|
DISOPYRAMIDE PHOSPHATE 150 MG CAPSULE [2536]
|
Facility
|
IP
|
$6.76
|
|
|
Service Code
|
NDC 0025276231
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$6.08 |
| Rate for Payer: Adventist Health Commercial |
$1.35
|
| Rate for Payer: Blue Shield of California Commercial |
$5.42
|
| Rate for Payer: Blue Shield of California EPN |
$3.41
|
| Rate for Payer: Cash Price |
$3.04
|
| Rate for Payer: Central Health Plan Commercial |
$5.41
|
| Rate for Payer: Cigna of CA HMO |
$4.73
|
| Rate for Payer: Cigna of CA PPO |
$4.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2.70
|
| Rate for Payer: Galaxy Health WC |
$5.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: Multiplan Commercial |
$5.07
|
| Rate for Payer: Networks By Design Commercial |
$4.39
|
| Rate for Payer: Prime Health Services Commercial |
$5.75
|
|
|
DISOPYRAMIDE PHOSPHATE 150 MG CAPSULE [2536]
|
Facility
|
OP
|
$6.76
|
|
|
Service Code
|
NDC 0025276231
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$6.08 |
| Rate for Payer: Adventist Health Commercial |
$1.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.93
|
| Rate for Payer: Blue Shield of California Commercial |
$4.29
|
| Rate for Payer: Blue Shield of California EPN |
$2.70
|
| Rate for Payer: Cash Price |
$3.04
|
| Rate for Payer: Central Health Plan Commercial |
$5.41
|
| Rate for Payer: Cigna of CA HMO |
$4.73
|
| Rate for Payer: Cigna of CA PPO |
$4.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2.70
|
| Rate for Payer: Galaxy Health WC |
$5.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.73
|
| Rate for Payer: Multiplan Commercial |
$5.07
|
| Rate for Payer: Networks By Design Commercial |
$4.39
|
| Rate for Payer: Prime Health Services Commercial |
$5.75
|
| Rate for Payer: Riverside University Health System MISP |
$2.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.38
|
| Rate for Payer: United Healthcare All Other HMO |
$3.38
|
| Rate for Payer: United Healthcare HMO Rider |
$3.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5.75
|
|
|
DISORDERS OF GALLBLADDER AND BILIARY TRACT
|
Facility
|
IP
|
$32,412.35
|
|
|
Service Code
|
APR-DRG 2844
|
| Min. Negotiated Rate |
$20,470.96 |
| Max. Negotiated Rate |
$32,412.35 |
| Rate for Payer: Adventist Health Medi-Cal |
$20,470.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24,394.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32,412.35
|
|
|
DISORDERS OF GALLBLADDER AND BILIARY TRACT
|
Facility
|
IP
|
$18,971.65
|
|
|
Service Code
|
APR-DRG 2843
|
| Min. Negotiated Rate |
$11,982.10 |
| Max. Negotiated Rate |
$18,971.65 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,982.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,278.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,971.65
|
|
|
DISORDERS OF GALLBLADDER AND BILIARY TRACT
|
Facility
|
IP
|
$10,008.52
|
|
|
Service Code
|
APR-DRG 2841
|
| Min. Negotiated Rate |
$6,321.17 |
| Max. Negotiated Rate |
$10,008.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,321.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,532.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,008.52
|
|
|
DISORDERS OF GALLBLADDER AND BILIARY TRACT
|
Facility
|
IP
|
$14,044.95
|
|
|
Service Code
|
APR-DRG 2842
|
| Min. Negotiated Rate |
$8,870.50 |
| Max. Negotiated Rate |
$14,044.95 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,870.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,570.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,044.95
|
|
|
DISORDERS OF IMPULSE CONTROL & DEVELOPMENT
|
Facility
|
IP
|
$12,906.93
|
|
|
Service Code
|
APR-DRG 7583
|
| Min. Negotiated Rate |
$8,151.74 |
| Max. Negotiated Rate |
$12,906.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,151.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,714.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,906.93
|
|
|
DISORDERS OF IMPULSE CONTROL & DEVELOPMENT
|
Facility
|
IP
|
$6,405.13
|
|
|
Service Code
|
APR-DRG 7581
|
| Min. Negotiated Rate |
$4,045.34 |
| Max. Negotiated Rate |
$6,405.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,045.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,820.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,405.13
|
|
|
DISORDERS OF IMPULSE CONTROL & DEVELOPMENT
|
Facility
|
IP
|
$43,278.90
|
|
|
Service Code
|
APR-DRG 7584
|
| Min. Negotiated Rate |
$27,334.04 |
| Max. Negotiated Rate |
$43,278.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$27,334.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32,573.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43,278.90
|
|
|
DISORDERS OF IMPULSE CONTROL & DEVELOPMENT
|
Facility
|
IP
|
$7,931.87
|
|
|
Service Code
|
APR-DRG 7582
|
| Min. Negotiated Rate |
$5,009.60 |
| Max. Negotiated Rate |
$7,931.87 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,009.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,969.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,931.87
|
|
|
DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC
|
Facility
|
IP
|
$25,405.73
|
|
|
Service Code
|
MSDRG 442
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$25,405.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,405.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16,411.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,976.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,454.87
|
| Rate for Payer: EPIC Health Plan Senior |
$15,636.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,215.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,901.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,048.19
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,215.07
|
| Rate for Payer: Prime Health Services Medicare |
$15,067.97
|
| 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
|
|
|
DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC
|
Facility
|
IP
|
$47,234.71
|
|
|
Service Code
|
MSDRG 441
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$47,234.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47,234.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30,511.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42,717.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,329.40
|
| Rate for Payer: EPIC Health Plan Senior |
$28,219.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,654.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35,915.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34,376.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25,654.18
|
| Rate for Payer: Prime Health Services Medicare |
$27,193.43
|
| 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
|
|
|
DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$18,415.40
|
|
|
Service Code
|
MSDRG 443
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$18,415.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18,415.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,895.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,654.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,410.63
|
| Rate for Payer: EPIC Health Plan Senior |
$11,607.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,551.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,772.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,139.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10,551.90
|
| Rate for Payer: Prime Health Services Medicare |
$11,185.01
|
| 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
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY
|
Facility
|
IP
|
$38,009.79
|
|
|
Service Code
|
APR-DRG 2824
|
| Min. Negotiated Rate |
$24,006.18 |
| Max. Negotiated Rate |
$38,009.79 |
| Rate for Payer: Adventist Health Medi-Cal |
$24,006.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28,607.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38,009.79
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY
|
Facility
|
IP
|
$8,532.10
|
|
|
Service Code
|
APR-DRG 2821
|
| Min. Negotiated Rate |
$5,388.70 |
| Max. Negotiated Rate |
$8,532.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,388.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,421.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,532.10
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY
|
Facility
|
IP
|
$17,833.65
|
|
|
Service Code
|
APR-DRG 2823
|
| Min. Negotiated Rate |
$11,263.36 |
| Max. Negotiated Rate |
$17,833.65 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,263.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,422.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,833.65
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY
|
Facility
|
IP
|
$11,396.30
|
|
|
Service Code
|
APR-DRG 2822
|
| Min. Negotiated Rate |
$7,197.66 |
| Max. Negotiated Rate |
$11,396.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,197.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,577.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,396.30
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC
|
Facility
|
IP
|
$22,139.54
|
|
|
Service Code
|
MSDRG 439
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$22,139.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,139.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14,301.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20,022.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,630.73
|
| Rate for Payer: EPIC Health Plan Senior |
$13,753.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,503.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,504.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,754.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12,503.47
|
| Rate for Payer: Prime Health Services Medicare |
$13,253.68
|
| 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
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC
|
Facility
|
IP
|
$42,905.23
|
|
|
Service Code
|
MSDRG 438
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$42,905.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42,905.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27,715.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38,802.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,585.89
|
| Rate for Payer: EPIC Health Plan Senior |
$25,723.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,385.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32,739.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,336.42
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,385.39
|
| Rate for Payer: Prime Health Services Medicare |
$24,788.51
|
| 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
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$16,354.63
|
|
|
Service Code
|
MSDRG 440
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$16,354.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16,354.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,564.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,790.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,628.77
|
| Rate for Payer: EPIC Health Plan Senior |
$10,419.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,471.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,260.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,692.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,471.98
|
| Rate for Payer: Prime Health Services Medicare |
$10,040.30
|
| 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
|
|
|
DISORDERS OF PERSONALITY AND IMPULSE CONTROL
|
Facility
|
IP
|
$51,751.05
|
|
|
Service Code
|
MSDRG 883
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$51,751.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$51,751.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33,429.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46,801.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,234.50
|
| Rate for Payer: EPIC Health Plan Senior |
$30,823.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,020.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39,229.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37,548.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$28,020.91
|
| Rate for Payer: Prime Health Services Medicare |
$29,702.16
|
| 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
|
|
|
DISORDERS OF THE BILIARY TRACT WITH CC
|
Facility
|
IP
|
$28,803.51
|
|
|
Service Code
|
MSDRG 445
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$28,803.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28,803.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18,605.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,048.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,392.76
|
| Rate for Payer: EPIC Health Plan Senior |
$17,595.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15,995.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,393.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21,434.12
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15,995.61
|
| Rate for Payer: Prime Health Services Medicare |
$16,955.35
|
| 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
|
|
|
DISORDERS OF THE BILIARY TRACT WITH MCC
|
Facility
|
IP
|
$43,976.42
|
|
|
Service Code
|
MSDRG 444
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$43,976.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$43,976.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28,406.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39,770.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$39,512.09
|
| Rate for Payer: EPIC Health Plan Senior |
$26,341.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,946.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,525.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32,088.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,946.72
|
| Rate for Payer: Prime Health Services Medicare |
$25,383.52
|
| 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
|
|
|
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC
|
Facility
|
IP
|
$21,773.71
|
|
|
Service Code
|
MSDRG 446
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$21,773.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21,773.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14,064.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19,691.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,314.40
|
| Rate for Payer: EPIC Health Plan Senior |
$13,542.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,311.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,236.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,497.76
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12,311.76
|
| Rate for Payer: Prime Health Services Medicare |
$13,050.47
|
| 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
|
|
|
DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE [27631]
|
Facility
|
OP
|
$2.47
|
|
|
Service Code
|
NDC 0074611413
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.99
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Central Health Plan Commercial |
$1.98
|
| Rate for Payer: Cigna of CA HMO |
$1.73
|
| Rate for Payer: Cigna of CA PPO |
$1.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.99
|
| Rate for Payer: EPIC Health Plan Senior |
$0.99
|
| Rate for Payer: Galaxy Health WC |
$2.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$1.85
|
| Rate for Payer: Networks By Design Commercial |
$1.61
|
| Rate for Payer: Prime Health Services Commercial |
$2.10
|
| Rate for Payer: Riverside University Health System MISP |
$0.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2.10
|
|
