|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA
|
Facility
IP
|
$21,723.26
|
|
|
Service Code
|
APR-DRG 5133
|
| Min. Negotiated Rate |
$18,229.31 |
| Max. Negotiated Rate |
$21,723.26 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,229.31
|
| Rate for Payer: IEHP medi-cal |
$21,723.26
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA
|
Facility
IP
|
$13,673.30
|
|
|
Service Code
|
APR-DRG 5132
|
| Min. Negotiated Rate |
$11,474.10 |
| Max. Negotiated Rate |
$13,673.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,474.10
|
| Rate for Payer: IEHP medi-cal |
$13,673.30
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA
|
Facility
IP
|
$35,255.06
|
|
|
Service Code
|
APR-DRG 5134
|
| Min. Negotiated Rate |
$29,584.67 |
| Max. Negotiated Rate |
$35,255.06 |
| Rate for Payer: Adventist Health Medi-Cal |
$29,584.67
|
| Rate for Payer: IEHP medi-cal |
$35,255.06
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA
|
Facility
IP
|
$11,358.82
|
|
|
Service Code
|
APR-DRG 5131
|
| Min. Negotiated Rate |
$9,531.88 |
| Max. Negotiated Rate |
$11,358.82 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,531.88
|
| Rate for Payer: IEHP medi-cal |
$11,358.82
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY
|
Facility
IP
|
$14,699.73
|
|
|
Service Code
|
APR-DRG 5121
|
| Min. Negotiated Rate |
$12,335.44 |
| Max. Negotiated Rate |
$14,699.73 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,335.44
|
| Rate for Payer: IEHP medi-cal |
$14,699.73
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY
|
Facility
IP
|
$17,391.95
|
|
|
Service Code
|
APR-DRG 5122
|
| Min. Negotiated Rate |
$14,594.64 |
| Max. Negotiated Rate |
$17,391.95 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,594.64
|
| Rate for Payer: IEHP medi-cal |
$17,391.95
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY
|
Facility
IP
|
$46,894.19
|
|
|
Service Code
|
APR-DRG 5124
|
| Min. Negotiated Rate |
$39,351.77 |
| Max. Negotiated Rate |
$46,894.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$39,351.77
|
| Rate for Payer: IEHP medi-cal |
$46,894.19
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY
|
Facility
IP
|
$27,370.63
|
|
|
Service Code
|
APR-DRG 5123
|
| Min. Negotiated Rate |
$22,968.36 |
| Max. Negotiated Rate |
$27,370.63 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,968.36
|
| Rate for Payer: IEHP medi-cal |
$27,370.63
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY
|
Facility
IP
|
$28,673.36
|
|
|
Service Code
|
APR-DRG 5113
|
| Min. Negotiated Rate |
$24,061.56 |
| Max. Negotiated Rate |
$28,673.36 |
| Rate for Payer: Adventist Health Medi-Cal |
$24,061.56
|
| Rate for Payer: IEHP medi-cal |
$28,673.36
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY
|
Facility
IP
|
$16,031.83
|
|
|
Service Code
|
APR-DRG 5111
|
| Min. Negotiated Rate |
$13,453.28 |
| Max. Negotiated Rate |
$16,031.83 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,453.28
|
| Rate for Payer: IEHP medi-cal |
$16,031.83
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY
|
Facility
IP
|
$52,809.86
|
|
|
Service Code
|
APR-DRG 5114
|
| Min. Negotiated Rate |
$44,315.96 |
| Max. Negotiated Rate |
$52,809.86 |
| Rate for Payer: Adventist Health Medi-Cal |
$44,315.96
|
| Rate for Payer: IEHP medi-cal |
$52,809.86
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY
|
Facility
IP
|
$19,468.84
|
|
|
Service Code
|
APR-DRG 5112
|
| Min. Negotiated Rate |
$16,337.48 |
| Max. Negotiated Rate |
$19,468.84 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,337.48
|
| Rate for Payer: IEHP medi-cal |
$19,468.84
|
|
|
VAGINAL DELIVERY
|
Facility
IP
|
$6,189.30
|
|
|
Service Code
|
APR-DRG 5603
|
| Min. Negotiated Rate |
$5,193.82 |
| Max. Negotiated Rate |
$6,189.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,193.82
|
| Rate for Payer: IEHP medi-cal |
$6,189.30
|
|
|
VAGINAL DELIVERY
|
Facility
IP
|
$9,586.13
|
|
|
Service Code
|
APR-DRG 5604
|
| Min. Negotiated Rate |
$8,044.31 |
| Max. Negotiated Rate |
$9,586.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,044.31
|
| Rate for Payer: IEHP medi-cal |
$9,586.13
|
|
|
VAGINAL DELIVERY
|
Facility
IP
|
$4,161.79
|
|
|
Service Code
|
APR-DRG 5601
|
| Min. Negotiated Rate |
$3,492.41 |
| Max. Negotiated Rate |
$4,161.79 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,492.41
|
| Rate for Payer: IEHP medi-cal |
$4,161.79
|
|
|
VAGINAL DELIVERY
|
Facility
IP
|
$4,751.75
|
|
|
Service Code
|
APR-DRG 5602
|
| Min. Negotiated Rate |
$3,987.48 |
| Max. Negotiated Rate |
$4,751.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,987.48
|
| Rate for Payer: IEHP medi-cal |
$4,751.75
|
|
|
VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C
|
Facility
IP
|
$20,336.57
|
|
|
Service Code
|
APR-DRG 5424
|
| Min. Negotiated Rate |
$17,065.66 |
| Max. Negotiated Rate |
$20,336.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,065.66
|
| Rate for Payer: IEHP medi-cal |
$20,336.57
|
|
|
VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C
|
Facility
IP
|
$5,457.84
|
|
|
Service Code
|
APR-DRG 5422
|
| Min. Negotiated Rate |
$4,580.00 |
| Max. Negotiated Rate |
$5,457.84 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,580.00
|
| Rate for Payer: IEHP medi-cal |
$5,457.84
|
|
|
VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C
|
Facility
IP
|
$8,051.29
|
|
|
Service Code
|
APR-DRG 5423
|
| Min. Negotiated Rate |
$6,756.32 |
| Max. Negotiated Rate |
$8,051.29 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,756.32
|
| Rate for Payer: IEHP medi-cal |
$8,051.29
|
|
|
VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C
|
Facility
IP
|
$4,798.47
|
|
|
Service Code
|
APR-DRG 5421
|
| Min. Negotiated Rate |
$4,026.68 |
| Max. Negotiated Rate |
$4,798.47 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,026.68
|
| Rate for Payer: IEHP medi-cal |
$4,798.47
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C
|
Facility
IP
|
$7,311.83
|
|
|
Service Code
|
APR-DRG 5411
|
| Min. Negotiated Rate |
$6,135.80 |
| Max. Negotiated Rate |
$7,311.83 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,135.80
|
| Rate for Payer: IEHP medi-cal |
$7,311.83
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C
|
Facility
IP
|
$13,876.32
|
|
|
Service Code
|
APR-DRG 5414
|
| Min. Negotiated Rate |
$11,644.46 |
| Max. Negotiated Rate |
$13,876.32 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,644.46
|
| Rate for Payer: IEHP medi-cal |
$13,876.32
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C
|
Facility
IP
|
$7,621.49
|
|
|
Service Code
|
APR-DRG 5412
|
| Min. Negotiated Rate |
$6,395.65 |
| Max. Negotiated Rate |
$7,621.49 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,395.65
|
| Rate for Payer: IEHP medi-cal |
$7,621.49
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C
|
Facility
IP
|
$9,382.04
|
|
|
Service Code
|
APR-DRG 5413
|
| Min. Negotiated Rate |
$7,873.04 |
| Max. Negotiated Rate |
$9,382.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,873.04
|
| Rate for Payer: IEHP medi-cal |
$9,382.04
|
|
|
Vaginal hysterectomy, for uterus 250 g or less;
|
Facility
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 58260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,214.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,321.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,214.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| 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 |
$6,214.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,321.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,389.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,214.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,214.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10,191.89
|
| Rate for Payer: IEHP medi-cal |
$10,254.04
|
| Rate for Payer: IEHP Medicare Advantage |
$6,214.57
|
| Rate for Payer: Innovage PACE Commercial |
$9,321.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,214.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,327.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,327.52
|
| Rate for Payer: Prime Health Services Medicare |
$6,587.44
|
| Rate for Payer: Riverside University Health MISP |
$6,836.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,321.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,836.03
|
| Rate for Payer: Vantage Medical Group Senior |
$6,214.57
|
|
