|
SEVELAMER HCL 800 MG TABLET [28715]
|
Facility
IP
|
$8.92
|
|
|
Service Code
|
NDC 58468-0021-1
|
| Hospital Charge Code |
1712253
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$8.03 |
| Rate for Payer: Blue Shield of California Commercial |
$6.69
|
| Rate for Payer: Blue Shield of California EPN |
$4.76
|
| Rate for Payer: Cash Price |
$4.01
|
| Rate for Payer: Central Health Plan Commercial |
$7.14
|
| Rate for Payer: Cigna of CA HMO |
$6.24
|
| Rate for Payer: Cigna of CA PPO |
$6.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.57
|
| Rate for Payer: Galaxy Health WC |
$7.58
|
| Rate for Payer: Global Benefits Group Commercial |
$5.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.78
|
| Rate for Payer: Multiplan Commercial |
$6.69
|
| Rate for Payer: Networks By Design Commercial |
$5.80
|
| Rate for Payer: Prime Health Services Commercial |
$7.58
|
|
|
SEVELAMER HCL 800 MG TABLET [28715]
|
Facility
IP
|
$4.33
|
|
|
Service Code
|
NDC 68462-447-18
|
| Hospital Charge Code |
1712253
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Blue Shield of California Commercial |
$3.25
|
| Rate for Payer: Blue Shield of California EPN |
$2.31
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Central Health Plan Commercial |
$3.46
|
| Rate for Payer: Cigna of CA HMO |
$3.03
|
| Rate for Payer: Cigna of CA PPO |
$3.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$3.68
|
| Rate for Payer: Global Benefits Group Commercial |
$2.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$3.25
|
| Rate for Payer: Networks By Design Commercial |
$2.81
|
| Rate for Payer: Prime Health Services Commercial |
$3.68
|
|
|
SEVELAMER HCL 800 MG TABLET [28715]
|
Facility
OP
|
$4.33
|
|
|
Service Code
|
NDC 68462-447-18
|
| Hospital Charge Code |
1712253
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.56
|
| Rate for Payer: BCBS Transplant Transplant |
$2.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.72
|
| Rate for Payer: Blue Shield of California EPN |
$2.12
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Central Health Plan Commercial |
$3.46
|
| Rate for Payer: Cigna of CA HMO |
$3.03
|
| Rate for Payer: Cigna of CA PPO |
$3.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.73
|
| Rate for Payer: Galaxy Health WC |
$3.68
|
| Rate for Payer: Global Benefits Group Commercial |
$2.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.25
|
| Rate for Payer: IEHP medi-cal |
$1.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$3.25
|
| Rate for Payer: Networks By Design Commercial |
$2.81
|
| Rate for Payer: Prime Health Services Commercial |
$3.68
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.60
|
| Rate for Payer: Riverside University Health MISP |
$1.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.16
|
| Rate for Payer: United Healthcare All Other HMO |
$2.16
|
| Rate for Payer: United Healthcare HMO Rider |
$2.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.68
|
| Rate for Payer: Vantage Medical Group Senior |
$3.68
|
|
|
SEVELAMER HCL 800 MG TABLET [28715]
|
Facility
OP
|
$8.92
|
|
|
Service Code
|
NDC 58468-0021-1
|
| Hospital Charge Code |
1712253
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$8.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.27
|
| Rate for Payer: BCBS Transplant Transplant |
$5.35
|
| Rate for Payer: Blue Shield of California Commercial |
$5.61
|
| Rate for Payer: Blue Shield of California EPN |
$4.36
|
| Rate for Payer: Cash Price |
$4.01
|
| Rate for Payer: Central Health Plan Commercial |
$7.14
|
| Rate for Payer: Cigna of CA HMO |
$6.24
|
| Rate for Payer: Cigna of CA PPO |
$6.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.57
|
| Rate for Payer: Galaxy Health WC |
$7.58
|
| Rate for Payer: Global Benefits Group Commercial |
$5.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.69
|
| Rate for Payer: IEHP medi-cal |
$3.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.78
|
| Rate for Payer: Multiplan Commercial |
$6.69
|
| Rate for Payer: Networks By Design Commercial |
$5.80
|
| Rate for Payer: Prime Health Services Commercial |
$7.58
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.35
|
| Rate for Payer: Riverside University Health MISP |
$3.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Other HMO |
$4.46
|
| Rate for Payer: United Healthcare HMO Rider |
$4.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Senior |
$7.58
|
|
|
SEVELAMER ORAL SUSPENSION COMPOUND 50 MG/ML [4080333]
|
Facility
IP
|
$0.47
|
|
|
Service Code
|
NDC 9994-0803-33
|
| Hospital Charge Code |
1715236
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.25
|
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$0.31
|
| 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 9994-0803-33
|
| Hospital Charge Code |
1715236
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: BCBS Transplant Transplant |
$0.28
|
| Rate for Payer: Blue Shield of California Commercial |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| 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: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.35
|
| Rate for Payer: IEHP medi-cal |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.31
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.28
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$0.40
|
| Rate for Payer: Vantage Medical Group Senior |
$0.40
|
|
|
Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); posterior synechiae
|
Facility
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 65875
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,911.63 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,911.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$2,911.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,930.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,911.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,775.07
|
| Rate for Payer: IEHP medi-cal |
$4,804.19
|
| Rate for Payer: IEHP Medicare Advantage |
$2,911.63
|
| Rate for Payer: Innovage PACE Commercial |
$4,367.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,911.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,901.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,901.58
|
| Rate for Payer: Prime Health Services Medicare |
$3,086.33
|
| Rate for Payer: Riverside University Health MISP |
$3,202.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
Severing of tarsorrhaphy
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 67710
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,264.97 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,264.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,897.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,391.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,264.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,264.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,897.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,707.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,264.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,264.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,074.55
|
| Rate for Payer: IEHP medi-cal |
$2,087.20
|
| Rate for Payer: IEHP Medicare Advantage |
$1,264.97
|
| Rate for Payer: Innovage PACE Commercial |
$1,897.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,264.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,695.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,695.06
|
| Rate for Payer: Prime Health Services Medicare |
$1,340.87
|
| Rate for Payer: Riverside University Health MISP |
$1,391.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,391.47
|
| Rate for Payer: Vantage Medical Group Senior |
$1,264.97
|
|
|
SHOULDER AND ELBOW JOINT REPLACEMENT
|
Facility
IP
|
$30,668.82
|
|
|
Service Code
|
APR-DRG 3223
|
| Min. Negotiated Rate |
$25,736.08 |
| Max. Negotiated Rate |
$30,668.82 |
| Rate for Payer: Adventist Health Medi-Cal |
$25,736.08
|
| Rate for Payer: IEHP medi-cal |
$30,668.82
|
|
|
SHOULDER AND ELBOW JOINT REPLACEMENT
|
Facility
IP
|
$21,509.69
|
|
|
Service Code
|
APR-DRG 3221
|
| Min. Negotiated Rate |
$18,050.09 |
| Max. Negotiated Rate |
$21,509.69 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,050.09
|
| Rate for Payer: IEHP medi-cal |
$21,509.69
|
|
|
SHOULDER AND ELBOW JOINT REPLACEMENT
|
Facility
IP
|
$23,354.33
|
|
|
Service Code
|
APR-DRG 3222
|
| Min. Negotiated Rate |
$19,598.04 |
| Max. Negotiated Rate |
$23,354.33 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,598.04
|
| Rate for Payer: IEHP medi-cal |
$23,354.33
|
|
|
SHOULDER AND ELBOW JOINT REPLACEMENT
|
Facility
IP
|
$41,063.95
|
|
|
Service Code
|
APR-DRG 3224
|
| Min. Negotiated Rate |
$34,459.26 |
| Max. Negotiated Rate |
$41,063.95 |
| Rate for Payer: Adventist Health Medi-Cal |
$34,459.26
|
| Rate for Payer: IEHP medi-cal |
$41,063.95
|
|
|
SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT
|
Facility
IP
|
$44,181.95
|
|
|
Service Code
|
APR-DRG 3154
|
| Min. Negotiated Rate |
$37,075.76 |
| Max. Negotiated Rate |
$44,181.95 |
| Rate for Payer: Adventist Health Medi-Cal |
$37,075.76
|
| Rate for Payer: IEHP medi-cal |
$44,181.95
|
|
|
SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT
|
Facility
IP
|
$18,235.52
|
|
|
Service Code
|
APR-DRG 3152
|
| Min. Negotiated Rate |
$15,302.53 |
| Max. Negotiated Rate |
$18,235.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,302.53
|
| Rate for Payer: IEHP medi-cal |
$18,235.52
|
|
|
SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT
|
Facility
IP
|
$27,171.74
|
|
|
Service Code
|
APR-DRG 3153
|
| Min. Negotiated Rate |
$22,801.46 |
| Max. Negotiated Rate |
$27,171.74 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,801.46
|
| Rate for Payer: IEHP medi-cal |
$27,171.74
|
|
|
SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT
|
Facility
IP
|
$11,394.87
|
|
|
Service Code
|
APR-DRG 3151
|
| Min. Negotiated Rate |
$9,562.13 |
| Max. Negotiated Rate |
$11,394.87 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,562.13
|
| Rate for Payer: IEHP medi-cal |
$11,394.87
|
|
|
Sialolithotomy; submandibular (submaxillary), sublingual or parotid, uncomplicated, intraoral
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 42330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,901.00 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,022.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$4,022.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,597.21
|
| Rate for Payer: IEHP medi-cal |
$6,637.44
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Innovage PACE Commercial |
$6,034.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,390.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Prime Health Services Medicare |
$4,264.05
|
| Rate for Payer: Riverside University Health MISP |
$4,424.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
IP
|
$8,092.66
|
|
|
Service Code
|
APR-DRG 6622
|
| Min. Negotiated Rate |
$6,791.04 |
| Max. Negotiated Rate |
$8,092.66 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,791.04
|
| Rate for Payer: IEHP medi-cal |
$8,092.66
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
IP
|
$21,572.42
|
|
|
Service Code
|
APR-DRG 6624
|
| Min. Negotiated Rate |
$18,102.73 |
| Max. Negotiated Rate |
$21,572.42 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,102.73
|
| Rate for Payer: IEHP medi-cal |
$21,572.42
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
IP
|
$5,900.98
|
|
|
Service Code
|
APR-DRG 6621
|
| Min. Negotiated Rate |
$4,951.87 |
| Max. Negotiated Rate |
$5,900.98 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,951.87
|
| Rate for Payer: IEHP medi-cal |
$5,900.98
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
IP
|
$11,473.62
|
|
|
Service Code
|
APR-DRG 6623
|
| Min. Negotiated Rate |
$9,628.21 |
| Max. Negotiated Rate |
$11,473.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,628.21
|
| Rate for Payer: IEHP medi-cal |
$11,473.62
|
|
|
Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 45330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,141.93 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,141.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,141.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,141.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,872.77
|
| Rate for Payer: IEHP medi-cal |
$1,884.18
|
| Rate for Payer: IEHP Medicare Advantage |
$1,141.93
|
| Rate for Payer: Innovage PACE Commercial |
$1,712.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,141.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,530.19
|
| Rate for Payer: Prime Health Services Medicare |
$1,210.45
|
| Rate for Payer: Riverside University Health MISP |
$1,256.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
Sigmoidoscopy, flexible; with biopsy, single or multiple
|
Facility
OP
|
$397,400.00
|
|
|
Service Code
|
CPT 45331
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,141.93 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,141.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,141.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,141.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,872.77
|
| Rate for Payer: IEHP medi-cal |
$1,884.18
|
| Rate for Payer: IEHP Medicare Advantage |
$1,141.93
|
| Rate for Payer: Innovage PACE Commercial |
$1,712.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,141.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,530.19
|
| Rate for Payer: Prime Health Services Medicare |
$1,210.45
|
| Rate for Payer: Riverside University Health MISP |
$1,256.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
IP
|
$7,119.63
|
|
|
Service Code
|
APR-DRG 8612
|
| Min. Negotiated Rate |
$5,974.51 |
| Max. Negotiated Rate |
$7,119.63 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,974.51
|
| Rate for Payer: IEHP medi-cal |
$7,119.63
|
|
|
SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
IP
|
$9,959.99
|
|
|
Service Code
|
APR-DRG 8613
|
| Min. Negotiated Rate |
$8,358.04 |
| Max. Negotiated Rate |
$9,959.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,358.04
|
| Rate for Payer: IEHP medi-cal |
$9,959.99
|
|
