|
INFECTIONS OF UPPER RESPIRATORY TRACT
|
Facility
IP
|
$7,627.64
|
|
|
Service Code
|
APR-DRG 1132
|
| Min. Negotiated Rate |
$5,851.21 |
| Max. Negotiated Rate |
$7,627.64 |
| Rate for Payer: IEHP Medi-Cal |
$5,851.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,627.64
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
IP
|
$16,099.48
|
|
|
Service Code
|
APR-DRG 7101
|
| Min. Negotiated Rate |
$12,350.00 |
| Max. Negotiated Rate |
$16,099.48 |
| Rate for Payer: IEHP Medi-Cal |
$12,350.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,099.48
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
IP
|
$38,157.76
|
|
|
Service Code
|
APR-DRG 7103
|
| Min. Negotiated Rate |
$29,271.02 |
| Max. Negotiated Rate |
$38,157.76 |
| Rate for Payer: IEHP Medi-Cal |
$29,271.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38,157.76
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
IP
|
$23,289.08
|
|
|
Service Code
|
APR-DRG 7102
|
| Min. Negotiated Rate |
$17,865.18 |
| Max. Negotiated Rate |
$23,289.08 |
| Rate for Payer: IEHP Medi-Cal |
$17,865.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,289.08
|
|
|
INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE
|
Facility
IP
|
$70,372.68
|
|
|
Service Code
|
APR-DRG 7104
|
| Min. Negotiated Rate |
$53,983.25 |
| Max. Negotiated Rate |
$70,372.68 |
| Rate for Payer: IEHP Medi-Cal |
$53,983.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70,372.68
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
IP
|
$8,794.59
|
|
|
Service Code
|
APR-DRG 2451
|
| Min. Negotiated Rate |
$6,746.37 |
| Max. Negotiated Rate |
$8,794.59 |
| Rate for Payer: IEHP Medi-Cal |
$6,746.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,794.59
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
IP
|
$28,118.21
|
|
|
Service Code
|
APR-DRG 2454
|
| Min. Negotiated Rate |
$21,569.63 |
| Max. Negotiated Rate |
$28,118.21 |
| Rate for Payer: IEHP Medi-Cal |
$21,569.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28,118.21
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
IP
|
$16,092.37
|
|
|
Service Code
|
APR-DRG 2453
|
| Min. Negotiated Rate |
$12,344.54 |
| Max. Negotiated Rate |
$16,092.37 |
| Rate for Payer: IEHP Medi-Cal |
$12,344.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,092.37
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
IP
|
$11,217.14
|
|
|
Service Code
|
APR-DRG 2452
|
| Min. Negotiated Rate |
$8,604.73 |
| Max. Negotiated Rate |
$11,217.14 |
| Rate for Payer: IEHP Medi-Cal |
$8,604.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,217.14
|
|
|
INFLIXIMAB 100 MG INTRAVENOUS SOLUTION [23796]
|
Facility
IP
|
$570.00
|
|
|
Service Code
|
CPT J1745
|
| Hospital Charge Code |
1757347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Blue Shield of California Commercial |
$405.84
|
| Rate for Payer: Blue Shield of California EPN |
$291.84
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$217.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
|
|
INFLIXIMAB 100 MG INTRAVENOUS SOLUTION [23796]
|
Facility
OP
|
$570.00
|
|
|
Service Code
|
CPT J1745
|
| Hospital Charge Code |
1757347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$202.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$35.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.69
|
| Rate for Payer: BCBS Transplant Transplant |
$342.00
|
| Rate for Payer: Blue Shield of California Commercial |
$420.09
|
| Rate for Payer: Blue Shield of California EPN |
$140.14
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.24
|
| Rate for Payer: Dignity Health Media |
$32.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$32.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.16
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$427.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$52.74
|
| Rate for Payer: IEHP Medi-Cal |
$52.10
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$52.10
|
| Rate for Payer: IEHP Medicare Advantage |
$32.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.10
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$342.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$342.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$285.00
|
| Rate for Payer: United Healthcare All Other HMO |
$285.00
|
| Rate for Payer: United Healthcare HMO Rider |
$285.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.38
|
| Rate for Payer: Vantage Medical Group Senior |
$32.16
|
|
|
INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION [219233]
|
Facility
IP
|
$904.07
|
|
|
Service Code
|
NDC 78206-162-99
|
| Hospital Charge Code |
ERX219233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$216.98 |
| Max. Negotiated Rate |
$768.46 |
| Rate for Payer: Blue Shield of California Commercial |
$643.70
|
| Rate for Payer: Blue Shield of California EPN |
$462.88
|
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Cigna of CA HMO |
$632.85
|
| Rate for Payer: Cigna of CA PPO |
$632.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$361.63
|
| Rate for Payer: Galaxy Health WC |
$768.46
|
| Rate for Payer: Global Benefits Group Commercial |
$542.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$603.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.98
|
| Rate for Payer: Multiplan Commercial |
$723.26
|
| Rate for Payer: Networks By Design Commercial |
$452.04
|
| Rate for Payer: Prime Health Services Commercial |
$768.46
|
|
|
INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION [219233]
|
Facility
IP
|
$904.07
|
|
|
Service Code
|
NDC 78206-162-01
|
| Hospital Charge Code |
ERX219233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$216.98 |
| Max. Negotiated Rate |
$768.46 |
| Rate for Payer: Blue Shield of California Commercial |
$643.70
|
| Rate for Payer: Blue Shield of California EPN |
$462.88
|
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Cigna of CA HMO |
$632.85
|
| Rate for Payer: Cigna of CA PPO |
$632.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$361.63
|
| Rate for Payer: Galaxy Health WC |
$768.46
|
| Rate for Payer: Global Benefits Group Commercial |
$542.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$603.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.98
|
| Rate for Payer: Multiplan Commercial |
$723.26
|
| Rate for Payer: Networks By Design Commercial |
$452.04
|
| Rate for Payer: Prime Health Services Commercial |
$768.46
|
|
|
INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION [219233]
|
Facility
OP
|
$904.07
|
|
|
Service Code
|
NDC 78206-162-99
|
| Hospital Charge Code |
ERX219233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$216.98 |
| Max. Negotiated Rate |
$768.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$592.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$768.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$497.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$497.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$538.64
|
| Rate for Payer: BCBS Transplant Transplant |
$542.44
|
| Rate for Payer: Blue Shield of California Commercial |
$666.30
|
| Rate for Payer: Blue Shield of California EPN |
$527.98
|
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Cigna of CA HMO |
$632.85
|
| Rate for Payer: Cigna of CA PPO |
$632.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$768.46
|
| Rate for Payer: Dignity Health Media |
$768.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$361.63
|
| Rate for Payer: Galaxy Health WC |
$768.46
|
| Rate for Payer: Global Benefits Group Commercial |
$542.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$678.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$603.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.98
|
| Rate for Payer: Multiplan Commercial |
$723.26
|
| Rate for Payer: Networks By Design Commercial |
$452.04
|
| Rate for Payer: Prime Health Services Commercial |
$768.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$542.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$542.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$452.04
|
| Rate for Payer: United Healthcare All Other HMO |
$452.04
|
| Rate for Payer: United Healthcare HMO Rider |
$452.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$452.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$768.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.46
|
| Rate for Payer: Vantage Medical Group Senior |
$768.46
|
|
|
INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION [219233]
|
Facility
OP
|
$904.07
|
|
|
Service Code
|
NDC 78206-162-01
|
| Hospital Charge Code |
ERX219233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$216.98 |
| Max. Negotiated Rate |
$768.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$592.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$768.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$497.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$497.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$538.64
|
| Rate for Payer: BCBS Transplant Transplant |
$542.44
|
| Rate for Payer: Blue Shield of California Commercial |
$666.30
|
| Rate for Payer: Blue Shield of California EPN |
$527.98
|
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Cigna of CA HMO |
$632.85
|
| Rate for Payer: Cigna of CA PPO |
$632.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$768.46
|
| Rate for Payer: Dignity Health Media |
$768.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$361.63
|
| Rate for Payer: Galaxy Health WC |
$768.46
|
| Rate for Payer: Global Benefits Group Commercial |
$542.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$678.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$603.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.98
|
| Rate for Payer: Multiplan Commercial |
$723.26
|
| Rate for Payer: Networks By Design Commercial |
$452.04
|
| Rate for Payer: Prime Health Services Commercial |
$768.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$542.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$542.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$452.04
|
| Rate for Payer: United Healthcare All Other HMO |
$452.04
|
| Rate for Payer: United Healthcare HMO Rider |
$452.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$452.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$768.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.46
|
| Rate for Payer: Vantage Medical Group Senior |
$768.46
|
|
|
INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION [216056]
|
Facility
IP
|
$1,135.54
|
|
|
Service Code
|
NDC 0069-0809-01
|
| Hospital Charge Code |
ERX216056
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$272.53 |
| Max. Negotiated Rate |
$965.21 |
| Rate for Payer: Blue Shield of California Commercial |
$808.50
|
| Rate for Payer: Blue Shield of California EPN |
$581.40
|
| Rate for Payer: Cash Price |
$510.99
|
| Rate for Payer: Cigna of CA HMO |
$794.88
|
| Rate for Payer: Cigna of CA PPO |
$794.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$454.22
|
| Rate for Payer: Galaxy Health WC |
$965.21
|
| Rate for Payer: Global Benefits Group Commercial |
$681.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$757.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.53
|
| Rate for Payer: Multiplan Commercial |
$908.43
|
| Rate for Payer: Networks By Design Commercial |
$567.77
|
| Rate for Payer: Prime Health Services Commercial |
$965.21
|
|
|
INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION [216056]
|
Facility
OP
|
$1,135.54
|
|
|
Service Code
|
NDC 0069-0809-01
|
| Hospital Charge Code |
ERX216056
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$272.53 |
| Max. Negotiated Rate |
$965.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$744.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$965.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$624.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$624.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$676.55
|
| Rate for Payer: BCBS Transplant Transplant |
$681.32
|
| Rate for Payer: Blue Shield of California Commercial |
$836.89
|
| Rate for Payer: Blue Shield of California EPN |
$663.16
|
| Rate for Payer: Cash Price |
$510.99
|
| Rate for Payer: Cash Price |
$510.99
|
| Rate for Payer: Cigna of CA HMO |
$794.88
|
| Rate for Payer: Cigna of CA PPO |
$794.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$965.21
|
| Rate for Payer: Dignity Health Media |
$965.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$965.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$454.22
|
| Rate for Payer: Galaxy Health WC |
$965.21
|
| Rate for Payer: Global Benefits Group Commercial |
$681.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$851.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$757.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.53
|
| Rate for Payer: Multiplan Commercial |
$908.43
|
| Rate for Payer: Networks By Design Commercial |
$567.77
|
| Rate for Payer: Prime Health Services Commercial |
$965.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$681.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$681.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$567.77
|
| Rate for Payer: United Healthcare All Other HMO |
$567.77
|
| Rate for Payer: United Healthcare HMO Rider |
$567.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$567.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$965.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$965.21
|
| Rate for Payer: Vantage Medical Group Senior |
$965.21
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
IP
|
$24,833.76
|
|
|
Service Code
|
APR-DRG 2283
|
| Min. Negotiated Rate |
$19,050.11 |
| Max. Negotiated Rate |
$24,833.76 |
| Rate for Payer: IEHP Medi-Cal |
$19,050.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24,833.76
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
IP
|
$18,236.48
|
|
|
Service Code
|
APR-DRG 2282
|
| Min. Negotiated Rate |
$13,989.30 |
| Max. Negotiated Rate |
$18,236.48 |
| Rate for Payer: IEHP Medi-Cal |
$13,989.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,236.48
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
IP
|
$42,722.66
|
|
|
Service Code
|
APR-DRG 2284
|
| Min. Negotiated Rate |
$32,772.78 |
| Max. Negotiated Rate |
$42,722.66 |
| Rate for Payer: IEHP Medi-Cal |
$32,772.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42,722.66
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
IP
|
$14,141.57
|
|
|
Service Code
|
APR-DRG 2281
|
| Min. Negotiated Rate |
$10,848.07 |
| Max. Negotiated Rate |
$14,141.57 |
| Rate for Payer: IEHP Medi-Cal |
$10,848.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,141.57
|
|
|
Injection procedure for elbow arthrography
|
Facility
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 24220
|
| Min. Negotiated Rate |
$388.34 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.34
|
|
|
Injection(s), anesthetic agent(s) and/or steroid; femoral nerve, including imaging guidance, when performed
|
Facility
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 64447
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$394.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,417.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,417.03
|
| Rate for Payer: IEHP Medi-Cal |
$1,399.74
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,399.74
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch
|
Facility
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 64450
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,417.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,417.03
|
| Rate for Payer: IEHP Medi-Cal |
$1,399.74
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,399.74
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve, including imaging guidance, when performed
|
Facility
OP
|
$4,984.00
|
|
|
Service Code
|
CPT 64445
|
| Min. Negotiated Rate |
$149.26 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,417.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,417.03
|
| Rate for Payer: IEHP Medi-Cal |
$1,399.74
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,399.74
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
