|
INPATIENT MS-DRG 958: OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC
|
Facility
IP
|
$122,622.16
|
|
|
Service Code
|
MS-DRG 958
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$122,622.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$122,622.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$79,324.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$58,759.19
|
| Rate for Payer: IEHP Medicare Advantage |
$58,759.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58,759.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74,036.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78,737.31
|
| Rate for Payer: Multiplan WC |
$85,647.37
|
| Rate for Payer: Prime Health Services WC |
$84,773.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 959: OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC
|
Facility
IP
|
$76,772.24
|
|
|
Service Code
|
MS-DRG 959
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$76,772.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76,772.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$56,686.03
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$41,989.65
|
| Rate for Payer: IEHP Medicare Advantage |
$41,989.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41,989.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52,906.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56,266.13
|
| Rate for Payer: Multiplan WC |
$52,752.05
|
| Rate for Payer: Prime Health Services WC |
$52,213.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 963: OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC
|
Facility
IP
|
$82,893.04
|
|
|
Service Code
|
MS-DRG 963
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$82,893.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$82,893.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$59,708.25
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$44,228.33
|
| Rate for Payer: IEHP Medicare Advantage |
$44,228.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44,228.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55,727.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59,265.96
|
| Rate for Payer: Multiplan WC |
$56,951.76
|
| Rate for Payer: Prime Health Services WC |
$56,370.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 964: OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC
|
Facility
IP
|
$45,504.32
|
|
|
Service Code
|
MS-DRG 964
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$45,504.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45,504.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,247.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30,553.47
|
| Rate for Payer: IEHP Medicare Advantage |
$30,553.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,553.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38,497.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40,941.65
|
| Rate for Payer: Multiplan WC |
$30,075.67
|
| Rate for Payer: Prime Health Services WC |
$29,768.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 965: OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC
|
Facility
IP
|
$33,087.66
|
|
|
Service Code
|
MS-DRG 965
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$33,087.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28,979.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,087.66
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24,509.38
|
| Rate for Payer: IEHP Medicare Advantage |
$24,509.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,509.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,881.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,842.57
|
| Rate for Payer: Multiplan WC |
$18,686.14
|
| Rate for Payer: Prime Health Services WC |
$18,495.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 969: HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC
|
Facility
IP
|
$208,349.74
|
|
|
Service Code
|
MS-DRG 969
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$208,349.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$208,349.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$121,653.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$90,113.90
|
| Rate for Payer: IEHP Medicare Advantage |
$90,113.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90,113.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113,543.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$120,752.63
|
| Rate for Payer: Multiplan WC |
$148,840.17
|
| Rate for Payer: Prime Health Services WC |
$147,321.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 970: HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC
|
Facility
IP
|
$72,891.79
|
|
|
Service Code
|
MS-DRG 970
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$72,891.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$72,891.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$60,386.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$44,730.62
|
| Rate for Payer: IEHP Medicare Advantage |
$44,730.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44,730.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56,360.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59,939.03
|
| Rate for Payer: Multiplan WC |
$63,424.86
|
| Rate for Payer: Prime Health Services WC |
$62,777.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 974: HIV WITH MAJOR RELATED CONDITION WITH MCC
|
Facility
IP
|
$88,416.61
|
|
|
Service Code
|
MS-DRG 974
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$88,416.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$88,416.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$62,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$46,248.57
|
| Rate for Payer: IEHP Medicare Advantage |
$46,248.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46,248.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58,273.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61,973.08
|
| Rate for Payer: Multiplan WC |
$59,001.29
|
| Rate for Payer: Prime Health Services WC |
$58,399.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 975: HIV WITH MAJOR RELATED CONDITION WITH CC
|
Facility
IP
|
$41,329.80
|
|
|
Service Code
|
MS-DRG 975
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$41,329.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41,329.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$39,185.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29,026.64
|
| Rate for Payer: IEHP Medicare Advantage |
$29,026.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,026.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,573.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,895.70
|
| Rate for Payer: Multiplan WC |
$28,252.03
|
| Rate for Payer: Prime Health Services WC |
$27,963.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 976: HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC
|
Facility
IP
|
$31,432.13
|
|
|
Service Code
|
MS-DRG 976
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$31,432.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,626.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,432.13
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,283.06
|
| Rate for Payer: IEHP Medicare Advantage |
$23,283.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,283.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,336.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,199.30
|
| Rate for Payer: Multiplan WC |
$18,951.06
|
| Rate for Payer: Prime Health Services WC |
$18,757.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 977: HIV WITH OR WITHOUT OTHER RELATED CONDITION
|
Facility
IP
|
$42,930.49
|
|
|
Service Code
|
MS-DRG 977
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$42,930.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42,930.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$39,976.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29,612.09
|
| Rate for Payer: IEHP Medicare Advantage |
$29,612.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,612.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37,311.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39,680.20
|
| Rate for Payer: Multiplan WC |
$26,695.37
|
| Rate for Payer: Prime Health Services WC |
$26,422.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 981: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC
|
Facility
IP
|
$143,709.97
|
|
|
Service Code
|
MS-DRG 981
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$143,709.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$143,709.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$89,737.23
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$66,472.02
|
| Rate for Payer: IEHP Medicare Advantage |
$66,472.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66,472.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83,754.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89,072.51
|
| Rate for Payer: Multiplan WC |
$94,065.28
|
| Rate for Payer: Prime Health Services WC |
$93,105.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 982: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC
|
Facility
IP
|
$75,365.58
|
|
|
Service Code
|
MS-DRG 982
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$75,365.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$75,365.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$55,991.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$41,475.17
|
| Rate for Payer: IEHP Medicare Advantage |
$41,475.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41,475.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52,258.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55,576.73
|
| Rate for Payer: Multiplan WC |
$51,509.59
|
| Rate for Payer: Prime Health Services WC |
$50,983.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 983: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC
|
Facility
IP
|
$49,572.72
|
|
|
Service Code
|
MS-DRG 983
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$49,572.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49,572.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$43,256.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$32,041.48
|
| Rate for Payer: IEHP Medicare Advantage |
$32,041.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,041.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40,372.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42,935.58
|
| Rate for Payer: Multiplan WC |
$34,300.02
|
| Rate for Payer: Prime Health Services WC |
$33,950.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 987: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC
|
Facility
IP
|
$102,368.04
|
|
|
Service Code
|
MS-DRG 987
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$102,368.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$102,368.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$69,324.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$51,351.27
|
| Rate for Payer: IEHP Medicare Advantage |
$51,351.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51,351.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64,702.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68,810.70
|
| Rate for Payer: Multiplan WC |
$68,148.24
|
| Rate for Payer: Prime Health Services WC |
$67,452.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 988: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC
|
Facility
IP
|
$51,446.25
|
|
|
Service Code
|
MS-DRG 988
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$51,446.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$51,446.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$44,181.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$32,726.72
|
| Rate for Payer: IEHP Medicare Advantage |
$32,726.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,726.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41,235.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43,853.80
|
| Rate for Payer: Multiplan WC |
$34,838.08
|
| Rate for Payer: Prime Health Services WC |
$34,482.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 989: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC
|
Facility
IP
|
$34,949.80
|
|
|
Service Code
|
MS-DRG 989
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$34,949.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,750.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,949.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,888.74
|
| Rate for Payer: IEHP Medicare Advantage |
$25,888.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,888.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,619.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,690.91
|
| Rate for Payer: Multiplan WC |
$22,639.41
|
| Rate for Payer: Prime Health Services WC |
$22,408.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
IP
|
$26,188.69
|
|
|
Service Code
|
APR-DRG 1761
|
| Min. Negotiated Rate |
$20,089.48 |
| Max. Negotiated Rate |
$26,188.69 |
| Rate for Payer: IEHP Medi-Cal |
$20,089.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26,188.69
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
IP
|
$31,069.24
|
|
|
Service Code
|
APR-DRG 1762
|
| Min. Negotiated Rate |
$23,833.38 |
| Max. Negotiated Rate |
$31,069.24 |
| Rate for Payer: IEHP Medi-Cal |
$23,833.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31,069.24
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
IP
|
$79,720.58
|
|
|
Service Code
|
APR-DRG 1764
|
| Min. Negotiated Rate |
$61,154.08 |
| Max. Negotiated Rate |
$79,720.58 |
| Rate for Payer: IEHP Medi-Cal |
$61,154.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79,720.58
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
IP
|
$48,131.71
|
|
|
Service Code
|
APR-DRG 1763
|
| Min. Negotiated Rate |
$36,922.09 |
| Max. Negotiated Rate |
$48,131.71 |
| Rate for Payer: IEHP Medi-Cal |
$36,922.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48,131.71
|
|
|
INSULIN DEGLUDEC (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [223708]
|
Facility
IP
|
$40.67
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
NDG223708
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$34.57 |
| Rate for Payer: Blue Shield of California Commercial |
$28.96
|
| Rate for Payer: Blue Shield of California EPN |
$20.82
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna of CA HMO |
$28.47
|
| Rate for Payer: Cigna of CA PPO |
$28.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: Galaxy Health WC |
$34.57
|
| Rate for Payer: Global Benefits Group Commercial |
$24.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.76
|
| Rate for Payer: Multiplan Commercial |
$32.54
|
| Rate for Payer: Networks By Design Commercial |
$26.44
|
| Rate for Payer: Prime Health Services Commercial |
$34.57
|
|
|
INSULIN DEGLUDEC (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [223708]
|
Facility
OP
|
$40.67
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
NDG223708
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$34.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: BCBS Transplant Transplant |
$24.40
|
| Rate for Payer: Blue Shield of California Commercial |
$29.97
|
| Rate for Payer: Blue Shield of California EPN |
$23.75
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna of CA HMO |
$28.47
|
| Rate for Payer: Cigna of CA PPO |
$28.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.57
|
| Rate for Payer: Dignity Health Media |
$34.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.27
|
| Rate for Payer: Galaxy Health WC |
$34.57
|
| Rate for Payer: Global Benefits Group Commercial |
$24.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$30.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.76
|
| Rate for Payer: Multiplan Commercial |
$32.54
|
| Rate for Payer: Networks By Design Commercial |
$26.44
|
| Rate for Payer: Prime Health Services Commercial |
$34.57
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$24.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.34
|
| Rate for Payer: United Healthcare All Other HMO |
$20.34
|
| Rate for Payer: United Healthcare HMO Rider |
$20.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.57
|
| Rate for Payer: Vantage Medical Group Senior |
$34.57
|
|
|
INSULIN GLARGINE VIAL (LANTUS) 100 UNIT/ML SUBCUTANEOUS [28282]
|
Facility
IP
|
$35.05
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
1721115
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$29.79 |
| Rate for Payer: Blue Shield of California Commercial |
$24.96
|
| Rate for Payer: Blue Shield of California EPN |
$17.95
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cigna of CA HMO |
$24.54
|
| Rate for Payer: Cigna of CA PPO |
$24.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.02
|
| Rate for Payer: Galaxy Health WC |
$29.79
|
| Rate for Payer: Global Benefits Group Commercial |
$21.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.41
|
| Rate for Payer: Multiplan Commercial |
$28.04
|
| Rate for Payer: Networks By Design Commercial |
$22.78
|
| Rate for Payer: Prime Health Services Commercial |
$29.79
|
|
|
INSULIN GLARGINE VIAL (LANTUS) 100 UNIT/ML SUBCUTANEOUS [28282]
|
Facility
OP
|
$35.05
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
1721115
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$29.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.28
|
| Rate for Payer: BCBS Transplant Transplant |
$21.03
|
| Rate for Payer: Blue Shield of California Commercial |
$25.83
|
| Rate for Payer: Blue Shield of California EPN |
$20.47
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cigna of CA HMO |
$24.54
|
| Rate for Payer: Cigna of CA PPO |
$24.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.79
|
| Rate for Payer: Dignity Health Media |
$29.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.02
|
| Rate for Payer: Galaxy Health WC |
$29.79
|
| Rate for Payer: Global Benefits Group Commercial |
$21.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$26.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.41
|
| Rate for Payer: Multiplan Commercial |
$28.04
|
| Rate for Payer: Networks By Design Commercial |
$22.78
|
| Rate for Payer: Prime Health Services Commercial |
$29.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.52
|
| Rate for Payer: United Healthcare All Other HMO |
$17.52
|
| Rate for Payer: United Healthcare HMO Rider |
$17.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.79
|
| Rate for Payer: Vantage Medical Group Senior |
$29.79
|
|
