|
PEPPERMINT SPIRIT ORAL [28205]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 0395224391
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.18
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
|
|
PEPPERMINT SPIRIT ORAL [28205]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
NDC 0395224391
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.22
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.25
|
| Rate for Payer: Cigna of CA PPO |
$0.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.30
|
| Rate for Payer: Global Benefits Group Commercial |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.28
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Vantage Medical Group Senior |
$0.30
|
|
|
PEPTIC ULCER AND GASTRITIS
|
Facility
|
IP
|
$60,288.73
|
|
|
Service Code
|
APR-DRG 2414
|
| Min. Negotiated Rate |
$48,151.66 |
| Max. Negotiated Rate |
$60,288.73 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48,151.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60,288.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53,942.55
|
|
|
PEPTIC ULCER AND GASTRITIS
|
Facility
|
IP
|
$25,326.22
|
|
|
Service Code
|
APR-DRG 2413
|
| Min. Negotiated Rate |
$20,227.65 |
| Max. Negotiated Rate |
$25,326.22 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,227.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,326.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,660.30
|
|
|
PEPTIC ULCER AND GASTRITIS
|
Facility
|
IP
|
$14,068.91
|
|
|
Service Code
|
APR-DRG 2411
|
| Min. Negotiated Rate |
$11,236.62 |
| Max. Negotiated Rate |
$14,068.91 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,236.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,068.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,587.97
|
|
|
PEPTIC ULCER AND GASTRITIS
|
Facility
|
IP
|
$17,527.69
|
|
|
Service Code
|
APR-DRG 2412
|
| Min. Negotiated Rate |
$13,999.09 |
| Max. Negotiated Rate |
$17,527.69 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,999.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,527.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,682.67
|
|
|
PERAMPANEL 2 MG TABLET [204501]
|
Facility
|
IP
|
$21.46
|
|
|
Service Code
|
NDC 0480706256
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$18.24 |
| Rate for Payer: Adventist Health Commercial |
$4.29
|
| Rate for Payer: Blue Shield of California Commercial |
$10.88
|
| Rate for Payer: Blue Shield of California Commercial |
$16.50
|
| Rate for Payer: Cash Price |
$9.66
|
| Rate for Payer: Cigna of CA HMO |
$15.02
|
| Rate for Payer: Cigna of CA PPO |
$15.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.58
|
| Rate for Payer: EPIC Health Plan Senior |
$8.58
|
| Rate for Payer: Galaxy Health WC |
$18.24
|
| Rate for Payer: Global Benefits Group Commercial |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.15
|
| Rate for Payer: Multiplan Commercial |
$17.17
|
| Rate for Payer: Networks By Design Commercial |
$13.95
|
| Rate for Payer: Prime Health Services Commercial |
$18.24
|
|
|
PERAMPANEL 2 MG TABLET [204501]
|
Facility
|
OP
|
$21.46
|
|
|
Service Code
|
NDC 0480706256
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$18.24 |
| Rate for Payer: Adventist Health Commercial |
$4.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.77
|
| Rate for Payer: Cash Price |
$9.66
|
| Rate for Payer: Cigna of CA HMO |
$15.02
|
| Rate for Payer: Cigna of CA PPO |
$15.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.58
|
| Rate for Payer: EPIC Health Plan Senior |
$8.58
|
| Rate for Payer: Galaxy Health WC |
$18.24
|
| Rate for Payer: Global Benefits Group Commercial |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.02
|
| Rate for Payer: Multiplan Commercial |
$17.17
|
| Rate for Payer: Networks By Design Commercial |
$13.95
|
| Rate for Payer: Prime Health Services Commercial |
$18.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.73
|
| Rate for Payer: United Healthcare All Other HMO |
$10.73
|
| Rate for Payer: United Healthcare HMO Rider |
$10.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.24
|
|
|
PERAMPANEL 2 MG TABLET [204501]
|
Facility
|
IP
|
$24.84
|
|
|
Service Code
|
NDC 6961627230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Adventist Health Commercial |
$4.97
|
| Rate for Payer: Blue Shield of California Commercial |
$12.59
|
| Rate for Payer: Blue Shield of California Commercial |
$19.10
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cigna of CA HMO |
$17.39
|
| Rate for Payer: Cigna of CA PPO |
$17.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.94
|
| Rate for Payer: EPIC Health Plan Senior |
$9.94
|
| Rate for Payer: Galaxy Health WC |
$21.11
|
| Rate for Payer: Global Benefits Group Commercial |
$14.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.96
|
| Rate for Payer: Multiplan Commercial |
$19.87
|
| Rate for Payer: Networks By Design Commercial |
$16.15
|
| Rate for Payer: Prime Health Services Commercial |
$21.11
|
|
|
PERAMPANEL 2 MG TABLET [204501]
|
Facility
|
OP
|
$24.84
|
|
|
Service Code
|
NDC 6961627230
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Adventist Health Commercial |
$4.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.94
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cigna of CA HMO |
$17.39
|
| Rate for Payer: Cigna of CA PPO |
$17.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.94
|
| Rate for Payer: EPIC Health Plan Senior |
$9.94
|
| Rate for Payer: Galaxy Health WC |
$21.11
|
| Rate for Payer: Global Benefits Group Commercial |
$14.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.39
|
| Rate for Payer: Multiplan Commercial |
$19.87
|
| Rate for Payer: Networks By Design Commercial |
$16.15
|
| Rate for Payer: Prime Health Services Commercial |
$21.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.42
|
| Rate for Payer: United Healthcare All Other HMO |
$12.42
|
| Rate for Payer: United Healthcare HMO Rider |
$12.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.11
|
| Rate for Payer: Vantage Medical Group Senior |
$21.11
|
|
|
PERAMPANEL 2 MG TABLET [204501]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 7220522130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$6.80 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4.06
|
| Rate for Payer: Blue Shield of California Commercial |
$6.15
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna of CA HMO |
$5.60
|
| Rate for Payer: Cigna of CA PPO |
$5.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3.20
|
| Rate for Payer: Galaxy Health WC |
$6.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: Networks By Design Commercial |
$5.20
|
| Rate for Payer: Prime Health Services Commercial |
$6.80
|
|
|
PERAMPANEL 2 MG TABLET [204501]
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 7220522130
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$6.80 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.13
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna of CA HMO |
$5.60
|
| Rate for Payer: Cigna of CA PPO |
$5.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3.20
|
| Rate for Payer: Galaxy Health WC |
$6.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.60
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: Networks By Design Commercial |
$5.20
|
| Rate for Payer: Prime Health Services Commercial |
$6.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.80
|
| Rate for Payer: Vantage Medical Group Senior |
$6.80
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC
|
Facility
|
IP
|
$152,455.89
|
|
|
Service Code
|
MSDRG 273
|
| Min. Negotiated Rate |
$7,978.00 |
| Max. Negotiated Rate |
$152,455.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$125,068.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$152,455.89
|
| Rate for Payer: EPIC Health Plan Senior |
$101,637.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92,397.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129,356.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$123,812.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$62,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$62,136.00
|
| Rate for Payer: United Healthcare HMO Rider |
$36,699.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33,623.00
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$137,660.26
|
|
|
Service Code
|
MSDRG 274
|
| Min. Negotiated Rate |
$7,978.00 |
| Max. Negotiated Rate |
$137,660.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$99,791.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$137,660.26
|
| Rate for Payer: EPIC Health Plan Senior |
$91,773.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$83,430.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116,802.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$111,796.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$42,353.00
|
| Rate for Payer: United Healthcare All Other HMO |
$42,353.00
|
| Rate for Payer: United Healthcare HMO Rider |
$25,015.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22,918.00
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITH AMI
|
Facility
|
IP
|
$41,127.25
|
|
|
Service Code
|
APR-DRG 1741
|
| Min. Negotiated Rate |
$32,847.68 |
| Max. Negotiated Rate |
$41,127.25 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32,847.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41,127.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,798.06
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITH AMI
|
Facility
|
IP
|
$52,392.71
|
|
|
Service Code
|
APR-DRG 1742
|
| Min. Negotiated Rate |
$41,845.23 |
| Max. Negotiated Rate |
$52,392.71 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41,845.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52,392.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46,877.69
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITH AMI
|
Facility
|
IP
|
$59,234.10
|
|
|
Service Code
|
APR-DRG 1743
|
| Min. Negotiated Rate |
$47,309.34 |
| Max. Negotiated Rate |
$59,234.10 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47,309.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59,234.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52,998.93
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITH AMI
|
Facility
|
IP
|
$108,187.69
|
|
|
Service Code
|
APR-DRG 1744
|
| Min. Negotiated Rate |
$86,407.80 |
| Max. Negotiated Rate |
$108,187.69 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86,407.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108,187.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96,799.51
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI
|
Facility
|
IP
|
$42,660.85
|
|
|
Service Code
|
APR-DRG 1751
|
| Min. Negotiated Rate |
$34,072.55 |
| Max. Negotiated Rate |
$42,660.85 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34,072.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42,660.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38,170.24
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI
|
Facility
|
IP
|
$119,890.13
|
|
|
Service Code
|
APR-DRG 1754
|
| Min. Negotiated Rate |
$95,754.36 |
| Max. Negotiated Rate |
$119,890.13 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$95,754.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119,890.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$107,270.12
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI
|
Facility
|
IP
|
$55,574.13
|
|
|
Service Code
|
APR-DRG 1752
|
| Min. Negotiated Rate |
$44,386.18 |
| Max. Negotiated Rate |
$55,574.13 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$44,386.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55,574.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49,724.22
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI
|
Facility
|
IP
|
$65,001.43
|
|
|
Service Code
|
APR-DRG 1753
|
| Min. Negotiated Rate |
$51,915.62 |
| Max. Negotiated Rate |
$65,001.43 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51,915.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65,001.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58,159.18
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES
|
Facility
|
IP
|
$127,529.72
|
|
|
Service Code
|
MSDRG 321
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$127,529.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$82,483.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$127,529.72
|
| Rate for Payer: EPIC Health Plan Senior |
$85,019.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$77,290.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108,207.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$103,569.59
|
| 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
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$110,533.75
|
|
|
Service Code
|
MSDRG 322
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$110,533.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53,447.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$110,533.75
|
| Rate for Payer: EPIC Health Plan Senior |
$73,689.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$66,990.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93,786.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89,766.80
|
| 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
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC
|
Facility
|
IP
|
$117,977.71
|
|
|
Service Code
|
MSDRG 250
|
| Min. Negotiated Rate |
$7,978.00 |
| Max. Negotiated Rate |
$117,977.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$66,164.67
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$117,977.71
|
| Rate for Payer: EPIC Health Plan Senior |
$78,651.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$71,501.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100,102.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95,812.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$32,556.00
|
| Rate for Payer: United Healthcare All Other HMO |
$32,556.00
|
| Rate for Payer: United Healthcare HMO Rider |
$27,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24,796.00
|
|
