|
DISOPYRAMIDE PHOSPHATE 100 MG CAPSULE [2535]
|
Facility
|
OP
|
$2.39
|
|
|
Service Code
|
NDC 0093312701
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.03 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.53
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna of CA HMO |
$1.67
|
| Rate for Payer: Cigna of CA PPO |
$1.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.96
|
| Rate for Payer: EPIC Health Plan Senior |
$0.96
|
| Rate for Payer: Galaxy Health WC |
$2.03
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$1.91
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.20
|
| Rate for Payer: United Healthcare All Other HMO |
$1.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.03
|
| Rate for Payer: Vantage Medical Group Senior |
$2.03
|
|
|
DISOPYRAMIDE PHOSPHATE 150 MG CAPSULE [2536]
|
Facility
|
IP
|
$6.76
|
|
|
Service Code
|
NDC 0025276231
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$5.75 |
| Rate for Payer: Adventist Health Commercial |
$1.35
|
| Rate for Payer: Blue Shield of California Commercial |
$3.43
|
| Rate for Payer: Blue Shield of California Commercial |
$5.20
|
| Rate for Payer: Cash Price |
$3.04
|
| Rate for Payer: Cigna of CA HMO |
$4.73
|
| Rate for Payer: Cigna of CA PPO |
$4.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2.70
|
| Rate for Payer: Galaxy Health WC |
$5.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$5.41
|
| Rate for Payer: Networks By Design Commercial |
$4.39
|
| Rate for Payer: Prime Health Services Commercial |
$5.75
|
|
|
DISOPYRAMIDE PHOSPHATE 150 MG CAPSULE [2536]
|
Facility
|
OP
|
$2.70
|
|
|
Service Code
|
NDC 0093312901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.73
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$1.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.29
|
| Rate for Payer: Global Benefits Group Commercial |
$1.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.89
|
| Rate for Payer: Multiplan Commercial |
$2.16
|
| Rate for Payer: Networks By Design Commercial |
$1.75
|
| Rate for Payer: Prime Health Services Commercial |
$2.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.29
|
|
|
DISOPYRAMIDE PHOSPHATE 150 MG CAPSULE [2536]
|
Facility
|
OP
|
$6.76
|
|
|
Service Code
|
NDC 0025276231
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$5.75 |
| Rate for Payer: Adventist Health Commercial |
$1.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.34
|
| Rate for Payer: Cash Price |
$3.04
|
| Rate for Payer: Cigna of CA HMO |
$4.73
|
| Rate for Payer: Cigna of CA PPO |
$4.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2.70
|
| Rate for Payer: Galaxy Health WC |
$5.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.73
|
| Rate for Payer: Multiplan Commercial |
$5.41
|
| Rate for Payer: Networks By Design Commercial |
$4.39
|
| Rate for Payer: Prime Health Services Commercial |
$5.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.38
|
| Rate for Payer: United Healthcare All Other HMO |
$3.38
|
| Rate for Payer: United Healthcare HMO Rider |
$3.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5.75
|
|
|
DISOPYRAMIDE PHOSPHATE 150 MG CAPSULE [2536]
|
Facility
|
IP
|
$2.70
|
|
|
Service Code
|
NDC 0093312901
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1.37
|
| Rate for Payer: Blue Shield of California Commercial |
$2.08
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cigna of CA HMO |
$1.89
|
| Rate for Payer: Cigna of CA PPO |
$1.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.29
|
| Rate for Payer: Global Benefits Group Commercial |
$1.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$2.16
|
| Rate for Payer: Networks By Design Commercial |
$1.75
|
| Rate for Payer: Prime Health Services Commercial |
$2.29
|
|
|
DISORDERS OF GALLBLADDER AND BILIARY TRACT
|
Facility
|
IP
|
$13,511.49
|
|
|
Service Code
|
APR-DRG 2841
|
| Min. Negotiated Rate |
$10,791.41 |
| Max. Negotiated Rate |
$13,511.49 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,791.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,511.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,089.23
|
|
|
DISORDERS OF GALLBLADDER AND BILIARY TRACT
|
Facility
|
IP
|
$18,960.67
|
|
|
Service Code
|
APR-DRG 2842
|
| Min. Negotiated Rate |
$15,143.59 |
| Max. Negotiated Rate |
$18,960.67 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15,143.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,960.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,964.81
|
|
|
DISORDERS OF GALLBLADDER AND BILIARY TRACT
|
Facility
|
IP
|
$25,611.73
|
|
|
Service Code
|
APR-DRG 2843
|
| Min. Negotiated Rate |
$20,455.69 |
| Max. Negotiated Rate |
$25,611.73 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,455.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,611.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,915.76
|
|
|
DISORDERS OF GALLBLADDER AND BILIARY TRACT
|
Facility
|
IP
|
$56,721.61
|
|
|
Service Code
|
APR-DRG 2844
|
| Min. Negotiated Rate |
$45,302.66 |
| Max. Negotiated Rate |
$56,721.61 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45,302.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56,721.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50,750.92
|
|
|
DISORDERS OF IMPULSE CONTROL & DEVELOPMENT
|
Facility
|
IP
|
$43,278.90
|
|
|
Service Code
|
APR-DRG 7584
|
| Min. Negotiated Rate |
$34,566.18 |
| Max. Negotiated Rate |
$43,278.90 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34,566.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43,278.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38,723.23
|
|
|
DISORDERS OF IMPULSE CONTROL & DEVELOPMENT
|
Facility
|
IP
|
$7,931.87
|
|
|
Service Code
|
APR-DRG 7582
|
| Min. Negotiated Rate |
$6,335.06 |
| Max. Negotiated Rate |
$7,931.87 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,335.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,931.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,096.94
|
|
|
DISORDERS OF IMPULSE CONTROL & DEVELOPMENT
|
Facility
|
IP
|
$6,405.13
|
|
|
Service Code
|
APR-DRG 7581
|
| Min. Negotiated Rate |
$5,115.67 |
| Max. Negotiated Rate |
$6,405.13 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,115.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,405.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,730.90
|
|
|
DISORDERS OF IMPULSE CONTROL & DEVELOPMENT
|
Facility
|
IP
|
$12,906.93
|
|
|
Service Code
|
APR-DRG 7583
|
| Min. Negotiated Rate |
$10,308.56 |
| Max. Negotiated Rate |
$12,906.93 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,308.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,906.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,548.30
|
|
|
DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC
|
Facility
|
IP
|
$96,378.71
|
|
|
Service Code
|
MSDRG 442
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$96,378.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29,264.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$96,378.71
|
| Rate for Payer: EPIC Health Plan Senior |
$64,252.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58,411.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81,775.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78,271.20
|
| 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
|
|
|
DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC
|
Facility
|
IP
|
$111,096.25
|
|
|
Service Code
|
MSDRG 441
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$111,096.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$54,408.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$111,096.25
|
| Rate for Payer: EPIC Health Plan Senior |
$74,064.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67,331.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94,263.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90,223.62
|
| 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
|
|
|
DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$91,665.67
|
|
|
Service Code
|
MSDRG 443
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$91,665.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21,212.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$91,665.67
|
| Rate for Payer: EPIC Health Plan Senior |
$61,110.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55,554.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77,776.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74,443.63
|
| 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
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY
|
Facility
|
IP
|
$66,517.12
|
|
|
Service Code
|
APR-DRG 2824
|
| Min. Negotiated Rate |
$53,126.17 |
| Max. Negotiated Rate |
$66,517.12 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53,126.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66,517.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59,515.32
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY
|
Facility
|
IP
|
$24,075.41
|
|
|
Service Code
|
APR-DRG 2823
|
| Min. Negotiated Rate |
$19,228.65 |
| Max. Negotiated Rate |
$24,075.41 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19,228.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24,075.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,541.16
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY
|
Facility
|
IP
|
$11,518.35
|
|
|
Service Code
|
APR-DRG 2821
|
| Min. Negotiated Rate |
$9,199.53 |
| Max. Negotiated Rate |
$11,518.35 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,199.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,518.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,305.89
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY
|
Facility
|
IP
|
$15,384.98
|
|
|
Service Code
|
APR-DRG 2822
|
| Min. Negotiated Rate |
$12,287.74 |
| Max. Negotiated Rate |
$15,384.98 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12,287.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,384.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,765.51
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC
|
Facility
|
IP
|
$94,176.55
|
|
|
Service Code
|
MSDRG 439
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$94,176.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,501.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$94,176.55
|
| Rate for Payer: EPIC Health Plan Senior |
$62,784.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57,076.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79,907.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76,482.78
|
| 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
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC
|
Facility
|
IP
|
$108,177.23
|
|
|
Service Code
|
MSDRG 438
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$108,177.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49,421.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$108,177.23
|
| Rate for Payer: EPIC Health Plan Senior |
$72,118.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65,561.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91,786.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87,853.03
|
| 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
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$90,276.25
|
|
|
Service Code
|
MSDRG 440
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$90,276.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18,838.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$90,276.25
|
| Rate for Payer: EPIC Health Plan Senior |
$60,184.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$54,712.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76,598.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73,315.26
|
| 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
|
|
|
DISORDERS OF PERSONALITY AND IMPULSE CONTROL
|
Facility
|
IP
|
$114,141.27
|
|
|
Service Code
|
MSDRG 883
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$114,141.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$59,610.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$114,141.27
|
| Rate for Payer: EPIC Health Plan Senior |
$76,094.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$69,176.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$96,847.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92,696.55
|
| 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 HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
DISORDERS OF THE BILIARY TRACT WITH CC
|
Facility
|
IP
|
$98,669.55
|
|
|
Service Code
|
MSDRG 445
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$98,669.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$33,177.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$98,669.55
|
| Rate for Payer: EPIC Health Plan Senior |
$65,779.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59,799.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83,719.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80,131.64
|
| 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
|
|
