|
INDOMETHACIN 50 MG CAPSULE [3898]
|
Facility
|
OP
|
$0.39
|
|
|
Service Code
|
NDC 5026843111
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.23
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.31
|
| Rate for Payer: Cigna of CA HMO |
$0.27
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.25
|
| Rate for Payer: Prime Health Services Commercial |
$0.33
|
| Rate for Payer: Riverside University Health System MISP |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare HMO Rider |
$0.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: Vantage Medical Group Senior |
$0.33
|
|
|
INDOMETHACIN 50 MG CAPSULE [3898]
|
Facility
|
IP
|
$0.33
|
|
|
Service Code
|
NDC 6846230201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
|
|
INDOMETHACIN 50 MG CAPSULE [3898]
|
Facility
|
OP
|
$0.33
|
|
|
Service Code
|
NDC 6846230201
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
| Rate for Payer: Riverside University Health System MISP |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
INDOMETHACIN 50 MG RECTAL SUPPOSITORY [3901]
|
Facility
|
OP
|
$434.29
|
|
|
Service Code
|
NDC 6934410233
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$86.86 |
| Max. Negotiated Rate |
$390.86 |
| Rate for Payer: Adventist Health Commercial |
$86.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$263.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$369.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$238.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$210.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$252.63
|
| Rate for Payer: Blue Shield of California Commercial |
$275.34
|
| Rate for Payer: Blue Shield of California EPN |
$173.28
|
| Rate for Payer: Cash Price |
$195.43
|
| Rate for Payer: Central Health Plan Commercial |
$347.43
|
| Rate for Payer: Cigna of CA HMO |
$304.00
|
| Rate for Payer: Cigna of CA PPO |
$304.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$369.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$304.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.72
|
| Rate for Payer: EPIC Health Plan Senior |
$173.72
|
| Rate for Payer: Galaxy Health WC |
$369.15
|
| Rate for Payer: Global Benefits Group Commercial |
$260.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$390.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$275.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$157.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$256.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$304.00
|
| Rate for Payer: Multiplan Commercial |
$325.72
|
| Rate for Payer: Networks By Design Commercial |
$282.29
|
| Rate for Payer: Prime Health Services Commercial |
$369.15
|
| Rate for Payer: Riverside University Health System MISP |
$173.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$260.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$260.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.15
|
| Rate for Payer: United Healthcare All Other HMO |
$217.15
|
| Rate for Payer: United Healthcare HMO Rider |
$217.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$217.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$369.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.15
|
| Rate for Payer: Vantage Medical Group Senior |
$369.15
|
|
|
INDOMETHACIN 50 MG RECTAL SUPPOSITORY [3901]
|
Facility
|
IP
|
$434.29
|
|
|
Service Code
|
NDC 6934410233
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$86.86 |
| Max. Negotiated Rate |
$390.86 |
| Rate for Payer: Adventist Health Commercial |
$86.86
|
| Rate for Payer: Blue Shield of California Commercial |
$348.30
|
| Rate for Payer: Blue Shield of California EPN |
$218.88
|
| Rate for Payer: Cash Price |
$195.43
|
| Rate for Payer: Central Health Plan Commercial |
$347.43
|
| Rate for Payer: Cigna of CA HMO |
$304.00
|
| Rate for Payer: Cigna of CA PPO |
$304.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$304.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.72
|
| Rate for Payer: EPIC Health Plan Senior |
$173.72
|
| Rate for Payer: Galaxy Health WC |
$369.15
|
| Rate for Payer: Global Benefits Group Commercial |
$260.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$390.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$275.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$256.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.86
|
| Rate for Payer: Multiplan Commercial |
$325.72
|
| Rate for Payer: Networks By Design Commercial |
$282.29
|
| Rate for Payer: Prime Health Services Commercial |
$369.15
|
|
|
INDOMETHACIN ER 75 MG CAPSULE,EXTENDED RELEASE [14628]
|
Facility
|
OP
|
$0.42
|
|
|
Service Code
|
NDC 6846232560
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.17
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Central Health Plan Commercial |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Senior |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.36
|
| Rate for Payer: Riverside University Health System MISP |
$0.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Vantage Medical Group Senior |
$0.36
|
|
|
INDOMETHACIN ER 75 MG CAPSULE,EXTENDED RELEASE [14628]
|
Facility
|
IP
|
$0.42
|
|
|
Service Code
|
NDC 6846232560
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Blue Shield of California EPN |
$0.21
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Central Health Plan Commercial |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.29
|
| Rate for Payer: Cigna of CA PPO |
$0.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.17
|
| Rate for Payer: EPIC Health Plan Senior |
$0.17
|
| Rate for Payer: Galaxy Health WC |
$0.36
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.32
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.36
|
|
|
INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC
|
Facility
|
IP
|
$25,766.30
|
|
|
Service Code
|
MSDRG 758
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$25,766.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,766.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16,643.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23,302.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,766.63
|
| Rate for Payer: EPIC Health Plan Senior |
$15,844.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,404.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,165.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,301.39
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,404.02
|
| Rate for Payer: Prime Health Services Medicare |
$15,268.26
|
| 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
|
|
|
INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC
|
Facility
|
IP
|
$37,686.18
|
|
|
Service Code
|
MSDRG 757
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$37,686.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37,686.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24,343.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,082.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,073.21
|
| Rate for Payer: EPIC Health Plan Senior |
$22,715.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,650.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,910.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27,671.58
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20,650.43
|
| Rate for Payer: Prime Health Services Medicare |
$21,889.46
|
| 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
|
|
|
INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC
|
Facility
|
IP
|
$17,465.29
|
|
|
Service Code
|
MSDRG 759
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$17,465.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17,465.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,281.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,795.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,589.10
|
| Rate for Payer: EPIC Health Plan Senior |
$11,059.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,054.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,075.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13,472.36
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10,054.00
|
| Rate for Payer: Prime Health Services Medicare |
$10,657.24
|
| 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
|
|
|
INFECTIONS OF UPPER RESPIRATORY TRACT
|
Facility
|
IP
|
$12,175.77
|
|
|
Service Code
|
APR-DRG 1133
|
| Min. Negotiated Rate |
$7,689.96 |
| Max. Negotiated Rate |
$12,175.77 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,689.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,163.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,175.77
|
|
|
INFECTIONS OF UPPER RESPIRATORY TRACT
|
Facility
|
IP
|
$23,366.62
|
|
|
Service Code
|
APR-DRG 1134
|
| Min. Negotiated Rate |
$14,757.86 |
| Max. Negotiated Rate |
$23,366.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,757.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17,586.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23,366.62
|
|
|
INFECTIONS OF UPPER RESPIRATORY TRACT
|
Facility
|
IP
|
$5,222.80
|
|
|
Service Code
|
APR-DRG 1131
|
| Min. Negotiated Rate |
$3,298.61 |
| Max. Negotiated Rate |
$5,222.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,298.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,930.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,222.80
|
|
|
INFECTIONS OF UPPER RESPIRATORY TRACT
|
Facility
|
IP
|
$7,915.76
|
|
|
Service Code
|
APR-DRG 1132
|
| Min. Negotiated Rate |
$4,999.43 |
| Max. Negotiated Rate |
$7,915.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,999.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,957.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,915.76
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
|
IP
|
$70,111.94
|
|
|
Service Code
|
APR-DRG 7104
|
| Min. Negotiated Rate |
$44,281.22 |
| Max. Negotiated Rate |
$70,111.94 |
| Rate for Payer: Adventist Health Medi-Cal |
$44,281.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52,768.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70,111.94
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
|
IP
|
$44,149.03
|
|
|
Service Code
|
APR-DRG 7103
|
| Min. Negotiated Rate |
$27,883.60 |
| Max. Negotiated Rate |
$44,149.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$27,883.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33,227.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44,149.03
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
|
IP
|
$29,560.26
|
|
|
Service Code
|
APR-DRG 7102
|
| Min. Negotiated Rate |
$18,669.64 |
| Max. Negotiated Rate |
$29,560.26 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,669.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22,247.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29,560.26
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
|
IP
|
$19,108.62
|
|
|
Service Code
|
APR-DRG 7101
|
| Min. Negotiated Rate |
$12,068.60 |
| Max. Negotiated Rate |
$19,108.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,068.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,381.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,108.62
|
|
|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$52,587.99
|
|
|
Service Code
|
MSDRG 854
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$52,587.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52,587.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33,969.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,558.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,958.19
|
| Rate for Payer: EPIC Health Plan Senior |
$31,305.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,459.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39,843.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$38,135.74
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$28,459.51
|
| Rate for Payer: Prime Health Services Medicare |
$30,167.08
|
| 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
|
|
|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$129,979.01
|
|
|
Service Code
|
MSDRG 853
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$129,979.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$129,979.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$83,961.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117,548.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$113,874.75
|
| Rate for Payer: EPIC Health Plan Senior |
$75,916.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$69,015.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$96,621.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$92,480.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$69,015.00
|
| Rate for Payer: Prime Health Services Medicare |
$73,155.90
|
| 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
|
|
|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$39,404.81
|
|
|
Service Code
|
MSDRG 855
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$39,404.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,404.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25,453.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35,636.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,559.25
|
| Rate for Payer: EPIC Health Plan Senior |
$23,706.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,551.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,171.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28,878.42
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21,551.06
|
| Rate for Payer: Prime Health Services Medicare |
$22,844.12
|
| 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
|
|
|
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC
|
Facility
|
IP
|
$39,028.45
|
|
|
Service Code
|
MSDRG 727
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$39,028.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,028.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25,210.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35,295.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,233.82
|
| Rate for Payer: EPIC Health Plan Senior |
$23,489.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,353.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29,895.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28,614.13
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21,353.83
|
| Rate for Payer: Prime Health Services Medicare |
$22,635.06
|
| 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
|
|
|
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC
|
Facility
|
IP
|
$21,349.97
|
|
|
Service Code
|
MSDRG 728
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$21,349.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21,349.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,791.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19,308.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$13,298.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,089.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,925.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,200.21
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12,089.71
|
| Rate for Payer: Prime Health Services Medicare |
$12,815.09
|
| 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
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
|
IP
|
$17,120.62
|
|
|
Service Code
|
APR-DRG 2453
|
| Min. Negotiated Rate |
$10,813.02 |
| Max. Negotiated Rate |
$17,120.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,813.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,885.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,120.62
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
|
IP
|
$9,041.70
|
|
|
Service Code
|
APR-DRG 2451
|
| Min. Negotiated Rate |
$5,710.55 |
| Max. Negotiated Rate |
$9,041.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,710.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,805.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,041.70
|
|
