EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
IP
|
$22,721.57
|
|
Service Code
|
APR-DRG 9501
|
Min. Negotiated Rate |
$17,429.83 |
Max. Negotiated Rate |
$22,721.57 |
Rate for Payer: IEHP Medi-Cal |
$17,429.83
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,721.57
|
|
EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
IP
|
$46,762.59
|
|
Service Code
|
APR-DRG 9503
|
Min. Negotiated Rate |
$35,871.83 |
Max. Negotiated Rate |
$46,762.59 |
Rate for Payer: IEHP Medi-Cal |
$35,871.83
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46,762.59
|
|
EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
IP
|
$85,317.62
|
|
Service Code
|
APR-DRG 9504
|
Min. Negotiated Rate |
$65,447.59 |
Max. Negotiated Rate |
$85,317.62 |
Rate for Payer: IEHP Medi-Cal |
$65,447.59
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85,317.62
|
|
EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT
|
Facility
IP
|
$31,058.60
|
|
Service Code
|
APR-DRG 8434
|
Min. Negotiated Rate |
$23,825.21 |
Max. Negotiated Rate |
$31,058.60 |
Rate for Payer: IEHP Medi-Cal |
$23,825.21
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31,058.60
|
|
EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT
|
Facility
IP
|
$15,083.28
|
|
Service Code
|
APR-DRG 8433
|
Min. Negotiated Rate |
$11,570.47 |
Max. Negotiated Rate |
$15,083.28 |
Rate for Payer: IEHP Medi-Cal |
$11,570.47
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,083.28
|
|
EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT
|
Facility
IP
|
$11,130.24
|
|
Service Code
|
APR-DRG 8432
|
Min. Negotiated Rate |
$8,538.06 |
Max. Negotiated Rate |
$11,130.24 |
Rate for Payer: IEHP Medi-Cal |
$8,538.06
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,130.24
|
|
EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT
|
Facility
IP
|
$7,251.67
|
|
Service Code
|
APR-DRG 8431
|
Min. Negotiated Rate |
$5,562.80 |
Max. Negotiated Rate |
$7,251.67 |
Rate for Payer: IEHP Medi-Cal |
$5,562.80
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,251.67
|
|
EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT
|
Facility
IP
|
$24,950.80
|
|
Service Code
|
APR-DRG 8411
|
Min. Negotiated Rate |
$19,139.89 |
Max. Negotiated Rate |
$24,950.80 |
Rate for Payer: IEHP Medi-Cal |
$19,139.89
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24,950.80
|
|
EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT
|
Facility
IP
|
$28,400.19
|
|
Service Code
|
APR-DRG 8412
|
Min. Negotiated Rate |
$21,785.94 |
Max. Negotiated Rate |
$28,400.19 |
Rate for Payer: IEHP Medi-Cal |
$21,785.94
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28,400.19
|
|
EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT
|
Facility
IP
|
$97,011.82
|
|
Service Code
|
APR-DRG 8413
|
Min. Negotiated Rate |
$74,418.27 |
Max. Negotiated Rate |
$97,011.82 |
Rate for Payer: IEHP Medi-Cal |
$74,418.27
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97,011.82
|
|
EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT
|
Facility
IP
|
$264,344.85
|
|
Service Code
|
APR-DRG 8414
|
Min. Negotiated Rate |
$202,780.33 |
Max. Negotiated Rate |
$264,344.85 |
Rate for Payer: IEHP Medi-Cal |
$202,780.33
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264,344.85
|
|
EXTERNAL HEART ASSIST SYSTEMS
|
Facility
IP
|
$126,360.79
|
|
Service Code
|
APR-DRG 1784
|
Min. Negotiated Rate |
$96,932.03 |
Max. Negotiated Rate |
$126,360.79 |
Rate for Payer: IEHP Medi-Cal |
$96,932.03
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126,360.79
|
|
EXTERNAL HEART ASSIST SYSTEMS
|
Facility
IP
|
$77,681.10
|
|
Service Code
|
APR-DRG 1781
|
Min. Negotiated Rate |
$59,589.58 |
Max. Negotiated Rate |
$77,681.10 |
Rate for Payer: IEHP Medi-Cal |
$59,589.58
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77,681.10
|
|
EXTERNAL HEART ASSIST SYSTEMS
|
Facility
IP
|
$87,094.61
|
|
Service Code
|
APR-DRG 1782
|
Min. Negotiated Rate |
$66,810.74 |
Max. Negotiated Rate |
$87,094.61 |
Rate for Payer: IEHP Medi-Cal |
$66,810.74
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87,094.61
|
|
EXTERNAL HEART ASSIST SYSTEMS
|
Facility
IP
|
$93,480.86
|
|
Service Code
|
APR-DRG 1783
|
Min. Negotiated Rate |
$71,709.66 |
Max. Negotiated Rate |
$93,480.86 |
Rate for Payer: IEHP Medi-Cal |
$71,709.66
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93,480.86
|
|
EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)
|
Facility
IP
|
$105,992.60
|
|
Service Code
|
APR-DRG 0093
|
Min. Negotiated Rate |
$81,307.48 |
Max. Negotiated Rate |
$105,992.60 |
Rate for Payer: IEHP Medi-Cal |
$81,307.48
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105,992.60
|
|
EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)
|
Facility
IP
|
$63,445.54
|
|
Service Code
|
APR-DRG 0091
|
Min. Negotiated Rate |
$48,669.41 |
Max. Negotiated Rate |
$63,445.54 |
Rate for Payer: IEHP Medi-Cal |
$48,669.41
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63,445.54
|
|
EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)
|
Facility
IP
|
$229,973.44
|
|
Service Code
|
APR-DRG 0094
|
Min. Negotiated Rate |
$176,413.83 |
Max. Negotiated Rate |
$229,973.44 |
Rate for Payer: IEHP Medi-Cal |
$176,413.83
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229,973.44
|
|
EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)
|
Facility
IP
|
$77,306.90
|
|
Service Code
|
APR-DRG 0092
|
Min. Negotiated Rate |
$59,302.53 |
Max. Negotiated Rate |
$77,306.90 |
Rate for Payer: IEHP Medi-Cal |
$59,302.53
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77,306.90
|
|
EYE INFECTIONS AND OTHER EYE DISORDERS
|
Facility
IP
|
$30,021.14
|
|
Service Code
|
APR-DRG 0824
|
Min. Negotiated Rate |
$23,029.37 |
Max. Negotiated Rate |
$30,021.14 |
Rate for Payer: IEHP Medi-Cal |
$23,029.37
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,021.14
|
|
EYE INFECTIONS AND OTHER EYE DISORDERS
|
Facility
IP
|
$10,440.37
|
|
Service Code
|
APR-DRG 0822
|
Min. Negotiated Rate |
$8,008.86 |
Max. Negotiated Rate |
$10,440.37 |
Rate for Payer: IEHP Medi-Cal |
$8,008.86
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,440.37
|
|
EYE INFECTIONS AND OTHER EYE DISORDERS
|
Facility
IP
|
$8,496.65
|
|
Service Code
|
APR-DRG 0821
|
Min. Negotiated Rate |
$6,517.82 |
Max. Negotiated Rate |
$8,496.65 |
Rate for Payer: IEHP Medi-Cal |
$6,517.82
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,496.65
|
|
EYE INFECTIONS AND OTHER EYE DISORDERS
|
Facility
IP
|
$15,195.00
|
|
Service Code
|
APR-DRG 0823
|
Min. Negotiated Rate |
$11,656.17 |
Max. Negotiated Rate |
$15,195.00 |
Rate for Payer: IEHP Medi-Cal |
$11,656.17
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,195.00
|
|
EZETIMIBE 10 MG-SIMVASTATIN 20 MG TABLET [39221]
|
Facility
IP
|
$13.67
|
|
Service Code
|
NDC 66582-312-31
|
Hospital Charge Code |
1710951
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$3.28 |
Max. Negotiated Rate |
$11.62 |
Rate for Payer: Blue Shield of California Commercial |
$9.73
|
Rate for Payer: Blue Shield of California EPN |
$7.00
|
Rate for Payer: Cash Price |
$6.15
|
Rate for Payer: Cigna of CA HMO |
$9.57
|
Rate for Payer: Cigna of CA PPO |
$9.57
|
Rate for Payer: EPIC Health Plan Commercial |
$5.47
|
Rate for Payer: Galaxy Health WC |
$11.62
|
Rate for Payer: Global Benefits Group Commercial |
$8.20
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.12
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.21
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.28
|
Rate for Payer: Multiplan Commercial |
$10.94
|
Rate for Payer: Networks By Design Commercial |
$8.89
|
Rate for Payer: Prime Health Services Commercial |
$11.62
|
|
EZETIMIBE 10 MG-SIMVASTATIN 20 MG TABLET [39221]
|
Facility
OP
|
$13.67
|
|
Service Code
|
NDC 66582-312-31
|
Hospital Charge Code |
1710951
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$3.28 |
Max. Negotiated Rate |
$11.62 |
Rate for Payer: Aetna of CA HMO/PPO |
$8.97
|
Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.62
|
Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.52
|
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.52
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.14
|
Rate for Payer: BCBS Transplant Transplant |
$8.20
|
Rate for Payer: Blue Shield of California Commercial |
$10.07
|
Rate for Payer: Blue Shield of California EPN |
$7.98
|
Rate for Payer: Cash Price |
$6.15
|
Rate for Payer: Cigna of CA HMO |
$9.57
|
Rate for Payer: Cigna of CA PPO |
$9.57
|
Rate for Payer: Dignity Health Commercial/Exchange |
$11.62
|
Rate for Payer: Dignity Health Media |
$11.62
|
Rate for Payer: Dignity Health Medi-Cal |
$11.62
|
Rate for Payer: EPIC Health Plan Commercial |
$5.47
|
Rate for Payer: EPIC Health Plan Transplant |
$5.47
|
Rate for Payer: Galaxy Health WC |
$11.62
|
Rate for Payer: Global Benefits Group Commercial |
$8.20
|
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.25
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.12
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.21
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.28
|
Rate for Payer: Multiplan Commercial |
$10.94
|
Rate for Payer: Networks By Design Commercial |
$8.89
|
Rate for Payer: Prime Health Services Commercial |
$11.62
|
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.20
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.20
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.20
|
Rate for Payer: United Healthcare All Other Commercial |
$6.84
|
Rate for Payer: United Healthcare All Other HMO |
$6.84
|
Rate for Payer: United Healthcare HMO Rider |
$6.84
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$6.84
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.62
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$11.62
|
Rate for Payer: Vantage Medical Group Senior |
$11.62
|
|