|
HC XR RIBS UNI & PA CHEST
|
Facility
OP
|
$1,026.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
950463101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.41 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$167.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.73
|
| Rate for Payer: BCBS Transplant Transplant |
$615.60
|
| Rate for Payer: Blue Shield of California Commercial |
$606.37
|
| Rate for Payer: Blue Shield of California EPN |
$481.19
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna of CA HMO |
$656.64
|
| Rate for Payer: Cigna of CA PPO |
$759.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$872.10
|
| Rate for Payer: Global Benefits Group Commercial |
$615.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$769.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$684.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$820.80
|
| Rate for Payer: Networks By Design Commercial |
$666.90
|
| Rate for Payer: Prime Health Services Commercial |
$872.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$615.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$615.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$615.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC XR RIBS UNI & PA CHEST
|
Facility
IP
|
$1,026.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
950463101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$246.24 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.40
|
| Rate for Payer: Galaxy Health WC |
$872.10
|
| Rate for Payer: Global Benefits Group Commercial |
$615.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$684.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$390.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.24
|
| Rate for Payer: Multiplan Commercial |
$820.80
|
| Rate for Payer: Networks By Design Commercial |
$666.90
|
| Rate for Payer: Prime Health Services Commercial |
$872.10
|
|
|
HC XR RIBS W PA CXR
|
Facility
IP
|
$1,306.00
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
950463102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.44 |
| Max. Negotiated Rate |
$1,110.10 |
| Rate for Payer: Cash Price |
$587.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$522.40
|
| Rate for Payer: Galaxy Health WC |
$1,110.10
|
| Rate for Payer: Global Benefits Group Commercial |
$783.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$871.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.44
|
| Rate for Payer: Multiplan Commercial |
$1,044.80
|
| Rate for Payer: Networks By Design Commercial |
$848.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,110.10
|
|
|
HC XR RIBS W PA CXR
|
Facility
OP
|
$1,306.00
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
950463102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$80.56 |
| Max. Negotiated Rate |
$1,110.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$237.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.72
|
| Rate for Payer: BCBS Transplant Transplant |
$783.60
|
| Rate for Payer: Blue Shield of California Commercial |
$771.85
|
| Rate for Payer: Blue Shield of California EPN |
$612.51
|
| Rate for Payer: Cash Price |
$587.70
|
| Rate for Payer: Cash Price |
$587.70
|
| Rate for Payer: Cigna of CA HMO |
$835.84
|
| Rate for Payer: Cigna of CA PPO |
$966.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,110.10
|
| Rate for Payer: Global Benefits Group Commercial |
$783.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$979.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$871.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,044.80
|
| Rate for Payer: Networks By Design Commercial |
$848.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,110.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$783.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$783.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$783.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC XR TEMP MANDIBULAR BILAT
|
Facility
IP
|
$941.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
909020170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.84 |
| Max. Negotiated Rate |
$799.85 |
| Rate for Payer: Cash Price |
$423.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.40
|
| Rate for Payer: Galaxy Health WC |
$799.85
|
| Rate for Payer: Global Benefits Group Commercial |
$564.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$627.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.84
|
| Rate for Payer: Multiplan Commercial |
$752.80
|
| Rate for Payer: Networks By Design Commercial |
$611.65
|
| Rate for Payer: Prime Health Services Commercial |
$799.85
|
|
|
HC XR TEMP MANDIBULAR BILAT
|
Facility
OP
|
$941.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
909020170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.37 |
| Max. Negotiated Rate |
$799.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$230.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.12
|
| Rate for Payer: BCBS Transplant Transplant |
$564.60
|
| Rate for Payer: Blue Shield of California Commercial |
$556.13
|
| Rate for Payer: Blue Shield of California EPN |
$441.33
|
| Rate for Payer: Cash Price |
$423.45
|
| Rate for Payer: Cash Price |
$423.45
|
| Rate for Payer: Cigna of CA HMO |
$602.24
|
| Rate for Payer: Cigna of CA PPO |
$696.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$799.85
|
| Rate for Payer: Global Benefits Group Commercial |
$564.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$705.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: IEHP Medi-Cal |
$183.93
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$183.93
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$627.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$752.80
|
| Rate for Payer: Networks By Design Commercial |
$611.65
|
| Rate for Payer: Prime Health Services Commercial |
$799.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$564.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$564.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$564.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC XYLOSE TOLERANCE BLD
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 84620
|
| Hospital Charge Code |
900910321
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$108.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$98.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.04
|
| Rate for Payer: BCBS Transplant Transplant |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$29.07
|
| Rate for Payer: Blue Shield of California EPN |
$23.04
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.36
|
| Rate for Payer: Dignity Health Media |
$12.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.91
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$33.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.17
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.17
|
| Rate for Payer: IEHP Medi-Cal |
$20.91
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$20.91
|
| Rate for Payer: IEHP Medicare Advantage |
$12.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.30
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.46
|
| Rate for Payer: United Healthcare All Other HMO |
$10.46
|
| Rate for Payer: United Healthcare HMO Rider |
$10.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.91
|
|
|
HC Y-90 ZEVALIN UP TO 40 MCI
|
Facility
IP
|
$89,048.00
|
|
|
Service Code
|
CPT A9543
|
| Hospital Charge Code |
909301343
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$21,371.52 |
| Max. Negotiated Rate |
$75,690.80 |
| Rate for Payer: Blue Shield of California Commercial |
$63,402.18
|
| Rate for Payer: Blue Shield of California EPN |
$45,592.58
|
| Rate for Payer: Cash Price |
$40,071.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,619.20
|
| Rate for Payer: Galaxy Health WC |
$75,690.80
|
| Rate for Payer: Global Benefits Group Commercial |
$53,428.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59,395.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33,927.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,371.52
|
| Rate for Payer: Multiplan Commercial |
$71,238.40
|
| Rate for Payer: Networks By Design Commercial |
$57,881.20
|
| Rate for Payer: Prime Health Services Commercial |
$75,690.80
|
|
|
HC Y-90 ZEVALIN UP TO 40 MCI
|
Facility
OP
|
$89,048.00
|
|
|
Service Code
|
CPT A9543
|
| Hospital Charge Code |
909301343
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$21,371.52 |
| Max. Negotiated Rate |
$427,722.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$427,722.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$98,214.87
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$72,024.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$65,476.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118,458.81
|
| Rate for Payer: BCBS Transplant Transplant |
$53,428.80
|
| Rate for Payer: Blue Shield of California Commercial |
$52,627.37
|
| Rate for Payer: Blue Shield of California EPN |
$41,763.51
|
| Rate for Payer: Cash Price |
$40,071.60
|
| Rate for Payer: Cash Price |
$40,071.60
|
| Rate for Payer: Cigna of CA HMO |
$56,990.72
|
| Rate for Payer: Cigna of CA PPO |
$65,895.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98,214.87
|
| Rate for Payer: Dignity Health Media |
$65,476.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$72,024.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$88,393.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$65,476.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$65,476.58
|
| Rate for Payer: Galaxy Health WC |
$75,690.80
|
| Rate for Payer: Global Benefits Group Commercial |
$53,428.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$66,786.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$107,381.59
|
| Rate for Payer: Heritage Provider Network Transplant |
$107,381.59
|
| Rate for Payer: IEHP Medi-Cal |
$106,072.06
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$106,072.06
|
| Rate for Payer: IEHP Medicare Advantage |
$65,476.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59,395.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117,372.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65,476.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21,371.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$82,500.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87,738.62
|
| Rate for Payer: Multiplan Commercial |
$71,238.40
|
| Rate for Payer: Networks By Design Commercial |
$57,881.20
|
| Rate for Payer: Prime Health Services Commercial |
$75,690.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$53,428.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53,428.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53,428.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$44,524.00
|
| Rate for Payer: United Healthcare All Other HMO |
$44,524.00
|
| Rate for Payer: United Healthcare HMO Rider |
$44,524.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44,524.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98,214.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72,024.24
|
| Rate for Payer: Vantage Medical Group Senior |
$65,476.58
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
IP
|
$9,833.83
|
|
|
Service Code
|
APR-DRG 0551
|
| Min. Negotiated Rate |
$7,543.58 |
| Max. Negotiated Rate |
$9,833.83 |
| Rate for Payer: IEHP Medi-Cal |
$7,543.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,833.83
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
IP
|
$13,852.50
|
|
|
Service Code
|
APR-DRG 0552
|
| Min. Negotiated Rate |
$10,626.33 |
| Max. Negotiated Rate |
$13,852.50 |
| Rate for Payer: IEHP Medi-Cal |
$10,626.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,852.50
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
IP
|
$20,758.36
|
|
|
Service Code
|
APR-DRG 0553
|
| Min. Negotiated Rate |
$15,923.84 |
| Max. Negotiated Rate |
$20,758.36 |
| Rate for Payer: IEHP Medi-Cal |
$15,923.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20,758.36
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
IP
|
$36,676.94
|
|
|
Service Code
|
APR-DRG 0554
|
| Min. Negotiated Rate |
$28,135.07 |
| Max. Negotiated Rate |
$36,676.94 |
| Rate for Payer: IEHP Medi-Cal |
$28,135.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36,676.94
|
|
|
HEART AND/OR LUNG TRANSPLANT
|
Facility
IP
|
$142,311.29
|
|
|
Service Code
|
APR-DRG 0021
|
| Min. Negotiated Rate |
$74,900.68 |
| Max. Negotiated Rate |
$142,311.29 |
| Rate for Payer: IEHP Medi-Cal |
$109,167.74
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$74,900.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142,311.29
|
|
|
HEART AND/OR LUNG TRANSPLANT
|
Facility
IP
|
$361,741.51
|
|
|
Service Code
|
APR-DRG 0024
|
| Min. Negotiated Rate |
$190,390.27 |
| Max. Negotiated Rate |
$361,741.51 |
| Rate for Payer: IEHP Medi-Cal |
$277,493.82
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$190,390.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361,741.51
|
|
|
HEART AND/OR LUNG TRANSPLANT
|
Facility
IP
|
$223,695.38
|
|
|
Service Code
|
APR-DRG 0023
|
| Min. Negotiated Rate |
$117,734.41 |
| Max. Negotiated Rate |
$223,695.38 |
| Rate for Payer: IEHP Medi-Cal |
$171,597.90
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$117,734.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223,695.38
|
|
|
HEART AND/OR LUNG TRANSPLANT
|
Facility
IP
|
$166,006.50
|
|
|
Service Code
|
APR-DRG 0022
|
| Min. Negotiated Rate |
$87,371.84 |
| Max. Negotiated Rate |
$166,006.50 |
| Rate for Payer: IEHP Medi-Cal |
$127,344.46
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$87,371.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166,006.50
|
|
|
Heart Assist Device - #2629
|
Facility
IP
|
$13,250.00
|
|
|
Service Code
|
ICD XRG2092
|
| Min. Negotiated Rate |
$13,250.00 |
| Max. Negotiated Rate |
$13,250.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,250.00
|
|
|
Heart Assist Device - #2629
|
Facility
IP
|
$13,250.00
|
|
|
Service Code
|
ICD XRG8092
|
| Min. Negotiated Rate |
$13,250.00 |
| Max. Negotiated Rate |
$13,250.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,250.00
|
|
|
Heart Assist Device - #2629
|
Facility
IP
|
$13,250.00
|
|
|
Service Code
|
ICD XRG6092
|
| Min. Negotiated Rate |
$13,250.00 |
| Max. Negotiated Rate |
$13,250.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,250.00
|
|
|
Heart Assist Device - #2629
|
Facility
IP
|
$13,250.00
|
|
|
Service Code
|
ICD 3E0U0GB
|
| Min. Negotiated Rate |
$13,250.00 |
| Max. Negotiated Rate |
$13,250.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,250.00
|
|
|
Heart Assist Device - #2629
|
Facility
IP
|
$13,250.00
|
|
|
Service Code
|
ICD XRGD092
|
| Min. Negotiated Rate |
$13,250.00 |
| Max. Negotiated Rate |
$13,250.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,250.00
|
|
|
Heart Assist Device - #2629
|
Facility
IP
|
$13,250.00
|
|
|
Service Code
|
ICD XRGC092
|
| Min. Negotiated Rate |
$13,250.00 |
| Max. Negotiated Rate |
$13,250.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,250.00
|
|
|
Heart Assist Device - #2629
|
Facility
IP
|
$13,250.00
|
|
|
Service Code
|
ICD XRGB092
|
| Min. Negotiated Rate |
$13,250.00 |
| Max. Negotiated Rate |
$13,250.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,250.00
|
|
|
Heart Assist Device - #2629
|
Facility
IP
|
$13,250.00
|
|
|
Service Code
|
ICD 0RGA0AJ
|
| Min. Negotiated Rate |
$13,250.00 |
| Max. Negotiated Rate |
$13,250.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,250.00
|
|
