|
OSELTAMIVIR 75 MG CAPSULE [26546]
|
Facility
|
IP
|
$18.23
|
|
|
Service Code
|
NDC 0004-0800-85
|
| Hospital Charge Code |
1712299
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$15.50 |
| Rate for Payer: Blue Shield of California Commercial |
$12.98
|
| Rate for Payer: Blue Shield of California EPN |
$9.33
|
| Rate for Payer: Cash Price |
$8.20
|
| Rate for Payer: Cigna of CA HMO |
$12.76
|
| Rate for Payer: Cigna of CA PPO |
$12.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.29
|
| Rate for Payer: Galaxy Health WC |
$15.50
|
| Rate for Payer: Global Benefits Group Commercial |
$10.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.38
|
| Rate for Payer: Multiplan Commercial |
$14.58
|
| Rate for Payer: Networks By Design Commercial |
$11.85
|
| Rate for Payer: Prime Health Services Commercial |
$15.50
|
|
|
OSELTAMIVIR 75 MG CAPSULE [26546]
|
Facility
|
OP
|
$18.23
|
|
|
Service Code
|
NDC 0004-0800-85
|
| Hospital Charge Code |
1712299
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$15.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.86
|
| Rate for Payer: Blue Distinction Transplant |
$10.94
|
| Rate for Payer: Blue Shield of California Commercial |
$13.44
|
| Rate for Payer: Blue Shield of California EPN |
$10.65
|
| Rate for Payer: Cash Price |
$8.20
|
| Rate for Payer: Cigna of CA HMO |
$12.76
|
| Rate for Payer: Cigna of CA PPO |
$12.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.50
|
| Rate for Payer: Dignity Health Media |
$15.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.29
|
| Rate for Payer: Galaxy Health WC |
$15.50
|
| Rate for Payer: Global Benefits Group Commercial |
$10.94
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.38
|
| Rate for Payer: Multiplan Commercial |
$14.58
|
| Rate for Payer: Networks By Design Commercial |
$11.85
|
| Rate for Payer: Prime Health Services Commercial |
$15.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.12
|
| Rate for Payer: United Healthcare All Other HMO |
$9.12
|
| Rate for Payer: United Healthcare HMO Rider |
$9.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.50
|
| Rate for Payer: Vantage Medical Group Senior |
$15.50
|
|
|
OSELTAMIVIR 75 MG CAPSULE [26546]
|
Facility
|
IP
|
$10.41
|
|
|
Service Code
|
NDC 69238-1266-1
|
| Hospital Charge Code |
1712299
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Blue Shield of California Commercial |
$7.41
|
| Rate for Payer: Blue Shield of California EPN |
$5.33
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Cigna of CA HMO |
$7.29
|
| Rate for Payer: Cigna of CA PPO |
$7.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.16
|
| Rate for Payer: Galaxy Health WC |
$8.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$8.33
|
| Rate for Payer: Networks By Design Commercial |
$6.77
|
| Rate for Payer: Prime Health Services Commercial |
$8.85
|
|
|
OSELTAMIVIR 75 MG CAPSULE [26546]
|
Facility
|
OP
|
$3.12
|
|
|
Service Code
|
NDC 31722-632-31
|
| Hospital Charge Code |
1712299
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.86
|
| Rate for Payer: Blue Distinction Transplant |
$1.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2.30
|
| Rate for Payer: Blue Shield of California EPN |
$1.82
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cigna of CA HMO |
$2.18
|
| Rate for Payer: Cigna of CA PPO |
$2.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.65
|
| Rate for Payer: Dignity Health Media |
$2.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.25
|
| Rate for Payer: Galaxy Health WC |
$2.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1.87
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Networks By Design Commercial |
$2.03
|
| Rate for Payer: Prime Health Services Commercial |
$2.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1.56
|
| Rate for Payer: United Healthcare HMO Rider |
$1.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2.65
|
|
|
OSELTAMIVIR 75 MG CAPSULE [26546]
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 31722-632-31
|
| Hospital Charge Code |
1712299
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Blue Shield of California Commercial |
$2.22
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cigna of CA HMO |
$2.18
|
| Rate for Payer: Cigna of CA PPO |
$2.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.25
|
| Rate for Payer: Galaxy Health WC |
$2.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Networks By Design Commercial |
$2.03
|
| Rate for Payer: Prime Health Services Commercial |
$2.65
|
|
|
OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS
|
Facility
|
IP
|
$13,269.03
|
|
|
Service Code
|
APR-DRG 3442
|
| Min. Negotiated Rate |
$10,178.74 |
| Max. Negotiated Rate |
$13,269.03 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,178.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,269.03
|
|
|
OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS
|
Facility
|
IP
|
$19,032.78
|
|
|
Service Code
|
APR-DRG 3443
|
| Min. Negotiated Rate |
$14,600.14 |
| Max. Negotiated Rate |
$19,032.78 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,600.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,032.78
|
|
|
OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS
|
Facility
|
IP
|
$10,458.09
|
|
|
Service Code
|
APR-DRG 3441
|
| Min. Negotiated Rate |
$8,022.46 |
| Max. Negotiated Rate |
$10,458.09 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,022.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,458.09
|
|
|
OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS
|
Facility
|
IP
|
$30,560.26
|
|
|
Service Code
|
APR-DRG 3444
|
| Min. Negotiated Rate |
$23,442.94 |
| Max. Negotiated Rate |
$30,560.26 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23,442.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,560.26
|
|
|
Osteotomy; calcaneus (eg, Dwyer or Chambers type procedure), with or without internal fixation
|
Facility
|
OP
|
$14,659.19
|
|
|
Service Code
|
CPT 28300
|
| Min. Negotiated Rate |
$761.12 |
| Max. Negotiated Rate |
$14,659.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,659.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$14,659.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,480.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14,480.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$761.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
Osteotomy, tarsal bones, other than calcaneus or talus;
|
Facility
|
OP
|
$14,659.19
|
|
|
Service Code
|
CPT 28304
|
| Min. Negotiated Rate |
$640.87 |
| Max. Negotiated Rate |
$14,659.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,659.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$14,659.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14,480.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14,480.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
OSTOMY ADHESIVE PASTE [115464]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 6845510690
|
| Hospital Charge Code |
1743626
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
|
|
OSTOMY ADHESIVE PASTE [115464]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 6845510690
|
| Hospital Charge Code |
1743626
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.10
|
| Rate for Payer: Blue Distinction Transplant |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Media |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.14
|
| Rate for Payer: Global Benefits Group Commercial |
$0.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.10
|
| Rate for Payer: Prime Health Services Commercial |
$0.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Other HMO |
$0.08
|
| Rate for Payer: United Healthcare HMO Rider |
$0.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
OSTOMY SUPPLIES POWDER [110541]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 6845510826
|
| Hospital Charge Code |
1743566
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
|
|
OSTOMY SUPPLIES POWDER [110541]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 6845510826
|
| Hospital Charge Code |
1743566
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Distinction Transplant |
$0.16
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.15
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO |
$0.17
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Media |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.21
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
OTHER AFTERCARE AND CONVALESCENCE
|
Facility
|
IP
|
$12,644.77
|
|
|
Service Code
|
APR-DRG 8624
|
| Min. Negotiated Rate |
$9,699.87 |
| Max. Negotiated Rate |
$12,644.77 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,699.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,644.77
|
|
|
OTHER AFTERCARE AND CONVALESCENCE
|
Facility
|
IP
|
$12,041.80
|
|
|
Service Code
|
APR-DRG 8623
|
| Min. Negotiated Rate |
$9,237.33 |
| Max. Negotiated Rate |
$12,041.80 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,237.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,041.80
|
|
|
OTHER AFTERCARE AND CONVALESCENCE
|
Facility
|
IP
|
$10,777.31
|
|
|
Service Code
|
APR-DRG 8622
|
| Min. Negotiated Rate |
$8,267.33 |
| Max. Negotiated Rate |
$10,777.31 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,267.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,777.31
|
|
|
OTHER AFTERCARE AND CONVALESCENCE
|
Facility
|
IP
|
$7,395.33
|
|
|
Service Code
|
APR-DRG 8621
|
| Min. Negotiated Rate |
$5,673.00 |
| Max. Negotiated Rate |
$7,395.33 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,673.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,395.33
|
|
|
OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE
|
Facility
|
IP
|
$28,118.21
|
|
|
Service Code
|
APR-DRG 2534
|
| Min. Negotiated Rate |
$21,569.63 |
| Max. Negotiated Rate |
$28,118.21 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21,569.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28,118.21
|
|
|
OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE
|
Facility
|
IP
|
$16,322.92
|
|
|
Service Code
|
APR-DRG 2533
|
| Min. Negotiated Rate |
$12,521.40 |
| Max. Negotiated Rate |
$16,322.92 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12,521.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,322.92
|
|
|
OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE
|
Facility
|
IP
|
$11,591.33
|
|
|
Service Code
|
APR-DRG 2532
|
| Min. Negotiated Rate |
$8,891.77 |
| Max. Negotiated Rate |
$11,591.33 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,891.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,591.33
|
|
|
OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE
|
Facility
|
IP
|
$8,970.17
|
|
|
Service Code
|
APR-DRG 2531
|
| Min. Negotiated Rate |
$6,881.06 |
| Max. Negotiated Rate |
$8,970.17 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,881.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,970.17
|
|
|
OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS
|
Facility
|
IP
|
$7,507.05
|
|
|
Service Code
|
APR-DRG 6631
|
| Min. Negotiated Rate |
$5,758.70 |
| Max. Negotiated Rate |
$7,507.05 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,758.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,507.05
|
|
|
OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS
|
Facility
|
IP
|
$24,509.22
|
|
|
Service Code
|
APR-DRG 6634
|
| Min. Negotiated Rate |
$18,801.15 |
| Max. Negotiated Rate |
$24,509.22 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18,801.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24,509.22
|
|
