|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC
|
Facility
|
IP
|
$129,831.24
|
|
|
Service Code
|
MSDRG 240
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$129,831.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$86,415.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$129,831.24
|
| Rate for Payer: EPIC Health Plan Senior |
$86,554.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$78,685.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110,159.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105,438.70
|
| 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
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC
|
Facility
|
IP
|
$166,584.31
|
|
|
Service Code
|
MSDRG 239
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$166,584.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$149,206.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$166,584.31
|
| Rate for Payer: EPIC Health Plan Senior |
$111,056.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$100,960.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$141,344.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$135,286.65
|
| 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
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC
|
Facility
|
IP
|
$103,815.56
|
|
|
Service Code
|
MSDRG 241
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$103,815.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41,969.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$103,815.56
|
| Rate for Payer: EPIC Health Plan Senior |
$69,210.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62,918.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88,085.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84,310.82
|
| 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
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$119,631.52
|
|
|
Service Code
|
MSDRG 475
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$119,631.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$68,990.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$119,631.52
|
| Rate for Payer: EPIC Health Plan Senior |
$79,754.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$72,503.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101,505.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$97,155.29
|
| 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
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$155,426.37
|
|
|
Service Code
|
MSDRG 474
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$155,426.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$130,143.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$155,426.37
|
| Rate for Payer: EPIC Health Plan Senior |
$103,617.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$94,197.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$131,876.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$126,225.05
|
| 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
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$100,192.06
|
|
|
Service Code
|
MSDRG 476
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$100,192.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35,778.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$100,192.06
|
| Rate for Payer: EPIC Health Plan Senior |
$66,794.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60,722.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$85,011.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81,368.10
|
| 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
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$24,129.79
|
|
|
Service Code
|
APR-DRG 3051
|
| Min. Negotiated Rate |
$19,272.08 |
| Max. Negotiated Rate |
$24,129.79 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19,272.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24,129.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,589.81
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$103,806.31
|
|
|
Service Code
|
APR-DRG 3054
|
| Min. Negotiated Rate |
$82,908.46 |
| Max. Negotiated Rate |
$103,806.31 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$82,908.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103,806.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92,879.33
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$32,270.95
|
|
|
Service Code
|
APR-DRG 3052
|
| Min. Negotiated Rate |
$25,774.30 |
| Max. Negotiated Rate |
$32,270.95 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25,774.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32,270.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,874.01
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$47,454.72
|
|
|
Service Code
|
APR-DRG 3053
|
| Min. Negotiated Rate |
$37,901.34 |
| Max. Negotiated Rate |
$47,454.72 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37,901.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47,454.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42,459.49
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC
|
Facility
|
IP
|
$112,437.76
|
|
|
Service Code
|
MSDRG 617
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$112,437.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$56,700.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$112,437.76
|
| Rate for Payer: EPIC Health Plan Senior |
$74,958.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$68,144.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95,401.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$91,313.09
|
| 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
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC
|
Facility
|
IP
|
$141,132.92
|
|
|
Service Code
|
MSDRG 616
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$141,132.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$105,724.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$141,132.92
|
| Rate for Payer: EPIC Health Plan Senior |
$94,088.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$85,535.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$119,749.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$114,617.03
|
| 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
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$104,417.10
|
|
|
Service Code
|
MSDRG 618
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$104,417.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42,997.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$104,417.10
|
| Rate for Payer: EPIC Health Plan Senior |
$69,611.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$63,283.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88,596.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84,799.34
|
| 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
|
|
|
AMPUTATION, TOE; INTERPHALANGEAL JOINT
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 28825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.25 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$340.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,891.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
ANAGRELIDE 0.5 MG CAPSULE [20446]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 1366845301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
ANAGRELIDE 0.5 MG CAPSULE [20446]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 1366845301
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.64
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
ANAKINRA 100 MG/0.67 ML SUBCUTANEOUS SYRINGE [31784]
|
Facility
|
IP
|
$403.76
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.75 |
| Max. Negotiated Rate |
$343.20 |
| Rate for Payer: Adventist Health Commercial |
$80.75
|
| Rate for Payer: Blue Shield of California Commercial |
$204.71
|
| Rate for Payer: Blue Shield of California Commercial |
$310.49
|
| Rate for Payer: Cash Price |
$181.69
|
| Rate for Payer: Cigna of CA HMO |
$282.63
|
| Rate for Payer: Cigna of CA PPO |
$282.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$282.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.50
|
| Rate for Payer: EPIC Health Plan Senior |
$161.50
|
| Rate for Payer: Galaxy Health WC |
$343.20
|
| Rate for Payer: Global Benefits Group Commercial |
$242.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$256.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.90
|
| Rate for Payer: Multiplan Commercial |
$323.01
|
| Rate for Payer: Networks By Design Commercial |
$201.88
|
| Rate for Payer: Prime Health Services Commercial |
$343.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.53
|
| Rate for Payer: United Healthcare All Other HMO |
$147.49
|
| Rate for Payer: United Healthcare HMO Rider |
$144.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.23
|
|
|
ANAKINRA 100 MG/0.67 ML SUBCUTANEOUS SYRINGE [31784]
|
Facility
|
OP
|
$403.76
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.75 |
| Max. Negotiated Rate |
$343.20 |
| Rate for Payer: Adventist Health Commercial |
$80.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$264.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$343.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$302.82
|
| Rate for Payer: Cash Price |
$181.69
|
| Rate for Payer: Cigna of CA HMO |
$282.63
|
| Rate for Payer: Cigna of CA PPO |
$282.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$343.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$343.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$343.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$282.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.50
|
| Rate for Payer: EPIC Health Plan Senior |
$161.50
|
| Rate for Payer: Galaxy Health WC |
$343.20
|
| Rate for Payer: Global Benefits Group Commercial |
$242.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$256.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$282.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$282.63
|
| Rate for Payer: Multiplan Commercial |
$323.01
|
| Rate for Payer: Networks By Design Commercial |
$201.88
|
| Rate for Payer: Prime Health Services Commercial |
$343.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$242.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$242.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.53
|
| Rate for Payer: United Healthcare All Other HMO |
$147.49
|
| Rate for Payer: United Healthcare HMO Rider |
$144.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$343.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$343.20
|
| Rate for Payer: Vantage Medical Group Senior |
$343.20
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
|
IP
|
$17,103.50
|
|
|
Service Code
|
APR-DRG 2261
|
| Min. Negotiated Rate |
$13,660.29 |
| Max. Negotiated Rate |
$17,103.50 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,660.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,103.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,303.13
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
|
IP
|
$72,167.41
|
|
|
Service Code
|
APR-DRG 2264
|
| Min. Negotiated Rate |
$57,638.97 |
| Max. Negotiated Rate |
$72,167.41 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57,638.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72,167.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64,570.85
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
|
IP
|
$21,076.19
|
|
|
Service Code
|
APR-DRG 2262
|
| Min. Negotiated Rate |
$16,833.22 |
| Max. Negotiated Rate |
$21,076.19 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16,833.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21,076.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,857.64
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
|
IP
|
$33,026.88
|
|
|
Service Code
|
APR-DRG 2263
|
| Min. Negotiated Rate |
$26,378.05 |
| Max. Negotiated Rate |
$33,026.88 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26,378.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33,026.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,550.37
|
|
|
ANAL AND STOMAL PROCEDURES WITH CC
|
Facility
|
IP
|
$102,474.04
|
|
|
Service Code
|
MSDRG 348
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$102,474.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,677.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$102,474.04
|
| Rate for Payer: EPIC Health Plan Senior |
$68,316.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62,105.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86,947.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83,221.34
|
| 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
|
|
|
ANAL AND STOMAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$119,984.65
|
|
|
Service Code
|
MSDRG 347
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$119,984.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$69,593.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$119,984.65
|
| Rate for Payer: EPIC Health Plan Senior |
$79,989.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$72,717.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101,805.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$97,442.08
|
| 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
|
|
|
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$94,698.27
|
|
|
Service Code
|
MSDRG 349
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$94,698.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26,393.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$94,698.27
|
| Rate for Payer: EPIC Health Plan Senior |
$63,132.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57,392.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80,350.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76,906.47
|
| 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
|
|
