|
URSODIOL 300 MG CAPSULE [11624]
|
Facility
|
OP
|
$8.98
|
|
|
Service Code
|
NDC 0904-6221-06
|
| Hospital Charge Code |
1711256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$7.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.35
|
| Rate for Payer: Blue Distinction Transplant |
$5.39
|
| Rate for Payer: Blue Shield of California Commercial |
$6.62
|
| Rate for Payer: Blue Shield of California EPN |
$5.24
|
| Rate for Payer: Cash Price |
$4.04
|
| Rate for Payer: Cigna of CA HMO |
$6.29
|
| Rate for Payer: Cigna of CA PPO |
$6.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.63
|
| Rate for Payer: Dignity Health Media |
$7.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.59
|
| Rate for Payer: Galaxy Health WC |
$7.63
|
| Rate for Payer: Global Benefits Group Commercial |
$5.39
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$7.18
|
| Rate for Payer: Networks By Design Commercial |
$5.84
|
| Rate for Payer: Prime Health Services Commercial |
$7.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.49
|
| Rate for Payer: United Healthcare All Other HMO |
$4.49
|
| Rate for Payer: United Healthcare HMO Rider |
$4.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.63
|
| Rate for Payer: Vantage Medical Group Senior |
$7.63
|
|
|
URSODIOL 300 MG CAPSULE [11624]
|
Facility
|
OP
|
$7.15
|
|
|
Service Code
|
NDC 60687-100-11
|
| Hospital Charge Code |
1711256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$6.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.26
|
| Rate for Payer: Blue Distinction Transplant |
$4.29
|
| Rate for Payer: Blue Shield of California Commercial |
$5.27
|
| Rate for Payer: Blue Shield of California EPN |
$4.18
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Cigna of CA HMO |
$5.00
|
| Rate for Payer: Cigna of CA PPO |
$5.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.08
|
| Rate for Payer: Dignity Health Media |
$6.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.86
|
| Rate for Payer: Galaxy Health WC |
$6.08
|
| Rate for Payer: Global Benefits Group Commercial |
$4.29
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$5.72
|
| Rate for Payer: Networks By Design Commercial |
$4.65
|
| Rate for Payer: Prime Health Services Commercial |
$6.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.58
|
| Rate for Payer: United Healthcare All Other HMO |
$3.58
|
| Rate for Payer: United Healthcare HMO Rider |
$3.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.08
|
| Rate for Payer: Vantage Medical Group Senior |
$6.08
|
|
|
URSODIOL 300 MG CAPSULE [11624]
|
Facility
|
IP
|
$3.06
|
|
|
Service Code
|
NDC 0378-1730-01
|
| Hospital Charge Code |
1711256
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$1.57
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$2.14
|
| Rate for Payer: Cigna of CA PPO |
$2.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.22
|
| Rate for Payer: Galaxy Health WC |
$2.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.73
|
| Rate for Payer: Multiplan Commercial |
$2.45
|
| Rate for Payer: Networks By Design Commercial |
$1.99
|
| Rate for Payer: Prime Health Services Commercial |
$2.60
|
|
|
URSODIOL ORAL SUSPENSION COMPOUND 60 MG/ML [4080354]
|
Facility
|
OP
|
$1.50
|
|
|
Service Code
|
NDC 9994-0803-54
|
| Hospital Charge Code |
1715942
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.89
|
| Rate for Payer: Blue Distinction Transplant |
$0.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$1.05
|
| Rate for Payer: Cigna of CA PPO |
$1.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.28
|
| Rate for Payer: Dignity Health Media |
$1.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$0.98
|
| Rate for Payer: Prime Health Services Commercial |
$1.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Other HMO |
$0.75
|
| Rate for Payer: United Healthcare HMO Rider |
$0.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1.28
|
|
|
URSODIOL ORAL SUSPENSION COMPOUND 60 MG/ML [4080354]
|
Facility
|
IP
|
$1.50
|
|
|
Service Code
|
NDC 9994-0803-54
|
| Hospital Charge Code |
1715942
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Blue Shield of California Commercial |
$1.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.77
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO |
$1.05
|
| Rate for Payer: Cigna of CA PPO |
$1.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.60
|
| Rate for Payer: Galaxy Health WC |
$1.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.20
|
| Rate for Payer: Networks By Design Commercial |
$0.98
|
| Rate for Payer: Prime Health Services Commercial |
$1.28
|
|
|
USTEKINUMAB 130 MG/26 ML INTRAVENOUS SOLUTION [215734]
|
Facility
|
OP
|
$88.99
|
|
|
Service Code
|
CPT J3358
|
| Hospital Charge Code |
NDG215734
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.62 |
| Max. Negotiated Rate |
$79.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$79.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.25
|
| Rate for Payer: Blue Distinction Transplant |
$53.39
|
| Rate for Payer: Blue Shield of California Commercial |
$65.59
|
| Rate for Payer: Blue Shield of California EPN |
$15.49
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Cigna of CA HMO |
$62.29
|
| Rate for Payer: Cigna of CA PPO |
$62.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.93
|
| Rate for Payer: Dignity Health Media |
$12.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.62
|
| Rate for Payer: Galaxy Health WC |
$75.64
|
| Rate for Payer: Global Benefits Group Commercial |
$53.39
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$66.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.70
|
| Rate for Payer: Heritage Provider Network Transplant |
$20.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$20.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.91
|
| Rate for Payer: Multiplan Commercial |
$71.19
|
| Rate for Payer: Networks By Design Commercial |
$44.50
|
| Rate for Payer: Prime Health Services Commercial |
$75.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.50
|
| Rate for Payer: United Healthcare All Other HMO |
$44.50
|
| Rate for Payer: United Healthcare HMO Rider |
$44.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.88
|
| Rate for Payer: Vantage Medical Group Senior |
$12.62
|
|
|
USTEKINUMAB 130 MG/26 ML INTRAVENOUS SOLUTION [215734]
|
Facility
|
IP
|
$88.99
|
|
|
Service Code
|
CPT J3358
|
| Hospital Charge Code |
NDG215734
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$75.64 |
| Rate for Payer: Blue Shield of California Commercial |
$63.36
|
| Rate for Payer: Blue Shield of California EPN |
$45.56
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Cigna of CA HMO |
$62.29
|
| Rate for Payer: Cigna of CA PPO |
$62.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.60
|
| Rate for Payer: Galaxy Health WC |
$75.64
|
| Rate for Payer: Global Benefits Group Commercial |
$53.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.36
|
| Rate for Payer: Multiplan Commercial |
$71.19
|
| Rate for Payer: Networks By Design Commercial |
$44.50
|
| Rate for Payer: Prime Health Services Commercial |
$75.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.60
|
| Rate for Payer: United Healthcare All Other HMO |
$32.82
|
| Rate for Payer: United Healthcare HMO Rider |
$32.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.37
|
|
|
USTEKINUMAB 90 MG/ML SUBCUTANEOUS SYRINGE [108054]
|
Facility
|
OP
|
$31,820.40
|
|
|
Service Code
|
CPT J3357
|
| Hospital Charge Code |
NDG108054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$153.96 |
| Max. Negotiated Rate |
$27,047.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$968.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$192.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$169.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.68
|
| Rate for Payer: Blue Distinction Transplant |
$19,092.24
|
| Rate for Payer: Blue Shield of California Commercial |
$23,451.63
|
| Rate for Payer: Blue Shield of California EPN |
$307.77
|
| Rate for Payer: Cash Price |
$14,319.18
|
| Rate for Payer: Cash Price |
$14,319.18
|
| Rate for Payer: Cigna of CA HMO |
$22,274.28
|
| Rate for Payer: Cigna of CA PPO |
$22,274.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$230.93
|
| Rate for Payer: Dignity Health Media |
$153.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$169.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$153.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$153.96
|
| Rate for Payer: Galaxy Health WC |
$27,047.34
|
| Rate for Payer: Global Benefits Group Commercial |
$19,092.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23,865.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$252.49
|
| Rate for Payer: Heritage Provider Network Transplant |
$252.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$249.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$249.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$153.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,224.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$153.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,636.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$193.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.30
|
| Rate for Payer: Multiplan Commercial |
$25,456.32
|
| Rate for Payer: Networks By Design Commercial |
$15,910.20
|
| Rate for Payer: Prime Health Services Commercial |
$27,047.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19,092.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19,092.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,910.20
|
| Rate for Payer: United Healthcare All Other HMO |
$15,910.20
|
| Rate for Payer: United Healthcare HMO Rider |
$15,910.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,910.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$230.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$169.35
|
| Rate for Payer: Vantage Medical Group Senior |
$153.96
|
|
|
USTEKINUMAB 90 MG/ML SUBCUTANEOUS SYRINGE [108054]
|
Facility
|
IP
|
$31,820.40
|
|
|
Service Code
|
CPT J3357
|
| Hospital Charge Code |
NDG108054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,636.90 |
| Max. Negotiated Rate |
$27,047.34 |
| Rate for Payer: Blue Shield of California Commercial |
$22,656.12
|
| Rate for Payer: Blue Shield of California EPN |
$16,292.04
|
| Rate for Payer: Cash Price |
$14,319.18
|
| Rate for Payer: Cigna of CA HMO |
$22,274.28
|
| Rate for Payer: Cigna of CA PPO |
$22,274.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,728.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$12,728.16
|
| Rate for Payer: Galaxy Health WC |
$27,047.34
|
| Rate for Payer: Global Benefits Group Commercial |
$19,092.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,224.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,123.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,636.90
|
| Rate for Payer: Multiplan Commercial |
$25,456.32
|
| Rate for Payer: Networks By Design Commercial |
$15,910.20
|
| Rate for Payer: Prime Health Services Commercial |
$27,047.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,015.38
|
| Rate for Payer: United Healthcare All Other HMO |
$11,735.36
|
| Rate for Payer: United Healthcare HMO Rider |
$11,480.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,500.73
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA
|
Facility
|
IP
|
$18,137.17
|
|
|
Service Code
|
APR-DRG 5192
|
| Min. Negotiated Rate |
$13,913.12 |
| Max. Negotiated Rate |
$18,137.17 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,913.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,137.17
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA
|
Facility
|
IP
|
$56,078.58
|
|
|
Service Code
|
APR-DRG 5194
|
| Min. Negotiated Rate |
$43,018.17 |
| Max. Negotiated Rate |
$56,078.58 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43,018.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56,078.58
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA
|
Facility
|
IP
|
$29,317.08
|
|
|
Service Code
|
APR-DRG 5193
|
| Min. Negotiated Rate |
$22,489.28 |
| Max. Negotiated Rate |
$29,317.08 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,489.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29,317.08
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA
|
Facility
|
IP
|
$14,272.80
|
|
|
Service Code
|
APR-DRG 5191
|
| Min. Negotiated Rate |
$10,948.74 |
| Max. Negotiated Rate |
$14,272.80 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,948.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,272.80
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA
|
Facility
|
IP
|
$15,092.14
|
|
|
Service Code
|
APR-DRG 5131
|
| Min. Negotiated Rate |
$11,577.26 |
| Max. Negotiated Rate |
$15,092.14 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,577.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,092.14
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA
|
Facility
|
IP
|
$46,842.39
|
|
|
Service Code
|
APR-DRG 5134
|
| Min. Negotiated Rate |
$35,933.04 |
| Max. Negotiated Rate |
$46,842.39 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35,933.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46,842.39
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA
|
Facility
|
IP
|
$18,167.32
|
|
|
Service Code
|
APR-DRG 5132
|
| Min. Negotiated Rate |
$13,936.25 |
| Max. Negotiated Rate |
$18,167.32 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,936.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,167.32
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA
|
Facility
|
IP
|
$28,863.07
|
|
|
Service Code
|
APR-DRG 5133
|
| Min. Negotiated Rate |
$22,141.01 |
| Max. Negotiated Rate |
$28,863.07 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,141.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28,863.07
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY
|
Facility
|
IP
|
$62,306.97
|
|
|
Service Code
|
APR-DRG 5124
|
| Min. Negotiated Rate |
$47,796.00 |
| Max. Negotiated Rate |
$62,306.97 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47,796.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62,306.97
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY
|
Facility
|
IP
|
$36,366.57
|
|
|
Service Code
|
APR-DRG 5123
|
| Min. Negotiated Rate |
$27,896.99 |
| Max. Negotiated Rate |
$36,366.57 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27,896.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36,366.57
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY
|
Facility
|
IP
|
$23,108.18
|
|
|
Service Code
|
APR-DRG 5122
|
| Min. Negotiated Rate |
$17,726.41 |
| Max. Negotiated Rate |
$23,108.18 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17,726.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,108.18
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY
|
Facility
|
IP
|
$19,531.11
|
|
|
Service Code
|
APR-DRG 5121
|
| Min. Negotiated Rate |
$14,982.41 |
| Max. Negotiated Rate |
$19,531.11 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,982.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,531.11
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY
|
Facility
|
IP
|
$38,097.47
|
|
|
Service Code
|
APR-DRG 5113
|
| Min. Negotiated Rate |
$29,224.77 |
| Max. Negotiated Rate |
$38,097.47 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29,224.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38,097.47
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY
|
Facility
|
IP
|
$70,166.94
|
|
|
Service Code
|
APR-DRG 5114
|
| Min. Negotiated Rate |
$53,825.43 |
| Max. Negotiated Rate |
$70,166.94 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53,825.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70,166.94
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY
|
Facility
|
IP
|
$21,301.03
|
|
|
Service Code
|
APR-DRG 5111
|
| Min. Negotiated Rate |
$16,340.13 |
| Max. Negotiated Rate |
$21,301.03 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16,340.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21,301.03
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY
|
Facility
|
IP
|
$25,867.68
|
|
|
Service Code
|
APR-DRG 5112
|
| Min. Negotiated Rate |
$19,843.24 |
| Max. Negotiated Rate |
$25,867.68 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19,843.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25,867.68
|
|
