"BLUE SHIELD OF CA PPO AND BARIATRIC","standard_charge_algorithm":"Per diem ($13,880). A payment threshold will be met when non-excluded charges is greater than 291500. For days after this threshold has been met, a payment of (non-excluded charges minus 291500) multiplied by .60 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Oncology Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":3027234.46},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE GARY AND MARY WEST","standard_charge_algorithm":"Fee schedule rate ($43.18). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43.18},{"payer_name":"INTEGRATED HEALTH PARTNERS [2068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD OF CALIFORNIA UC CARE \/ HSP","standard_charge_percentage":26.66,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":807060.71},{"payer_name":"CALIFORNIA HEALTH & WELLNESS MEDI-CAL [1122]","plan_name":"CALIFORNIA HEALTH AND WELLNESS MEDI-CAL (no longer Medi-Cal plan as of 1\/1\/24)","standard_charge_algorithm":"Per diem ($2,600).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2600.00},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"INLAND FACULTY MEDICAL GROUP [2063]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"MC SCAN GENERIC PAYOR [164034]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"USOC - US OLYMPIC COMMITTEE [1123]","plan_name":"USOC VIK (BSC UC CARE)","standard_charge_percentage":43.10,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1304738.05},{"payer_name":"ALTERNATE BRAND NEW DAY [2079]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"HEALTH NET [1039]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"EASY CHOICE [1029]","plan_name":"EASY CHOICE","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"GLOBAL EXCEL [1036]","plan_name":"GLOBAL EXCEL","standard_charge_algorithm":"Case rate ($535,917.39). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $495,741.47, add-ons for qualifying new technology services are included. If operating cost exceeds $544,426.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $40,230.24, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $498,099.34 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $494,952.36 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $37,028.95. The transfer capital threshold is the transfer adjustment factor * $37,028.95. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 165%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":535917.39},{"payer_name":"ETS - LIFETRAC NETWORK [1103]","plan_name":"LIFETRAC","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1967702.40},{"payer_name":"CARNIVAL CRUISES [1018]","plan_name":"CARNIVAL CRUISES [10180001]","standard_charge_percentage":90.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2724511.01},{"payer_name":"TRIWEST ALTERNATE [2036]","plan_name":"VA PATIENT CENTERED COMMUNITY CARE (PCCC) TRIWEST","standard_charge_algorithm":"Case rate ($535,917.39). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $495,741.47, add-ons for qualifying new technology services are included. If operating cost exceeds $544,426.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $40,230.24, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $498,099.34 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $494,952.36 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $37,028.95. The transfer capital threshold is the transfer adjustment factor * $37,028.95. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-9999: RC 0100:0179 @ $1,237.79; RC 0200:0219 @ $1,237.79.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":535917.39},{"payer_name":"TRI-CITY [1085]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET ENHANCED CARE PPO","standard_charge_algorithm":"Case rate ($406,725.25). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $374,640.36, add-ons for qualifying new technology services are included. If operating cost exceeds $423,799.25 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $31,667.25, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $377,787.34. The transfer operating threshold is the transfer adjustment factor * $374,640.36 If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $28,937.91. The transfer capital threshold is the transfer adjustment factor * $28,937.91. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 281%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services (MSDRG no DSH GME IME) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":406725.25},{"payer_name":"ALIGNMENT HEALTH PLAN [2020]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($531,117.65). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $491,124.03, add-ons for qualifying new technology services are included. If operating cost exceeds $540,282.92 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $39,575.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $493,481.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $490,334.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $36,846.64. The transfer capital threshold is the transfer adjustment factor * $36,846.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":531117.65},{"payer_name":"VILLAGE HEALTH [1094]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"HEALTH NET [1039]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($531,117.65). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $491,124.03, add-ons for qualifying new technology services are included. If operating cost exceeds $540,282.92 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $39,575.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $493,481.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $490,334.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $36,846.64. The transfer capital threshold is the transfer adjustment factor * $36,846.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":531117.65},{"payer_name":"WORKERS COMPENSATION [1097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($535,917.39). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $495,741.47, add-ons for qualifying new technology services are included. If operating cost exceeds $544,426.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $40,230.24, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $498,099.34 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $494,952.36 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $37,028.95. The transfer capital threshold is the transfer adjustment factor * $37,028.95. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":696692.61},{"payer_name":"UC AFF BLUE SHIELD SR\/SDSM [164037]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"CHESAPEAKE LIFE [1021]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"REDLANDS COMMUNITY HOSPITAL [2005]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"CHAMPVA [1020]","plan_name":"VETERANS ADMINISTRATION - CHAMPVA","standard_charge_algorithm":"Case rate ($535,917.39). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $495,741.47, add-ons for qualifying new technology services are included. If operating cost exceeds $544,426.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $40,230.24, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $498,099.34 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $494,952.36 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $37,028.95. The transfer capital threshold is the transfer adjustment factor * $37,028.95. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":535917.39},{"payer_name":"CAL OPTIMA [1016]","plan_name":"CalOptima Medicare","standard_charge_algorithm":"Case rate ($535,917.39). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $495,741.47, add-ons for qualifying new technology services are included. If operating cost exceeds $544,426.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $40,230.24, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $498,099.34 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $494,952.36 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $37,028.95. The transfer capital threshold is the transfer adjustment factor * $37,028.95. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":535917.39},{"payer_name":"SCRIPPS CLINIC [1073]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1816340.68},{"payer_name":"BLUE SHIELD [1014]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($433,911.63). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $399,144.20, add-ons for qualifying new technology services are included. If operating cost exceeds $448,303.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $34,349.79, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $401,502.07 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $398,355.09 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,620.45. The transfer capital threshold is the transfer adjustment factor * $31,620.45. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":433911.63},{"payer_name":"AETNA [1003]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1816340.68},{"payer_name":"GRAYBILL MED GRP [1037]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($2,140). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"All other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":3027234.46},{"payer_name":"UNITED AMERICAN [1087]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"PREMIER PATIENT CARE IPA [2069]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"UC AFF HUMANA\/SDSM [164025]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"CIGNA [1023]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UHC SELECT AND SELECT PLUS","standard_charge_algorithm":"Per diem ($14,996).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":14996.00},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($531,117.65). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $491,124.03, add-ons for qualifying new technology services are included. If operating cost exceeds $540,282.92 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $39,575.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $493,481.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $490,334.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $36,846.64. The transfer capital threshold is the transfer adjustment factor * $36,846.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":531117.65},{"payer_name":"BLUE SHIELD [1014]","plan_name":"BLUE SHIELD MEDICARE ADVANTAGE ","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","median_amount":1213061.93,"10th_percentile":1213061.93,"90th_percentile":1213061.93,"count":"1 through 10","additional_payer_notes":"Inpatient","standard_charge_dollar":426306.94},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($531,117.65). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $491,124.03, add-ons for qualifying new technology services are included. If operating cost exceeds $540,282.92 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $39,575.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $493,481.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $490,334.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $36,846.64. The transfer capital threshold is the transfer adjustment factor * $36,846.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":531117.65},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"SALUDPOL Peru Police","standard_charge_percentage":70.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2119064.12},{"payer_name":"SIERRA MEDICAL GROUP [2048]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"AETNA [1003]","plan_name":"AETNA BEHAVIORAL EATING DISORDER","standard_charge_percentage":43.70,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1322901.46},{"payer_name":"PYRAMID LIFE [1068]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"KERN HEALTH SYSTEMS [2033]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE PPO","standard_charge_percentage":49.55,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1499994.67},{"payer_name":"MC HUMANA HMO [164013]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"HERITAGE VICTOR VALLEY MEDICAL GROUP [2045]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($531,117.65). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $491,124.03, add-ons for qualifying new technology services are included. If operating cost exceeds $540,282.92 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $39,575.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $493,481.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $490,334.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $36,846.64. The transfer capital threshold is the transfer adjustment factor * $36,846.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":531117.65},{"payer_name":"WELL CARE [1096]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"STATE OF CALIFORNIA [1082]","plan_name":"California State Prison","standard_charge_algorithm":"Case rate ($535,917.39). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $495,741.47, add-ons for qualifying new technology services are included. If operating cost exceeds $544,426.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $40,230.24, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $498,099.34 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $494,952.36 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $37,028.95. The transfer capital threshold is the transfer adjustment factor * $37,028.95. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 250%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":535917.39},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MA\/SDPMG","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":413256.73},{"payer_name":"HUMANA [1042]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"BLUE CROSS [1013]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Per diem ($10,457).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":10457.00},{"payer_name":"RIVERSIDE MEDICAL CLINIC [2064]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"CMN - CANADIAN MEDICAL NETWORK [1024]","plan_name":"CMN GLOBAL INC","standard_charge_algorithm":"Case rate ($535,917.39). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $495,741.47, add-ons for qualifying new technology services are included. If operating cost exceeds $544,426.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $40,230.24, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $498,099.34 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $494,952.36 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $37,028.95. The transfer capital threshold is the transfer adjustment factor * $37,028.95. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 170%.","methodology":"other","count":"0","additional_payer_notes":"Inpatient DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":911059.56},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"MC UHC ALLIANCE HMO [164020]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"MONARCH HEALTHCARE [2006]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA LIFESOURCE [10230006]","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"ADVANTRA FREEDOM [1002]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"EMBASSY OF STATE OF KUWAIT [11010001]","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2058519.43},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA HMO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1522698.93},{"payer_name":"MGM RESORTS [1053]","plan_name":"MGM RESORT","standard_charge_percentage":75.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2270425.85},{"payer_name":"SHARP COMMUNITY MED GRP [1078]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($2,140). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","median_amount":892827.22,"10th_percentile":892827.22,"90th_percentile":892827.22,"count":"1 through 10","additional_payer_notes":"All other Inpatient Services","standard_charge_dollar":3027234.46},{"payer_name":"COMMUNITY CARE IPA [1131]","plan_name":"Community Care IPA Medi-Cal Managed Care","standard_charge_algorithm":"Includes a variable per diem for days 0-99999: RC 0100:0169 @ $1,750; RC 0200:0202 @ $1,750; RC 0208:0213 @ $1,750; RC 0219 @ $1,750; RC 0206 @ $2,300; RC 0207 @ $2,300.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":3027234.46},{"payer_name":"SAN DIEGO SOCKERS [2015]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($535,917.39). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $495,741.47, add-ons for qualifying new technology services are included. If operating cost exceeds $544,426.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $40,230.24, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $498,099.34 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $494,952.36 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $37,028.95. The transfer capital threshold is the transfer adjustment factor * $37,028.95. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":696692.61},{"payer_name":"CIGNA [1023]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1671033.42},{"payer_name":"KEY MED GRP [2074]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"ALTERNATE UNITED HEALTHCARE [1008]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":26901.00},{"payer_name":"SCAN HEALTH [1072]","plan_name":"SCAN HEALTH","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 95%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services (pending 10\/1\/25 update) Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":413256.73},{"payer_name":"INTER VALLEY HEALTH PLAN [2024]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"HUMANA [1042]","plan_name":"PRIMECARE MEDICAL NETWORK MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($433,911.63). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $399,144.20, add-ons for qualifying new technology services are included. If operating cost exceeds $448,303.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $34,349.79, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $401,502.07 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $398,355.09 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,620.45. The transfer capital threshold is the transfer adjustment factor * $31,620.45. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Includes a variable per diem for days 0-999: RC 0100:0179 @ $1,004.70; RC 0200:0219 @ $1,004.70.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":433911.63},{"payer_name":"AXA ASSISTANCE [1098]","plan_name":"AXA ASSISTANCE USA,INC","standard_charge_percentage":80.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2421787.57},{"payer_name":"MC HUMANA GENERIC PAYOR [164014]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"AMERICAN SPECIALTY HEALTH PLAN [2038]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"BRAND NEW DAY [1089]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET BLUE & GOLD","standard_charge_algorithm":"Per diem ($5,388). The outlier payment amount is calculated by taking the estimated cost amount, subtracting the threshold amount ($247,571), then multiplying the difference by the percent of outlier that is reimbursed (53%). If the calculated outlier amount is greater than $0, it is added to the reimbursement total. The estimated cost amount is the adjusted billed amount multiplied by the cost-to-charge ratio (1). The following revenue codes are excluded from the adjusted billed amount: RC 0274-0276, 0278, 0624, 0891.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":5388.00},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($7,660). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Post ICU\/CCU Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":3027234.46},{"payer_name":"HEALTH NET [1039]","plan_name":"HEALTH NET MEDICARE ADVANTAGE NON-UC EMPLOYER","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient-Medicare DRG Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"IMMIGRATION HEALTH SERVICES [1043]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($535,917.39). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $495,741.47, add-ons for qualifying new technology services are included. If operating cost exceeds $544,426.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $40,230.24, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $498,099.34 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $494,952.36 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $37,028.95. The transfer capital threshold is the transfer adjustment factor * $37,028.95. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":525199.04},{"payer_name":"OPTUM TRANSPLANT [1118]","plan_name":"OPTUM HEALTHCARE SOLUTIONS","standard_charge_algorithm":"Per diem ($9,034). Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. If accumulated reimbursement is less than the minimum allowed amount, defined as the applicable billed amount multiplied by 43%, reimbursement is adjusted to equal the minimum allowed amount minus accumulated reimbursement. Else, if accumulated reimbursement exceeds the maximum allowed amount, defined as the applicable billed amount multiplied by 100%, reimbursement is adjusted to equal the maximum allowed amount minus accumulated reimbursement. Else, reimbursement remains unchanged.","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":9034.00},{"payer_name":"SAN DIEGO PACE [2046]","plan_name":"UCSD PACE SAN DIEGO","standard_charge_algorithm":"Case rate ($531,117.65). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $491,124.03, add-ons for qualifying new technology services are included. If operating cost exceeds $540,282.92 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $39,575.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $493,481.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $490,334.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $36,846.64. The transfer capital threshold is the transfer adjustment factor * $36,846.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":531117.65},{"payer_name":"LA CARE HEALTH PLAN [2025]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"CIGNA LIFESOURCE TRANSPLANT [1117]","plan_name":"CIGNA LIFESOURCE TRANSPLANT [11170001]","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay.","standard_charge_dollar":9735.00},{"payer_name":"CIGNA [1023]","plan_name":"CIGNA PPO","standard_charge_percentage":50.30,"methodology":"percent of total billed charges","median_amount":723355.50,"10th_percentile":723355.50,"90th_percentile":723355.50,"count":"1 through 10","additional_payer_notes":"undefined","standard_charge_dollar":1522698.93},{"payer_name":"IMPERIAL HEALTH PLAN [2081]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"SCRIPPS HOSPICE [2008]","plan_name":"SCRIPPS HEALTH HOSPICE","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay.","standard_charge_dollar":700.00},{"payer_name":"AETNA [1003]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($531,117.65). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $491,124.03, add-ons for qualifying new technology services are included. If operating cost exceeds $540,282.92 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $39,575.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $493,481.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $490,334.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $36,846.64. The transfer capital threshold is the transfer adjustment factor * $36,846.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":531117.65},{"payer_name":"HIGH DESERT MEDICAL GROUP [2053]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MID-COUNTY PHYSICIANS NARROW NETWORK","standard_charge_algorithm":"Per diem ($17,123).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":17123.00},{"payer_name":"MC ANTHEM BLUE CROSS GENERIC PAYOR [164009]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($2,140). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"All other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":3027234.46},{"payer_name":"PACE [2044]","plan_name":"UCSD PACE FHCSD","standard_charge_algorithm":"Fee schedule rate ($43.18). Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":43.18},{"payer_name":"BLUE CROSS [1013]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($531,117.65). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $491,124.03, add-ons for qualifying new technology services are included. If operating cost exceeds $540,282.92 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $39,575.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $493,481.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $490,334.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $36,846.64. The transfer capital threshold is the transfer adjustment factor * $36,846.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":531117.65},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH CARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Inpatient Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EPO [10130074]","standard_charge_algorithm":"Per diem ($14,938).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":14938.00},{"payer_name":"GOLDEN PHYSICIANS MEDICAL GROUP [2082]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS EATING DISORDER","standard_charge_percentage":58.64,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1775170.29},{"payer_name":"HEALTHNET TRANSPLANTS [1114]","plan_name":"HEALTH NET COMMERCIAL","standard_charge_algorithm":"Per diem ($7,660). A payment threshold will be met when non-excluded charges is greater than 274361. For days after this threshold has been met, a payment of (non-excluded charges minus 274361) multiplied by .562 will be used instead of the standard payment.","methodology":"other","count":"0","additional_payer_notes":"Post ICU\/CCU Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":3027234.46},{"payer_name":"SCRIPPS HEALTH PLAN SERVICES [1075]","plan_name":"SCRIPPS CLINIC HEALTH PLAN SERVICES","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1816340.68},{"payer_name":"SHARP HEALTH PLAN [1079]","plan_name":"SHARP HEALTH PLAN","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1816340.68},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($531,117.65). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $491,124.03, add-ons for qualifying new technology services are included. If operating cost exceeds $540,282.92 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $39,575.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $493,481.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $490,334.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $36,846.64. The transfer capital threshold is the transfer adjustment factor * $36,846.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":531117.65},{"payer_name":"MEDI-CAL [1048]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"SCRIPPS COASTAL MED GRP [1074]","plan_name":"SCRIPPS COASTAL MED GRP [10740001]","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1967702.40},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH COMMERCIAL","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 120%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":522008.50},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"PALOMAR HEALTH MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inptient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"ALTERNATE CIGNA [1006]","plan_name":"EVERNORTH (FKA CIGNA) BEHAVIORAL AND EATING DISORDER TREATMENT","standard_charge_percentage":55.20,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1671033.42},{"payer_name":"CASSIDY MED GRP [1019]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1967702.40},{"payer_name":"BLUE SHIELD PROMISE [1017]","plan_name":"CARE 1ST HEALTHPLAN MEDICARE ADVANTAGE (BS PROMISE)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"ALTERNATE HUMANA [1120]","plan_name":"HUMANA MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","median_amount":566451.44,"10th_percentile":566451.44,"90th_percentile":566451.44,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":435007.08},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 110%.","methodology":"other","median_amount":638.29,"10th_percentile":638.29,"90th_percentile":638.29,"count":"1 through 10","additional_payer_notes":"All Inpatient","standard_charge_dollar":478507.79},{"payer_name":"UNITED HEALTHCARE [1088]","plan_name":"UNITED HEALTHCARE HMO","standard_charge_algorithm":"Per diem ($26,901).","methodology":"per diem","median_amount":1372078.38,"10th_percentile":1372078.38,"90th_percentile":1372078.38,"count":"1 through 10","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay.","standard_charge_dollar":26901.00},{"payer_name":"HEMET COMMUNITY MED GRP - PROMISECARE [1040]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"MC AETNA GENERIC PAYOR [164008]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"SHARP REES STEALY [1080]","plan_name":"SHARP HEALTH CARE","standard_charge_algorithm":"Per diem ($2,140). A payment threshold will be met when non-excluded charges is greater than 80250. For days after this threshold has been met, a payment of (non-excluded charges minus 80250) multiplied by .656 will be used instead of the standard payment.","methodology":"other","median_amount":705657.39,"10th_percentile":705657.39,"90th_percentile":705657.39,"count":"1 through 10","additional_payer_notes":"All other Inpatient Services","standard_charge_dollar":3027234.46},{"payer_name":"EMBASSY SPONSORED [1101]","plan_name":"INTERNATIONAL EMBASSY OF KUWAIT","standard_charge_percentage":68.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2058519.43},{"payer_name":"ALTERNATE MEDI-CAL [2001]","plan_name":"MEDI-CAL ","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay.","standard_charge_dollar":3106.36},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"BLUE CROSS OF CALIFORNIA SELECT HMO, EXCHANGE HMO ","standard_charge_algorithm":"Per diem ($10,457).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":10457.00}]},{"minimum":332086.99,"maximum":332086.99,"gross_charge":3003369.32,"discounted_cash":1651853.13,"setting":"inpatient","payers_information":[{"payer_name":"ALTERNATE AETNA [1004]","plan_name":"AETNA","standard_charge_percentage":60.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1816340.68},{"payer_name":"MC BLUE SHIELD HMO [164015]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"REGAL MG 'HERITAGE PROVIDER NETWORK' [2019]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($531,117.65). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $491,124.03, add-ons for qualifying new technology services are included. If operating cost exceeds $540,282.92 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $39,575.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $493,481.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $490,334.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $36,846.64. The transfer capital threshold is the transfer adjustment factor * $36,846.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":531117.65},{"payer_name":"TRI-CITY MEDICAL CENTER [1129]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"EMPIRE PHYS MED GRP [2072]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"PRIVATE HEALTHCARE SYSTEMS [1067]","plan_name":"KAISER RAD ONC ","standard_charge_algorithm":"Payment is accumulated by procedure count. Procedures 1 - 9999, Case rate ($9,379).","methodology":"other","count":"0","additional_payer_notes":"All Standard Modalities Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":3027234.46},{"payer_name":"ALTERNATE BLUE CROSS [1005]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Per diem ($14,938).","methodology":"per diem","count":"0","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay. Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":14938.00},{"payer_name":"OPTUM CARE NETWORK - PCAMG [1064]","plan_name":"PRIMARY CARE ASSOCIATES MEDICAL GROUP","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1967702.40},{"payer_name":"CLIPPERS WORKERS COMPENSATION [2097]","plan_name":"UCSD HB Workers Compensation","standard_charge_algorithm":"Case rate ($535,917.39). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $495,741.47, add-ons for qualifying new technology services are included. If operating cost exceeds $544,426.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $40,230.24, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $498,099.34 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $494,952.36 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $37,028.95. The transfer capital threshold is the transfer adjustment factor * $37,028.95. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 130%.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services  Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":696692.61},{"payer_name":"MEDICARE [1050]","plan_name":"MEDICARE ","standard_charge_algorithm":"Case rate ($535,917.39). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $495,741.47, add-ons for qualifying new technology services are included. If operating cost exceeds $544,426.09 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $40,230.24, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $498,099.34 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $494,952.36 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $37,028.95. The transfer capital threshold is the transfer adjustment factor * $37,028.95. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount. Final payment is multiplied by 98%.","methodology":"other","median_amount":628591.32,"10th_percentile":153409.00,"90th_percentile":667720.57,"count":"25","additional_payer_notes":"All Inpatient Services ","standard_charge_dollar":525199.04},{"payer_name":"LAKESIDE MEDICAL GROUP [2054]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"MC CIGNA HMO [164003]","plan_name":"UC MANAGED CARE ","standard_charge_percentage":12.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":363268.14},{"payer_name":"UNLISTED COMMERCIAL NON-CONTRACTED [1026]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"KAISER [1046]","plan_name":"KAISER","standard_charge_percentage":67.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":2028247.09},{"payer_name":"BLUE CROSS [1013]","plan_name":"ANTHEM BLUE CROSS","standard_charge_algorithm":"Per diem ($14,938).","methodology":"per diem","median_amount":687055.50,"10th_percentile":656730.02,"90th_percentile":774658.83,"count":"1 through 10","additional_payer_notes":"Estimated amount calculated based on 12 day length of stay.","standard_charge_dollar":14938.00},{"payer_name":"ALTERNATE SHERIFF CUSTODY [1106]","plan_name":"SHERIFF COUNTY CONTRACT # 514250","standard_charge_percentage":65.00,"methodology":"percent of total billed charges","count":"0","additional_payer_notes":"Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":1967702.40},{"payer_name":"ST JOSEPH ST JUDE [2065]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"TRICARE [1086]","plan_name":"TRICARE ","standard_charge_algorithm":"If the length of stay is greater than 4, the reimbursement is as follows: Case rate ($567,795.36). For stays with a transfer discharge disposition of 02 or 82, the transfer payment is a per diem payment of $48,947.87, and the first day is paid a rate of $97,895.75. The transfer payment is capped at $433,332.34. Billed amount less exclusions adjusted by a cost-to-charge ratio of 0.2348 that exceeds an outlier threshold of $620,466.53 is considered a cost outlier and adds an additional payment of 80% of the excess amount. For stays with a transfer discharge disposition, the outlier threshold is multiplied by (LOS \/ 11.6000003814697). Includes reimbursement from new technology add-ons. If the length of stay is less than or equal to 4, the reimbursement is as follows: Per diem ($86,686.31), capped at $433,332.34. For stays with a transfer discharge disposition of 02 or 82, the transfer payment is a per diem payment of $48,947.87, and the first day is paid a rate of $97,895.75. The transfer payment is capped at $433,332.34. Billed amount less exclusions adjusted by a cost-to-charge ratio of 0.2348 that exceeds an outlier threshold of $620,466.53 is considered a cost outlier and adds an additional payment of 80% of the excess amount. For stays with a transfer discharge disposition, the outlier threshold is multiplied by (LOS \/ 11.6000003814697). Includes reimbursement from new technology add-ons.","methodology":"other","median_amount":633026.38,"10th_percentile":633026.38,"90th_percentile":633026.38,"count":"1 through 10","additional_payer_notes":"All Inpatient Services","standard_charge_dollar":332086.99},{"payer_name":"AETNA [1003]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"US MARSHAL SERVICES [1090]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"BEACON HEALTH STRATEGY [2039]","plan_name":"UCSD HB MEDICARE ADVANTAGE OTHER (NON-CONTRACTED)","standard_charge_algorithm":"Case rate ($435,007.08). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.227, exceeds $400,155.73, add-ons for qualifying new technology services are included. If operating cost exceeds $448,840.35 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.015, exceeds $34,905.67, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $402,513.60 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $399,366.62 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $31,704.37. The transfer capital threshold is the transfer adjustment factor * $31,704.37. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":435007.08},{"payer_name":"BLUE SHIELD [1014]","plan_name":"HERITAGE PROVIDER NETWORK, INC COMMERCIAL","standard_charge_algorithm":"Case rate ($531,117.65). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $491,124.03, add-ons for qualifying new technology services are included. If operating cost exceeds $540,282.92 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $39,575.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $493,481.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the transfer adjustment factor * $490,334.92 + an uncompensated DSH payment of $789.11. If operating cost exceeds the transfer operating threshold, add-ons for qualifying new technology services are included. If operating cost exceeds the transfer operating threshold + the cost of any qualifying new technology services, the stay qualifies for a transfer operating outlier of 80% of the excess amount. The base transfer capital payment is the transfer adjustment factor * $36,846.64. The transfer capital threshold is the transfer adjustment factor * $36,846.64. If the capital cost exceeds the transfer capital threshold, the stay qualifies for a transfer capital outlier of 80% of the excess amount.","methodology":"other","count":"0","additional_payer_notes":"All Other Inpatient Services Zero final payments for the item or service in the 15 months prior to posting the file.","standard_charge_dollar":531117.65},{"payer_name":"DESERT OASIS HEALTH CARE [2052]","plan_name":"HERITAGE PROVIDER NETWORK, INC MEDICARE ADVANTAGE","standard_charge_algorithm":"Case rate ($531,117.65). If operating cost, defined as billed amount less exclusions * an operating cost-to-charge ratio of 0.233, exceeds $491,124.03, add-ons for qualifying new technology services are included. If operating cost exceeds $540,282.92 plus the cost of any qualifying new technology services, the stay qualifies for an operating outlier of 80% of the excess amount. If capital cost, defined as billed amount less exclusions * a capital cost-to-charge ratio of 0.013, exceeds $39,575.98, the stay qualifies for a capital outlier of 80% of the excess amount. For transfer cases, the transfer adjustment factor is defined as (length of stay + 1) \/ 12.4. The base transfer operating payment is the transfer adjustment factor * $493,481.90 + an uncompensated DSH payment of $789.11. The transfer operating threshold is the