|
SEVELAMER CARBONATE 800 MG TABLET [89201]
|
Facility
|
IP
|
$3.46
|
|
|
Service Code
|
NDC 0904670706
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$3.11 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2.77
|
| Rate for Payer: Blue Shield of California EPN |
$1.74
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Central Health Plan Commercial |
$2.77
|
| Rate for Payer: Cigna of CA HMO |
$2.42
|
| Rate for Payer: Cigna of CA PPO |
$2.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.94
|
| Rate for Payer: Global Benefits Group Commercial |
$2.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.60
|
| Rate for Payer: Networks By Design Commercial |
$2.25
|
| Rate for Payer: Prime Health Services Commercial |
$2.94
|
|
|
SEVELAMER CARBONATE 800 MG TABLET [89201]
|
Facility
|
OP
|
$2.28
|
|
|
Service Code
|
NDC 6809403464
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1.45
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Central Health Plan Commercial |
$1.82
|
| Rate for Payer: Cigna of CA HMO |
$1.60
|
| Rate for Payer: Cigna of CA PPO |
$1.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.91
|
| Rate for Payer: EPIC Health Plan Senior |
$0.91
|
| Rate for Payer: Galaxy Health WC |
$1.94
|
| Rate for Payer: Global Benefits Group Commercial |
$1.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$1.71
|
| Rate for Payer: Networks By Design Commercial |
$1.48
|
| Rate for Payer: Prime Health Services Commercial |
$1.94
|
| Rate for Payer: Riverside University Health System MISP |
$0.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.14
|
| Rate for Payer: United Healthcare All Other HMO |
$1.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.94
|
| Rate for Payer: Vantage Medical Group Senior |
$1.94
|
|
|
SEVELAMER HCL 800 MG TABLET [28715]
|
Facility
|
IP
|
$3.33
|
|
|
Service Code
|
NDC 6846244718
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Adventist Health Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California Commercial |
$2.67
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Central Health Plan Commercial |
$2.66
|
| Rate for Payer: Cigna of CA HMO |
$2.33
|
| Rate for Payer: Cigna of CA PPO |
$2.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.33
|
| Rate for Payer: EPIC Health Plan Senior |
$1.33
|
| Rate for Payer: Galaxy Health WC |
$2.83
|
| Rate for Payer: Global Benefits Group Commercial |
$2.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Networks By Design Commercial |
$1.67
|
| Rate for Payer: Prime Health Services Commercial |
$2.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.09
|
|
|
SEVELAMER HCL 800 MG TABLET [28715]
|
Facility
|
OP
|
$3.33
|
|
|
Service Code
|
NDC 6846244718
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Adventist Health Commercial |
$0.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.94
|
| Rate for Payer: Blue Shield of California Commercial |
$2.11
|
| Rate for Payer: Blue Shield of California EPN |
$1.33
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Central Health Plan Commercial |
$2.66
|
| Rate for Payer: Cigna of CA HMO |
$2.33
|
| Rate for Payer: Cigna of CA PPO |
$2.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.33
|
| Rate for Payer: EPIC Health Plan Senior |
$1.33
|
| Rate for Payer: Galaxy Health WC |
$2.83
|
| Rate for Payer: Global Benefits Group Commercial |
$2.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.33
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Networks By Design Commercial |
$1.67
|
| Rate for Payer: Prime Health Services Commercial |
$2.83
|
| Rate for Payer: Riverside University Health System MISP |
$1.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.25
|
| Rate for Payer: United Healthcare All Other HMO |
$1.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2.83
|
|
|
SEVELAMER ORAL SUSPENSION COMPOUND 50 MG/ML [4080333]
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
NDC 9994080333
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.33
|
| Rate for Payer: Cigna of CA PPO |
$0.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Senior |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.40
|
|
|
SEVELAMER ORAL SUSPENSION COMPOUND 50 MG/ML [4080333]
|
Facility
|
OP
|
$0.47
|
|
|
Service Code
|
NDC 9994080333
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.19
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Central Health Plan Commercial |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.33
|
| Rate for Payer: Cigna of CA PPO |
$0.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Senior |
$0.19
|
| Rate for Payer: Galaxy Health WC |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Networks By Design Commercial |
$0.31
|
| Rate for Payer: Prime Health Services Commercial |
$0.40
|
| Rate for Payer: Riverside University Health System MISP |
$0.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.40
|
| Rate for Payer: Vantage Medical Group Senior |
$0.40
|
|
|
SHOULDER AND ELBOW JOINT REPLACEMENT
|
Facility
|
IP
|
$42,716.94
|
|
|
Service Code
|
APR-DRG 3223
|
| Min. Negotiated Rate |
$26,979.12 |
| Max. Negotiated Rate |
$42,716.94 |
| Rate for Payer: Adventist Health Medi-Cal |
$26,979.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32,150.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42,716.94
|
|
|
SHOULDER AND ELBOW JOINT REPLACEMENT
|
Facility
|
IP
|
$32,525.13
|
|
|
Service Code
|
APR-DRG 3222
|
| Min. Negotiated Rate |
$20,542.19 |
| Max. Negotiated Rate |
$32,525.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$20,542.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24,479.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32,525.13
|
|
|
SHOULDER AND ELBOW JOINT REPLACEMENT
|
Facility
|
IP
|
$28,466.54
|
|
|
Service Code
|
APR-DRG 3221
|
| Min. Negotiated Rate |
$17,978.87 |
| Max. Negotiated Rate |
$28,466.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,978.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21,424.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28,466.54
|
|
|
SHOULDER AND ELBOW JOINT REPLACEMENT
|
Facility
|
IP
|
$56,916.99
|
|
|
Service Code
|
APR-DRG 3224
|
| Min. Negotiated Rate |
$35,947.57 |
| Max. Negotiated Rate |
$56,916.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$35,947.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42,837.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56,916.99
|
|
|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC
|
Facility
|
IP
|
$54,727.73
|
|
|
Service Code
|
MSDRG 511
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$54,727.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$54,727.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35,351.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49,493.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$48,808.30
|
| Rate for Payer: EPIC Health Plan Senior |
$32,538.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29,580.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41,413.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39,638.26
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$29,580.79
|
| Rate for Payer: Prime Health Services Medicare |
$31,355.64
|
| 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
|
|
|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC
|
Facility
|
IP
|
$79,496.54
|
|
|
Service Code
|
MSDRG 510
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$79,496.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$79,496.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51,351.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71,893.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$70,224.81
|
| Rate for Payer: EPIC Health Plan Senior |
$46,816.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42,560.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59,584.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57,031.06
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42,560.49
|
| Rate for Payer: Prime Health Services Medicare |
$45,114.12
|
| 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
|
|
|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$43,568.47
|
|
|
Service Code
|
MSDRG 512
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$43,568.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$43,568.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28,143.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39,401.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$39,159.38
|
| Rate for Payer: EPIC Health Plan Senior |
$26,106.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,732.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,226.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,802.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,732.96
|
| Rate for Payer: Prime Health Services Medicare |
$25,156.94
|
| 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
|
|
|
SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT
|
Facility
|
IP
|
$17,301.89
|
|
|
Service Code
|
APR-DRG 3151
|
| Min. Negotiated Rate |
$10,927.51 |
| Max. Negotiated Rate |
$17,301.89 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,927.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,021.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,301.89
|
|
|
SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT
|
Facility
|
IP
|
$26,756.50
|
|
|
Service Code
|
APR-DRG 3152
|
| Min. Negotiated Rate |
$16,898.84 |
| Max. Negotiated Rate |
$26,756.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,898.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20,137.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26,756.50
|
|
|
SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT
|
Facility
|
IP
|
$58,387.34
|
|
|
Service Code
|
APR-DRG 3154
|
| Min. Negotiated Rate |
$36,876.22 |
| Max. Negotiated Rate |
$58,387.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$36,876.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43,944.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58,387.34
|
|
|
SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT
|
Facility
|
IP
|
$37,030.89
|
|
|
Service Code
|
APR-DRG 3153
|
| Min. Negotiated Rate |
$23,387.93 |
| Max. Negotiated Rate |
$37,030.89 |
| Rate for Payer: Adventist Health Medi-Cal |
$23,387.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27,870.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37,030.89
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
|
IP
|
$11,503.04
|
|
|
Service Code
|
APR-DRG 6622
|
| Min. Negotiated Rate |
$7,265.08 |
| Max. Negotiated Rate |
$11,503.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,265.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,657.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,503.04
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
|
IP
|
$18,029.02
|
|
|
Service Code
|
APR-DRG 6623
|
| Min. Negotiated Rate |
$11,386.75 |
| Max. Negotiated Rate |
$18,029.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,386.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,569.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,029.02
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
|
IP
|
$33,749.78
|
|
|
Service Code
|
APR-DRG 6624
|
| Min. Negotiated Rate |
$21,315.65 |
| Max. Negotiated Rate |
$33,749.78 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,315.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25,401.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33,749.78
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
|
IP
|
$8,560.32
|
|
|
Service Code
|
APR-DRG 6621
|
| Min. Negotiated Rate |
$5,406.52 |
| Max. Negotiated Rate |
$8,560.32 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,406.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,442.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,560.32
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 45330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$94.14 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,196.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,845.73
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,315.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,196.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,973.53
|
| Rate for Payer: EPIC Health Plan Senior |
$1,315.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,961.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,674.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,602.75
|
| Rate for Payer: Multiplan WC |
$1,845.73
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Preferred Health Network WC |
$1,883.40
|
| Rate for Payer: Prime Health Services Medicare |
$1,267.84
|
| Rate for Payer: Prime Health Services WC |
$1,826.90
|
| Rate for Payer: Riverside University Health System MISP |
$1,315.69
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,196.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$27,467.00
|
|
|
Service Code
|
CPT 45331
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$124.24 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,196.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,845.73
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,315.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,196.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,973.53
|
| Rate for Payer: EPIC Health Plan Senior |
$1,315.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,961.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$124.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,674.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,602.75
|
| Rate for Payer: Multiplan WC |
$1,845.73
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Preferred Health Network WC |
$1,883.40
|
| Rate for Payer: Prime Health Services Medicare |
$1,267.84
|
| Rate for Payer: Prime Health Services WC |
$1,826.90
|
| Rate for Payer: Riverside University Health System MISP |
$1,315.69
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,196.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
|
|
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
|
IP
|
$34,788.45
|
|
|
Service Code
|
MSDRG 555
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$34,788.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$34,788.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22,471.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,461.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,567.68
|
| Rate for Payer: EPIC Health Plan Senior |
$21,045.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19,131.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26,784.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25,636.79
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19,131.93
|
| Rate for Payer: Prime Health Services Medicare |
$20,279.85
|
| 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
|
|
|
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC
|
Facility
|
IP
|
$21,860.56
|
|
|
Service Code
|
MSDRG 556
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$21,860.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21,860.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14,121.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19,769.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,389.51
|
| Rate for Payer: EPIC Health Plan Senior |
$13,593.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,357.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,300.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,558.76
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12,357.28
|
| Rate for Payer: Prime Health Services Medicare |
$13,098.72
|
| 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
|
|
