|
MAGNESIUM SULFATE ORAL SOLUTION (IV FORM) 0.5 G/ML [4080434]
|
Facility
OP
|
$1.04
|
|
|
Service Code
|
NDC 9994-0804-34
|
| Hospital Charge Code |
1715016
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Galaxy Health WC |
$0.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.62
|
| Rate for Payer: BCBS Transplant Transplant |
$0.62
|
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Blue Shield of California EPN |
$0.61
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cigna of CA HMO |
$0.73
|
| Rate for Payer: Cigna of CA PPO |
$0.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.88
|
| Rate for Payer: Dignity Health Media |
$0.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Networks By Design Commercial |
$0.68
|
| Rate for Payer: Prime Health Services Commercial |
$0.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.52
|
| Rate for Payer: United Healthcare All Other HMO |
$0.52
|
| Rate for Payer: United Healthcare HMO Rider |
$0.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.88
|
| Rate for Payer: Vantage Medical Group Senior |
$0.88
|
|
|
MAJOR ABDOMINAL VASCULAR PROCEDURES
|
Facility
IP
|
$98,145.05
|
|
|
Service Code
|
APR-DRG 1694
|
| Min. Negotiated Rate |
$75,287.59 |
| Max. Negotiated Rate |
$98,145.05 |
| Rate for Payer: IEHP Medi-Cal |
$75,287.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98,145.05
|
|
|
MAJOR ABDOMINAL VASCULAR PROCEDURES
|
Facility
IP
|
$46,168.48
|
|
|
Service Code
|
APR-DRG 1692
|
| Min. Negotiated Rate |
$35,416.08 |
| Max. Negotiated Rate |
$46,168.48 |
| Rate for Payer: IEHP Medi-Cal |
$35,416.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46,168.48
|
|
|
MAJOR ABDOMINAL VASCULAR PROCEDURES
|
Facility
IP
|
$60,327.79
|
|
|
Service Code
|
APR-DRG 1693
|
| Min. Negotiated Rate |
$46,277.77 |
| Max. Negotiated Rate |
$60,327.79 |
| Rate for Payer: IEHP Medi-Cal |
$46,277.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60,327.79
|
|
|
MAJOR ABDOMINAL VASCULAR PROCEDURES
|
Facility
IP
|
$45,554.88
|
|
|
Service Code
|
APR-DRG 1691
|
| Min. Negotiated Rate |
$34,945.38 |
| Max. Negotiated Rate |
$45,554.88 |
| Rate for Payer: IEHP Medi-Cal |
$34,945.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45,554.88
|
|
|
MAJOR BILIARY TRACT PROCEDURES
|
Facility
IP
|
$79,481.16
|
|
|
Service Code
|
APR-DRG 2614
|
| Min. Negotiated Rate |
$60,970.42 |
| Max. Negotiated Rate |
$79,481.16 |
| Rate for Payer: IEHP Medi-Cal |
$60,970.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79,481.16
|
|
|
MAJOR BILIARY TRACT PROCEDURES
|
Facility
IP
|
$30,116.90
|
|
|
Service Code
|
APR-DRG 2612
|
| Min. Negotiated Rate |
$23,102.83 |
| Max. Negotiated Rate |
$30,116.90 |
| Rate for Payer: IEHP Medi-Cal |
$23,102.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,116.90
|
|
|
MAJOR BILIARY TRACT PROCEDURES
|
Facility
IP
|
$41,727.74
|
|
|
Service Code
|
APR-DRG 2613
|
| Min. Negotiated Rate |
$32,009.57 |
| Max. Negotiated Rate |
$41,727.74 |
| Rate for Payer: IEHP Medi-Cal |
$32,009.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41,727.74
|
|
|
MAJOR BILIARY TRACT PROCEDURES
|
Facility
IP
|
$23,014.19
|
|
|
Service Code
|
APR-DRG 2611
|
| Min. Negotiated Rate |
$17,654.30 |
| Max. Negotiated Rate |
$23,014.19 |
| Rate for Payer: IEHP Medi-Cal |
$17,654.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,014.19
|
|
|
MAJOR BLADDER PROCEDURES
|
Facility
IP
|
$23,358.24
|
|
|
Service Code
|
APR-DRG 4411
|
| Min. Negotiated Rate |
$17,918.23 |
| Max. Negotiated Rate |
$23,358.24 |
| Rate for Payer: IEHP Medi-Cal |
$17,918.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,358.24
|
|
|
MAJOR BLADDER PROCEDURES
|
Facility
IP
|
$46,480.61
|
|
|
Service Code
|
APR-DRG 4413
|
| Min. Negotiated Rate |
$35,655.52 |
| Max. Negotiated Rate |
$46,480.61 |
| Rate for Payer: IEHP Medi-Cal |
$35,655.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46,480.61
|
|
|
MAJOR BLADDER PROCEDURES
|
Facility
IP
|
$91,572.61
|
|
|
Service Code
|
APR-DRG 4414
|
| Min. Negotiated Rate |
$70,245.83 |
| Max. Negotiated Rate |
$91,572.61 |
| Rate for Payer: IEHP Medi-Cal |
$70,245.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91,572.61
|
|
|
MAJOR BLADDER PROCEDURES
|
Facility
IP
|
$35,545.47
|
|
|
Service Code
|
APR-DRG 4412
|
| Min. Negotiated Rate |
$27,267.11 |
| Max. Negotiated Rate |
$35,545.47 |
| Rate for Payer: IEHP Medi-Cal |
$27,267.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35,545.47
|
|
|
MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY
|
Facility
IP
|
$55,184.76
|
|
|
Service Code
|
APR-DRG 1602
|
| Min. Negotiated Rate |
$42,332.52 |
| Max. Negotiated Rate |
$55,184.76 |
| Rate for Payer: IEHP Medi-Cal |
$42,332.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55,184.76
|
|
|
MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY
|
Facility
IP
|
$158,614.72
|
|
|
Service Code
|
APR-DRG 1604
|
| Min. Negotiated Rate |
$121,674.18 |
| Max. Negotiated Rate |
$158,614.72 |
| Rate for Payer: IEHP Medi-Cal |
$121,674.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158,614.72
|
|
|
MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY
|
Facility
IP
|
$44,801.14
|
|
|
Service Code
|
APR-DRG 1601
|
| Min. Negotiated Rate |
$34,367.19 |
| Max. Negotiated Rate |
$44,801.14 |
| Rate for Payer: IEHP Medi-Cal |
$34,367.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44,801.14
|
|
|
MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY
|
Facility
IP
|
$85,145.59
|
|
|
Service Code
|
APR-DRG 1603
|
| Min. Negotiated Rate |
$65,315.63 |
| Max. Negotiated Rate |
$85,145.59 |
| Rate for Payer: IEHP Medi-Cal |
$65,315.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85,145.59
|
|
|
MAJOR CHEST AND RESPIRATORY TRAUMA
|
Facility
IP
|
$30,751.80
|
|
|
Service Code
|
APR-DRG 1354
|
| Min. Negotiated Rate |
$23,589.87 |
| Max. Negotiated Rate |
$30,751.80 |
| Rate for Payer: IEHP Medi-Cal |
$23,589.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,751.80
|
|
|
MAJOR CHEST AND RESPIRATORY TRAUMA
|
Facility
IP
|
$10,935.15
|
|
|
Service Code
|
APR-DRG 1351
|
| Min. Negotiated Rate |
$8,388.41 |
| Max. Negotiated Rate |
$10,935.15 |
| Rate for Payer: IEHP Medi-Cal |
$8,388.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,935.15
|
|
|
MAJOR CHEST AND RESPIRATORY TRAUMA
|
Facility
IP
|
$18,254.23
|
|
|
Service Code
|
APR-DRG 1353
|
| Min. Negotiated Rate |
$14,002.92 |
| Max. Negotiated Rate |
$18,254.23 |
| Rate for Payer: IEHP Medi-Cal |
$14,002.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,254.23
|
|
|
MAJOR CHEST AND RESPIRATORY TRAUMA
|
Facility
IP
|
$12,724.58
|
|
|
Service Code
|
APR-DRG 1352
|
| Min. Negotiated Rate |
$9,761.10 |
| Max. Negotiated Rate |
$12,724.58 |
| Rate for Payer: IEHP Medi-Cal |
$9,761.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,724.58
|
|
|
MAJOR CRANIAL OR FACIAL BONE PROCEDURES
|
Facility
IP
|
$32,759.34
|
|
|
Service Code
|
APR-DRG 0892
|
| Min. Negotiated Rate |
$25,129.87 |
| Max. Negotiated Rate |
$32,759.34 |
| Rate for Payer: IEHP Medi-Cal |
$25,129.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32,759.34
|
|
|
MAJOR CRANIAL OR FACIAL BONE PROCEDURES
|
Facility
IP
|
$59,841.87
|
|
|
Service Code
|
APR-DRG 0893
|
| Min. Negotiated Rate |
$45,905.01 |
| Max. Negotiated Rate |
$59,841.87 |
| Rate for Payer: IEHP Medi-Cal |
$45,905.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59,841.87
|
|
|
MAJOR CRANIAL OR FACIAL BONE PROCEDURES
|
Facility
IP
|
$86,165.32
|
|
|
Service Code
|
APR-DRG 0894
|
| Min. Negotiated Rate |
$66,097.87 |
| Max. Negotiated Rate |
$86,165.32 |
| Rate for Payer: IEHP Medi-Cal |
$66,097.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86,165.32
|
|
|
MAJOR CRANIAL OR FACIAL BONE PROCEDURES
|
Facility
IP
|
$24,473.75
|
|
|
Service Code
|
APR-DRG 0891
|
| Min. Negotiated Rate |
$18,773.94 |
| Max. Negotiated Rate |
$24,473.75 |
| Rate for Payer: IEHP Medi-Cal |
$18,773.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24,473.75
|
|
