|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$36,833.44
|
|
|
Service Code
|
MSDRG 422
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$36,833.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36,833.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23,792.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33,310.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,335.87
|
| Rate for Payer: EPIC Health Plan Senior |
$22,223.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,203.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,284.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27,072.77
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20,203.56
|
| Rate for Payer: Prime Health Services Medicare |
$21,415.77
|
| 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
|
|
|
HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [34550]
|
Facility
|
IP
|
$257.90
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
901700022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.58 |
| Max. Negotiated Rate |
$232.11 |
| Rate for Payer: Adventist Health Commercial |
$51.58
|
| Rate for Payer: Blue Shield of California Commercial |
$206.84
|
| Rate for Payer: Blue Shield of California EPN |
$129.98
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Central Health Plan Commercial |
$206.32
|
| Rate for Payer: Cigna of CA HMO |
$180.53
|
| Rate for Payer: Cigna of CA PPO |
$180.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$180.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.16
|
| Rate for Payer: EPIC Health Plan Senior |
$103.16
|
| Rate for Payer: Galaxy Health WC |
$219.22
|
| Rate for Payer: Global Benefits Group Commercial |
$154.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$232.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$163.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$152.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.58
|
| Rate for Payer: Multiplan Commercial |
$193.43
|
| Rate for Payer: Networks By Design Commercial |
$128.95
|
| Rate for Payer: Prime Health Services Commercial |
$219.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.79
|
| Rate for Payer: United Healthcare All Other HMO |
$94.21
|
| Rate for Payer: United Healthcare HMO Rider |
$92.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.46
|
|
|
HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [34550]
|
Facility
|
OP
|
$257.90
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
901700022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.58 |
| Max. Negotiated Rate |
$674.93 |
| Rate for Payer: Adventist Health Commercial |
$51.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$674.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$219.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$141.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$193.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.97
|
| Rate for Payer: Blue Shield of California Commercial |
$128.49
|
| Rate for Payer: Blue Shield of California EPN |
$116.81
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Central Health Plan Commercial |
$206.32
|
| Rate for Payer: Cigna of CA HMO |
$180.53
|
| Rate for Payer: Cigna of CA PPO |
$180.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$219.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$219.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$180.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.16
|
| Rate for Payer: EPIC Health Plan Senior |
$103.16
|
| Rate for Payer: Galaxy Health WC |
$219.22
|
| Rate for Payer: Global Benefits Group Commercial |
$154.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$232.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$192.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$163.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$212.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$152.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.53
|
| Rate for Payer: Multiplan Commercial |
$193.43
|
| Rate for Payer: Networks By Design Commercial |
$128.95
|
| Rate for Payer: Prime Health Services Commercial |
$219.22
|
| Rate for Payer: Riverside University Health System MISP |
$103.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$154.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$154.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.79
|
| Rate for Payer: United Healthcare All Other HMO |
$94.21
|
| Rate for Payer: United Healthcare HMO Rider |
$92.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$219.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$219.22
|
| Rate for Payer: Vantage Medical Group Senior |
$219.22
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC
|
Facility
|
IP
|
$44,279.09
|
|
|
Service Code
|
MSDRG 354
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$44,279.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$44,279.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28,602.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40,044.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$39,773.83
|
| Rate for Payer: EPIC Health Plan Senior |
$26,515.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,105.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,747.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32,301.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24,105.35
|
| Rate for Payer: Prime Health Services Medicare |
$25,551.67
|
| 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
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC
|
Facility
|
IP
|
$76,377.74
|
|
|
Service Code
|
MSDRG 353
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$76,377.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76,377.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49,336.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69,073.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$67,528.13
|
| Rate for Payer: EPIC Health Plan Senior |
$45,018.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,926.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57,296.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54,841.03
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$40,926.14
|
| Rate for Payer: Prime Health Services Medicare |
$43,381.71
|
| 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
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC
|
Facility
|
IP
|
$35,399.06
|
|
|
Service Code
|
MSDRG 355
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$35,399.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35,399.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22,866.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32,013.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,095.63
|
| Rate for Payer: EPIC Health Plan Senior |
$21,397.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19,451.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,232.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26,065.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19,451.90
|
| Rate for Payer: Prime Health Services Medicare |
$20,619.01
|
| 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
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL
|
Facility
|
IP
|
$60,258.52
|
|
|
Service Code
|
APR-DRG 2274
|
| Min. Negotiated Rate |
$38,058.01 |
| Max. Negotiated Rate |
$60,258.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$38,058.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$45,352.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60,258.52
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL
|
Facility
|
IP
|
$18,490.27
|
|
|
Service Code
|
APR-DRG 2271
|
| Min. Negotiated Rate |
$11,678.06 |
| Max. Negotiated Rate |
$18,490.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,678.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,916.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,490.27
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL
|
Facility
|
IP
|
$31,856.43
|
|
|
Service Code
|
APR-DRG 2273
|
| Min. Negotiated Rate |
$20,119.85 |
| Max. Negotiated Rate |
$31,856.43 |
| Rate for Payer: Adventist Health Medi-Cal |
$20,119.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23,976.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31,856.43
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL
|
Facility
|
IP
|
$22,520.66
|
|
|
Service Code
|
APR-DRG 2272
|
| Min. Negotiated Rate |
$14,223.58 |
| Max. Negotiated Rate |
$22,520.66 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,223.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16,949.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22,520.66
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$27,614.54
|
|
|
Service Code
|
APR-DRG 3082
|
| Min. Negotiated Rate |
$17,440.76 |
| Max. Negotiated Rate |
$27,614.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,440.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20,783.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27,614.54
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$34,623.93
|
|
|
Service Code
|
APR-DRG 3083
|
| Min. Negotiated Rate |
$21,867.74 |
| Max. Negotiated Rate |
$34,623.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,867.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26,059.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34,623.93
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$22,232.62
|
|
|
Service Code
|
APR-DRG 3081
|
| Min. Negotiated Rate |
$14,041.66 |
| Max. Negotiated Rate |
$22,232.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,041.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16,732.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22,232.62
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$49,889.48
|
|
|
Service Code
|
APR-DRG 3084
|
| Min. Negotiated Rate |
$31,509.14 |
| Max. Negotiated Rate |
$49,889.48 |
| Rate for Payer: Adventist Health Medi-Cal |
$31,509.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37,548.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49,889.48
|
|
|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC
|
Facility
|
IP
|
$74,534.00
|
|
|
Service Code
|
MSDRG 481
|
| Min. Negotiated Rate |
$21,830.00 |
| Max. Negotiated Rate |
$74,534.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55,125.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35,608.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49,853.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$49,151.92
|
| Rate for Payer: EPIC Health Plan Senior |
$32,767.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29,789.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41,704.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39,917.31
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$29,789.04
|
| Rate for Payer: Prime Health Services Medicare |
$31,576.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$74,534.00
|
| Rate for Payer: United Healthcare All Other HMO |
$74,534.00
|
| Rate for Payer: United Healthcare HMO Rider |
$23,828.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21,830.00
|
|
|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC
|
Facility
|
IP
|
$76,648.82
|
|
|
Service Code
|
MSDRG 480
|
| Min. Negotiated Rate |
$24,564.00 |
| Max. Negotiated Rate |
$76,648.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76,648.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49,512.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69,318.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$67,762.50
|
| Rate for Payer: EPIC Health Plan Senior |
$45,175.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41,068.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57,495.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55,031.36
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$41,068.18
|
| Rate for Payer: Prime Health Services Medicare |
$43,532.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$56,679.00
|
| Rate for Payer: United Healthcare All Other HMO |
$56,679.00
|
| Rate for Payer: United Healthcare HMO Rider |
$30,970.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,371.00
|
|
|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC
|
Facility
|
IP
|
$60,760.00
|
|
|
Service Code
|
MSDRG 482
|
| Min. Negotiated Rate |
$18,472.00 |
| Max. Negotiated Rate |
$60,760.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42,926.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27,728.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38,821.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,604.09
|
| Rate for Payer: EPIC Health Plan Senior |
$25,736.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,396.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32,754.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,351.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,396.42
|
| Rate for Payer: Prime Health Services Medicare |
$24,800.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$60,760.00
|
| Rate for Payer: United Healthcare All Other HMO |
$60,760.00
|
| Rate for Payer: United Healthcare HMO Rider |
$20,163.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18,472.00
|
|
|
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC
|
Facility
|
IP
|
$75,540.79
|
|
|
Service Code
|
MSDRG 521
|
| Min. Negotiated Rate |
$40,487.54 |
| Max. Negotiated Rate |
$75,540.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$75,540.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48,796.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68,316.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$66,804.44
|
| Rate for Payer: EPIC Health Plan Senior |
$44,536.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,487.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56,682.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54,253.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$40,487.54
|
| Rate for Payer: Prime Health Services Medicare |
$42,916.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$59,995.00
|
| Rate for Payer: United Healthcare All Other HMO |
$59,995.00
|
| Rate for Payer: United Healthcare HMO Rider |
$54,441.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,540.00
|
|
|
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC
|
Facility
|
IP
|
$75,160.00
|
|
|
Service Code
|
MSDRG 522
|
| Min. Negotiated Rate |
$30,109.03 |
| Max. Negotiated Rate |
$75,160.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55,735.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36,003.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50,405.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$49,679.90
|
| Rate for Payer: EPIC Health Plan Senior |
$33,119.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30,109.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42,152.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$40,346.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$30,109.03
|
| Rate for Payer: Prime Health Services Medicare |
$31,915.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$75,160.00
|
| Rate for Payer: United Healthcare All Other HMO |
$75,160.00
|
| Rate for Payer: United Healthcare HMO Rider |
$35,860.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32,854.00
|
|
|
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$161,106.49
|
|
|
Service Code
|
MSDRG 969
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$161,106.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$161,106.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104,068.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145,699.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$140,789.35
|
| Rate for Payer: EPIC Health Plan Senior |
$93,859.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$85,326.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$119,457.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$114,338.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$85,326.88
|
| Rate for Payer: Prime Health Services Medicare |
$90,446.49
|
| 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
|
|
|
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$69,413.73
|
|
|
Service Code
|
MSDRG 970
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$69,413.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$69,413.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$44,838.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62,775.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$61,506.62
|
| Rate for Payer: EPIC Health Plan Senior |
$41,004.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37,276.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52,187.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49,950.83
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37,276.74
|
| Rate for Payer: Prime Health Services Medicare |
$39,513.34
|
| 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
|
|
|
HIV WITH MAJOR HIV RELATED CONDITION
|
Facility
|
IP
|
$29,848.28
|
|
|
Service Code
|
APR-DRG 8924
|
| Min. Negotiated Rate |
$18,851.54 |
| Max. Negotiated Rate |
$29,848.28 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,851.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22,464.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29,848.28
|
|
|
HIV WITH MAJOR HIV RELATED CONDITION
|
Facility
|
IP
|
$12,681.34
|
|
|
Service Code
|
APR-DRG 8922
|
| Min. Negotiated Rate |
$8,009.27 |
| Max. Negotiated Rate |
$12,681.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,009.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,544.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,681.34
|
|
|
HIV WITH MAJOR HIV RELATED CONDITION
|
Facility
|
IP
|
$18,079.37
|
|
|
Service Code
|
APR-DRG 8923
|
| Min. Negotiated Rate |
$11,418.55 |
| Max. Negotiated Rate |
$18,079.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,418.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,607.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,079.37
|
|
|
HIV WITH MAJOR HIV RELATED CONDITION
|
Facility
|
IP
|
$10,101.16
|
|
|
Service Code
|
APR-DRG 8921
|
| Min. Negotiated Rate |
$6,379.68 |
| Max. Negotiated Rate |
$10,101.16 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,379.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,602.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,101.16
|
|
