|
OSTOMY SUPPLIES POWDER [110541]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 6845510826
|
| Hospital Charge Code |
901700016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.16
|
| 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 |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Central Health Plan Commercial |
$0.21
|
| 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 Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.22
|
| Rate for Payer: Global Benefits Group Commercial |
$0.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: Networks By Design Commercial |
$0.17
|
| Rate for Payer: Prime Health Services Commercial |
$0.22
|
| Rate for Payer: Riverside University Health System MISP |
$0.10
|
| 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
|
$10,135.40
|
|
|
Service Code
|
APR-DRG 8622
|
| Min. Negotiated Rate |
$6,401.30 |
| Max. Negotiated Rate |
$10,135.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,401.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,628.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,135.40
|
|
|
OTHER AFTERCARE AND CONVALESCENCE
|
Facility
|
IP
|
$3,375.79
|
|
|
Service Code
|
APR-DRG 8621
|
| Min. Negotiated Rate |
$2,132.08 |
| Max. Negotiated Rate |
$3,375.79 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,132.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,540.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,375.79
|
|
|
OTHER AFTERCARE AND CONVALESCENCE
|
Facility
|
IP
|
$11,039.78
|
|
|
Service Code
|
APR-DRG 8623
|
| Min. Negotiated Rate |
$6,972.49 |
| Max. Negotiated Rate |
$11,039.78 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,972.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,308.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,039.78
|
|
|
OTHER AFTERCARE AND CONVALESCENCE
|
Facility
|
IP
|
$11,039.78
|
|
|
Service Code
|
APR-DRG 8624
|
| Min. Negotiated Rate |
$6,972.49 |
| Max. Negotiated Rate |
$11,039.78 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,972.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,308.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,039.78
|
|
|
OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE
|
Facility
|
IP
|
$29,062.74
|
|
|
Service Code
|
APR-DRG 2534
|
| Min. Negotiated Rate |
$18,355.42 |
| Max. Negotiated Rate |
$29,062.74 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,355.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21,873.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29,062.74
|
|
|
OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE
|
Facility
|
IP
|
$9,388.15
|
|
|
Service Code
|
APR-DRG 2531
|
| Min. Negotiated Rate |
$5,929.36 |
| Max. Negotiated Rate |
$9,388.15 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,929.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,065.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,388.15
|
|
|
OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE
|
Facility
|
IP
|
$17,432.82
|
|
|
Service Code
|
APR-DRG 2533
|
| Min. Negotiated Rate |
$11,010.20 |
| Max. Negotiated Rate |
$17,432.82 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,010.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,120.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,432.82
|
|
|
OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE
|
Facility
|
IP
|
$12,212.04
|
|
|
Service Code
|
APR-DRG 2532
|
| Min. Negotiated Rate |
$7,712.87 |
| Max. Negotiated Rate |
$12,212.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,712.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,191.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,212.04
|
|
|
OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS
|
Facility
|
IP
|
$11,146.52
|
|
|
Service Code
|
APR-DRG 6632
|
| Min. Negotiated Rate |
$7,039.91 |
| Max. Negotiated Rate |
$11,146.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,039.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,389.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,146.52
|
|
|
OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS
|
Facility
|
IP
|
$15,525.38
|
|
|
Service Code
|
APR-DRG 6633
|
| Min. Negotiated Rate |
$9,805.50 |
| Max. Negotiated Rate |
$15,525.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,805.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,684.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,525.38
|
|
|
OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS
|
Facility
|
IP
|
$7,833.19
|
|
|
Service Code
|
APR-DRG 6631
|
| Min. Negotiated Rate |
$4,947.28 |
| Max. Negotiated Rate |
$7,833.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,947.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,895.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,833.19
|
|
|
OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS
|
Facility
|
IP
|
$26,601.41
|
|
|
Service Code
|
APR-DRG 6634
|
| Min. Negotiated Rate |
$16,800.89 |
| Max. Negotiated Rate |
$26,601.41 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,800.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20,021.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26,601.41
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$27,867.39
|
|
|
Service Code
|
MSDRG 818
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$27,867.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,745.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17,922.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25,092.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,867.39
|
| Rate for Payer: EPIC Health Plan Senior |
$18,578.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,889.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,645.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22,631.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16,889.33
|
| Rate for Payer: Prime Health Services Medicare |
$17,902.69
|
| 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
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$53,409.74
|
|
|
Service Code
|
MSDRG 817
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$53,409.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$44,426.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28,697.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40,177.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$53,409.74
|
| Rate for Payer: EPIC Health Plan Senior |
$35,606.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32,369.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45,317.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$43,375.18
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$32,369.54
|
| Rate for Payer: Prime Health Services Medicare |
$34,311.71
|
| 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
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$22,631.71
|
|
|
Service Code
|
MSDRG 819
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$22,631.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,631.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14,619.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20,467.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,056.26
|
| Rate for Payer: EPIC Health Plan Senior |
$14,037.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,761.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,865.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,100.24
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12,761.37
|
| Rate for Payer: Prime Health Services Medicare |
$13,527.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$18,991.79
|
|
|
Service Code
|
MSDRG 832
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$18,991.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18,991.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,267.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,175.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,909.02
|
| Rate for Payer: EPIC Health Plan Senior |
$11,939.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,853.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,195.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,544.29
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10,853.95
|
| Rate for Payer: Prime Health Services Medicare |
$11,505.19
|
| 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
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$31,648.60
|
|
|
Service Code
|
MSDRG 831
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$31,648.60 |
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31,648.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20,443.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28,621.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,852.79
|
| Rate for Payer: EPIC Health Plan Senior |
$19,235.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17,486.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24,481.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23,431.96
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17,486.54
|
| Rate for Payer: Prime Health Services Medicare |
$18,535.73
|
| 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 Select/Navigate/Core |
$6,823.00
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$13,762.21
|
|
|
Service Code
|
MSDRG 833
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$13,762.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,762.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,889.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,446.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,387.21
|
| Rate for Payer: EPIC Health Plan Senior |
$8,924.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,113.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,358.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,872.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8,113.46
|
| Rate for Payer: Prime Health Services Medicare |
$8,600.27
|
| 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
|
|
|
OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES
|
Facility
|
IP
|
$30,261.19
|
|
|
Service Code
|
APR-DRG 3474
|
| Min. Negotiated Rate |
$19,112.33 |
| Max. Negotiated Rate |
$30,261.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,112.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22,775.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30,261.19
|
|
|
OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES
|
Facility
|
IP
|
$18,182.09
|
|
|
Service Code
|
APR-DRG 3473
|
| Min. Negotiated Rate |
$11,483.42 |
| Max. Negotiated Rate |
$18,182.09 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,483.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,684.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,182.09
|
|
|
OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES
|
Facility
|
IP
|
$12,620.92
|
|
|
Service Code
|
APR-DRG 3472
|
| Min. Negotiated Rate |
$7,971.11 |
| Max. Negotiated Rate |
$12,620.92 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,971.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,498.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,620.92
|
|
|
OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES
|
Facility
|
IP
|
$9,486.83
|
|
|
Service Code
|
APR-DRG 3471
|
| Min. Negotiated Rate |
$5,991.68 |
| Max. Negotiated Rate |
$9,486.83 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,991.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,140.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,486.83
|
|
|
OTHER BLADDER PROCEDURES
|
Facility
|
IP
|
$45,758.36
|
|
|
Service Code
|
APR-DRG 4454
|
| Min. Negotiated Rate |
$28,900.02 |
| Max. Negotiated Rate |
$45,758.36 |
| Rate for Payer: Adventist Health Medi-Cal |
$28,900.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34,439.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45,758.36
|
|
|
OTHER BLADDER PROCEDURES
|
Facility
|
IP
|
$16,284.73
|
|
|
Service Code
|
APR-DRG 4451
|
| Min. Negotiated Rate |
$10,285.09 |
| Max. Negotiated Rate |
$16,284.73 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,285.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,256.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,284.73
|
|
