|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 0527213335
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2.54
|
| Rate for Payer: Blue Shield of California Commercial |
$3.85
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna of CA HMO |
$3.50
|
| Rate for Payer: Cigna of CA PPO |
$3.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE [204306]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 7231902302
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Adventist Health Commercial |
$1.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4.56
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cigna of CA HMO |
$6.30
|
| Rate for Payer: Cigna of CA PPO |
$6.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3.60
|
| Rate for Payer: Galaxy Health WC |
$7.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Networks By Design Commercial |
$5.85
|
| Rate for Payer: Prime Health Services Commercial |
$7.65
|
|
|
POSACONAZOLE 300 MG/16.7 ML INTRAVENOUS SOLUTION [205239]
|
Facility
|
OP
|
$36.21
|
|
|
Service Code
|
HCPCS J1837
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$30.78 |
| Rate for Payer: Adventist Health Commercial |
$7.24
|
| Rate for Payer: Adventist Health Commercial |
$7.62
|
| Rate for Payer: Adventist Health Commercial |
$3.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.48
|
| Rate for Payer: Cash Price |
$16.29
|
| Rate for Payer: Cash Price |
$8.73
|
| Rate for Payer: Cash Price |
$8.73
|
| Rate for Payer: Cash Price |
$16.29
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cigna of CA HMO |
$26.68
|
| Rate for Payer: Cigna of CA HMO |
$25.35
|
| Rate for Payer: Cigna of CA HMO |
$13.58
|
| Rate for Payer: Cigna of CA PPO |
$25.35
|
| Rate for Payer: Cigna of CA PPO |
$26.68
|
| Rate for Payer: Cigna of CA PPO |
$13.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.56
|
| Rate for Payer: EPIC Health Plan Senior |
$0.37
|
| Rate for Payer: EPIC Health Plan Senior |
$0.37
|
| Rate for Payer: EPIC Health Plan Senior |
$0.37
|
| Rate for Payer: Galaxy Health WC |
$30.78
|
| Rate for Payer: Galaxy Health WC |
$32.40
|
| Rate for Payer: Galaxy Health WC |
$16.49
|
| Rate for Payer: Global Benefits Group Commercial |
$22.87
|
| Rate for Payer: Global Benefits Group Commercial |
$11.64
|
| Rate for Payer: Global Benefits Group Commercial |
$21.73
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
| Rate for Payer: Multiplan Commercial |
$28.97
|
| Rate for Payer: Multiplan Commercial |
$15.52
|
| Rate for Payer: Networks By Design Commercial |
$18.11
|
| Rate for Payer: Networks By Design Commercial |
$19.06
|
| Rate for Payer: Networks By Design Commercial |
$9.70
|
| Rate for Payer: Prime Health Services Commercial |
$16.49
|
| Rate for Payer: Prime Health Services Commercial |
$32.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.59
|
| Rate for Payer: United Healthcare All Other HMO |
$13.93
|
| Rate for Payer: United Healthcare All Other HMO |
$13.23
|
| Rate for Payer: United Healthcare All Other HMO |
$7.09
|
| Rate for Payer: United Healthcare HMO Rider |
$12.94
|
| Rate for Payer: United Healthcare HMO Rider |
$13.62
|
| Rate for Payer: United Healthcare HMO Rider |
$6.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
| Rate for Payer: Vantage Medical Group Senior |
$0.34
|
|
|
POSACONAZOLE 300 MG/16.7 ML INTRAVENOUS SOLUTION [205239]
|
Facility
|
IP
|
$19.40
|
|
|
Service Code
|
HCPCS J1837
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$16.49 |
| Rate for Payer: Adventist Health Commercial |
$3.88
|
| Rate for Payer: Adventist Health Commercial |
$7.24
|
| Rate for Payer: Adventist Health Commercial |
$7.62
|
| Rate for Payer: Blue Shield of California Commercial |
$27.85
|
| Rate for Payer: Blue Shield of California Commercial |
$14.92
|
| Rate for Payer: Blue Shield of California Commercial |
$9.84
|
| Rate for Payer: Blue Shield of California Commercial |
$29.31
|
| Rate for Payer: Blue Shield of California Commercial |
$19.33
|
| Rate for Payer: Blue Shield of California Commercial |
$18.36
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: Cash Price |
$16.29
|
| Rate for Payer: Cash Price |
$8.73
|
| Rate for Payer: Cigna of CA HMO |
$26.68
|
| Rate for Payer: Cigna of CA HMO |
$25.35
|
| Rate for Payer: Cigna of CA HMO |
$13.58
|
| Rate for Payer: Cigna of CA PPO |
$13.58
|
| Rate for Payer: Cigna of CA PPO |
$26.68
|
| Rate for Payer: Cigna of CA PPO |
$25.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.76
|
| Rate for Payer: EPIC Health Plan Senior |
$14.48
|
| Rate for Payer: EPIC Health Plan Senior |
$7.76
|
| Rate for Payer: EPIC Health Plan Senior |
$15.25
|
| Rate for Payer: Galaxy Health WC |
$32.40
|
| Rate for Payer: Galaxy Health WC |
$16.49
|
| Rate for Payer: Galaxy Health WC |
$30.78
|
| Rate for Payer: Global Benefits Group Commercial |
$21.73
|
| Rate for Payer: Global Benefits Group Commercial |
$11.64
|
| Rate for Payer: Global Benefits Group Commercial |
$22.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: Multiplan Commercial |
$15.52
|
| Rate for Payer: Multiplan Commercial |
$28.97
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
| Rate for Payer: Networks By Design Commercial |
$18.11
|
| Rate for Payer: Networks By Design Commercial |
$19.06
|
| Rate for Payer: Networks By Design Commercial |
$9.70
|
| Rate for Payer: Prime Health Services Commercial |
$16.49
|
| Rate for Payer: Prime Health Services Commercial |
$30.78
|
| Rate for Payer: Prime Health Services Commercial |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.31
|
| Rate for Payer: United Healthcare All Other HMO |
$13.93
|
| Rate for Payer: United Healthcare All Other HMO |
$7.09
|
| Rate for Payer: United Healthcare All Other HMO |
$13.23
|
| Rate for Payer: United Healthcare HMO Rider |
$12.94
|
| Rate for Payer: United Healthcare HMO Rider |
$13.62
|
| Rate for Payer: United Healthcare HMO Rider |
$6.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.86
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC
|
Facility
|
IP
|
$111,610.87
|
|
|
Service Code
|
MSDRG 862
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$111,610.87 |
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55,287.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$111,610.87
|
| Rate for Payer: EPIC Health Plan Senior |
$74,407.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67,642.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94,700.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90,641.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC
|
Facility
|
IP
|
$96,957.15
|
|
|
Service Code
|
MSDRG 863
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$96,957.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,252.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$96,957.15
|
| Rate for Payer: EPIC Health Plan Senior |
$64,638.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58,761.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82,266.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78,740.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$117,250.14
|
|
|
Service Code
|
MSDRG 857
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$117,250.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$64,921.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$117,250.14
|
| Rate for Payer: EPIC Health Plan Senior |
$78,166.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$71,060.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99,484.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95,221.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$159,965.50
|
|
|
Service Code
|
MSDRG 856
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$159,965.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$137,898.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$159,965.50
|
| Rate for Payer: EPIC Health Plan Senior |
$106,643.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$96,948.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135,728.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$129,911.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$103,966.37
|
|
|
Service Code
|
MSDRG 858
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$103,966.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42,227.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$103,966.37
|
| Rate for Payer: EPIC Health Plan Senior |
$69,310.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$63,009.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88,213.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84,433.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$118,621.18
|
|
|
Service Code
|
APR-DRG 7114
|
| Min. Negotiated Rate |
$94,740.86 |
| Max. Negotiated Rate |
$118,621.18 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94,740.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118,621.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106,134.74
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$22,234.54
|
|
|
Service Code
|
APR-DRG 7111
|
| Min. Negotiated Rate |
$17,758.38 |
| Max. Negotiated Rate |
$22,234.54 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17,758.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22,234.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,894.06
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$32,232.87
|
|
|
Service Code
|
APR-DRG 7112
|
| Min. Negotiated Rate |
$25,743.89 |
| Max. Negotiated Rate |
$32,232.87 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25,743.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32,232.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,839.94
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$51,196.28
|
|
|
Service Code
|
APR-DRG 7113
|
| Min. Negotiated Rate |
$40,889.66 |
| Max. Negotiated Rate |
$51,196.28 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40,889.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51,196.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45,807.20
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
|
IP
|
$64,092.04
|
|
|
Service Code
|
APR-DRG 7214
|
| Min. Negotiated Rate |
$51,189.30 |
| Max. Negotiated Rate |
$64,092.04 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51,189.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64,092.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57,345.50
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
|
IP
|
$28,260.20
|
|
|
Service Code
|
APR-DRG 7213
|
| Min. Negotiated Rate |
$22,570.98 |
| Max. Negotiated Rate |
$28,260.20 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,570.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28,260.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,285.44
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
|
IP
|
$17,185.06
|
|
|
Service Code
|
APR-DRG 7212
|
| Min. Negotiated Rate |
$13,725.44 |
| Max. Negotiated Rate |
$17,185.06 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,725.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,185.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,376.11
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
|
IP
|
$12,383.04
|
|
|
Service Code
|
APR-DRG 7211
|
| Min. Negotiated Rate |
$9,890.14 |
| Max. Negotiated Rate |
$12,383.04 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,890.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,383.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,079.56
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES
|
Facility
|
IP
|
$109,234.83
|
|
|
Service Code
|
MSDRG 769
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$109,234.83 |
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51,227.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$109,234.83
|
| Rate for Payer: EPIC Health Plan Senior |
$72,823.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$66,202.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92,684.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88,711.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES
|
Facility
|
IP
|
$90,867.13
|
|
|
Service Code
|
MSDRG 776
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$90,867.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19,847.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$90,867.13
|
| Rate for Payer: EPIC Health Plan Senior |
$60,578.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55,070.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77,099.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73,795.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE
|
Facility
|
IP
|
$6,243.65
|
|
|
Service Code
|
APR-DRG 5611
|
| Min. Negotiated Rate |
$3,445.36 |
| Max. Negotiated Rate |
$6,243.65 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,445.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,313.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,243.65
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE
|
Facility
|
IP
|
$17,438.60
|
|
|
Service Code
|
APR-DRG 5613
|
| Min. Negotiated Rate |
$9,622.94 |
| Max. Negotiated Rate |
$17,438.60 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,622.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,048.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,438.60
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE
|
Facility
|
IP
|
$35,094.68
|
|
|
Service Code
|
APR-DRG 5614
|
| Min. Negotiated Rate |
$19,365.88 |
| Max. Negotiated Rate |
$35,094.68 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19,365.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24,247.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,094.68
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE
|
Facility
|
IP
|
$9,723.04
|
|
|
Service Code
|
APR-DRG 5612
|
| Min. Negotiated Rate |
$5,365.35 |
| Max. Negotiated Rate |
$9,723.04 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,365.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,717.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,723.04
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$25,574.26
|
|
|
Service Code
|
APR-DRG 5482
|
| Min. Negotiated Rate |
$14,112.34 |
| Max. Negotiated Rate |
$25,574.26 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,112.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,669.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,574.26
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$40,171.61
|
|
|
Service Code
|
APR-DRG 5483
|
| Min. Negotiated Rate |
$22,167.43 |
| Max. Negotiated Rate |
$40,171.61 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,167.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27,754.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40,171.61
|
|
