|
MALIGNANCY, MALE REPRODUCTIVE SYSTEM
|
Facility
IP
|
$29,223.08
|
|
|
Service Code
|
APR-DRG 5004
|
| Min. Negotiated Rate |
$22,417.18 |
| Max. Negotiated Rate |
$29,223.08 |
| Rate for Payer: IEHP Medi-Cal |
$22,417.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29,223.08
|
|
|
MALIGNANCY OF HEPATOBILIARY SYSTEM AND PANCREAS
|
Facility
IP
|
$24,888.75
|
|
|
Service Code
|
APR-DRG 2814
|
| Min. Negotiated Rate |
$19,092.29 |
| Max. Negotiated Rate |
$24,888.75 |
| Rate for Payer: IEHP Medi-Cal |
$19,092.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24,888.75
|
|
|
MALIGNANCY OF HEPATOBILIARY SYSTEM AND PANCREAS
|
Facility
IP
|
$16,929.46
|
|
|
Service Code
|
APR-DRG 2813
|
| Min. Negotiated Rate |
$12,986.67 |
| Max. Negotiated Rate |
$16,929.46 |
| Rate for Payer: IEHP Medi-Cal |
$12,986.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,929.46
|
|
|
MALIGNANCY OF HEPATOBILIARY SYSTEM AND PANCREAS
|
Facility
IP
|
$13,008.33
|
|
|
Service Code
|
APR-DRG 2812
|
| Min. Negotiated Rate |
$9,978.76 |
| Max. Negotiated Rate |
$13,008.33 |
| Rate for Payer: IEHP Medi-Cal |
$9,978.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,008.33
|
|
|
MALIGNANCY OF HEPATOBILIARY SYSTEM AND PANCREAS
|
Facility
IP
|
$9,809.02
|
|
|
Service Code
|
APR-DRG 2811
|
| Min. Negotiated Rate |
$7,524.55 |
| Max. Negotiated Rate |
$9,809.02 |
| Rate for Payer: IEHP Medi-Cal |
$7,524.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,809.02
|
|
|
MALIGNANT BREAST DISORDERS
|
Facility
IP
|
$15,461.02
|
|
|
Service Code
|
APR-DRG 3823
|
| Min. Negotiated Rate |
$11,860.23 |
| Max. Negotiated Rate |
$15,461.02 |
| Rate for Payer: IEHP Medi-Cal |
$11,860.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,461.02
|
|
|
MALIGNANT BREAST DISORDERS
|
Facility
IP
|
$9,269.87
|
|
|
Service Code
|
APR-DRG 3821
|
| Min. Negotiated Rate |
$7,110.97 |
| Max. Negotiated Rate |
$9,269.87 |
| Rate for Payer: IEHP Medi-Cal |
$7,110.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,269.87
|
|
|
MALIGNANT BREAST DISORDERS
|
Facility
IP
|
$10,915.65
|
|
|
Service Code
|
APR-DRG 3822
|
| Min. Negotiated Rate |
$8,373.45 |
| Max. Negotiated Rate |
$10,915.65 |
| Rate for Payer: IEHP Medi-Cal |
$8,373.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,915.65
|
|
|
MALIGNANT BREAST DISORDERS
|
Facility
IP
|
$22,897.15
|
|
|
Service Code
|
APR-DRG 3824
|
| Min. Negotiated Rate |
$17,564.52 |
| Max. Negotiated Rate |
$22,897.15 |
| Rate for Payer: IEHP Medi-Cal |
$17,564.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,897.15
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
IP
|
$27,334.33
|
|
|
Service Code
|
APR-DRG 4214
|
| Min. Negotiated Rate |
$20,968.31 |
| Max. Negotiated Rate |
$27,334.33 |
| Rate for Payer: IEHP Medi-Cal |
$20,968.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27,334.33
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
IP
|
$9,351.46
|
|
|
Service Code
|
APR-DRG 4212
|
| Min. Negotiated Rate |
$7,173.55 |
| Max. Negotiated Rate |
$9,351.46 |
| Rate for Payer: IEHP Medi-Cal |
$7,173.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,351.46
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
IP
|
$6,253.22
|
|
|
Service Code
|
APR-DRG 4211
|
| Min. Negotiated Rate |
$4,796.88 |
| Max. Negotiated Rate |
$6,253.22 |
| Rate for Payer: IEHP Medi-Cal |
$4,796.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,253.22
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
IP
|
$14,171.72
|
|
|
Service Code
|
APR-DRG 4213
|
| Min. Negotiated Rate |
$10,871.20 |
| Max. Negotiated Rate |
$14,171.72 |
| Rate for Payer: IEHP Medi-Cal |
$10,871.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,171.72
|
|
|
MANGO FLAVOR LIQUID [213757]
|
Facility
OP
|
$2.86
|
|
|
Service Code
|
NDC 3877929822
|
| Hospital Charge Code |
NDG213757
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.70
|
| Rate for Payer: BCBS Transplant Transplant |
$1.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2.11
|
| Rate for Payer: Blue Shield of California EPN |
$1.67
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cigna of CA HMO |
$2.00
|
| Rate for Payer: Cigna of CA PPO |
$2.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.43
|
| Rate for Payer: Dignity Health Media |
$2.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.29
|
| Rate for Payer: Networks By Design Commercial |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$2.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.43
|
| Rate for Payer: United Healthcare All Other HMO |
$1.43
|
| Rate for Payer: United Healthcare HMO Rider |
$1.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.43
|
| Rate for Payer: Vantage Medical Group Senior |
$2.43
|
|
|
MANGO FLAVOR LIQUID [213757]
|
Facility
OP
|
$2.86
|
|
|
Service Code
|
NDC 78573-00081
|
| Hospital Charge Code |
NDG10056
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.70
|
| Rate for Payer: BCBS Transplant Transplant |
$1.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2.11
|
| Rate for Payer: Blue Shield of California EPN |
$1.67
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cigna of CA HMO |
$2.00
|
| Rate for Payer: Cigna of CA PPO |
$2.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.43
|
| Rate for Payer: Dignity Health Media |
$2.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.29
|
| Rate for Payer: Networks By Design Commercial |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$2.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.43
|
| Rate for Payer: United Healthcare All Other HMO |
$1.43
|
| Rate for Payer: United Healthcare HMO Rider |
$1.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.43
|
| Rate for Payer: Vantage Medical Group Senior |
$2.43
|
|
|
MANGO FLAVOR LIQUID [213757]
|
Facility
IP
|
$2.86
|
|
|
Service Code
|
NDC 78573-00081
|
| Hospital Charge Code |
NDG10056
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Blue Shield of California Commercial |
$2.04
|
| Rate for Payer: Blue Shield of California EPN |
$1.46
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cigna of CA HMO |
$2.00
|
| Rate for Payer: Cigna of CA PPO |
$2.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.29
|
| Rate for Payer: Networks By Design Commercial |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$2.43
|
|
|
MANGO FLAVOR LIQUID [213757]
|
Facility
IP
|
$2.86
|
|
|
Service Code
|
NDC 3877929822
|
| Hospital Charge Code |
NDG213757
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Blue Shield of California Commercial |
$2.04
|
| Rate for Payer: Blue Shield of California EPN |
$1.46
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cigna of CA HMO |
$2.00
|
| Rate for Payer: Cigna of CA PPO |
$2.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.14
|
| Rate for Payer: Galaxy Health WC |
$2.43
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.29
|
| Rate for Payer: Networks By Design Commercial |
$1.86
|
| Rate for Payer: Prime Health Services Commercial |
$2.43
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION [4749]
|
Facility
OP
|
$0.11
|
|
|
Service Code
|
NDC 0990-7715-12
|
| Hospital Charge Code |
NDG4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: BCBS Transplant Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Media |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION [4749]
|
Facility
IP
|
$0.11
|
|
|
Service Code
|
NDC 0990-7715-02
|
| Hospital Charge Code |
NDG4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION [4749]
|
Facility
OP
|
$0.11
|
|
|
Service Code
|
NDC 0990-7715-02
|
| Hospital Charge Code |
NDG4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.07
|
| Rate for Payer: BCBS Transplant Transplant |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.07
|
| Rate for Payer: Cigna of CA PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Media |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Other HMO |
$0.06
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION [4749]
|
Facility
IP
|
$0.11
|
|
|
Service Code
|
NDC 0990-7715-12
|
| Hospital Charge Code |
NDG4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Blue Shield of California Commercial |
$0.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.04
|
| Rate for Payer: Galaxy Health WC |
$0.09
|
| Rate for Payer: Global Benefits Group Commercial |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Networks By Design Commercial |
$0.07
|
| Rate for Payer: Prime Health Services Commercial |
$0.09
|
|
|
MASTECTOMY PROCEDURES
|
Facility
IP
|
$28,797.44
|
|
|
Service Code
|
APR-DRG 3622
|
| Min. Negotiated Rate |
$22,090.67 |
| Max. Negotiated Rate |
$28,797.44 |
| Rate for Payer: IEHP Medi-Cal |
$22,090.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28,797.44
|
|
|
MASTECTOMY PROCEDURES
|
Facility
IP
|
$20,001.09
|
|
|
Service Code
|
APR-DRG 3621
|
| Min. Negotiated Rate |
$15,342.94 |
| Max. Negotiated Rate |
$20,001.09 |
| Rate for Payer: IEHP Medi-Cal |
$15,342.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20,001.09
|
|
|
MASTECTOMY PROCEDURES
|
Facility
IP
|
$60,604.45
|
|
|
Service Code
|
APR-DRG 3624
|
| Min. Negotiated Rate |
$46,489.99 |
| Max. Negotiated Rate |
$60,604.45 |
| Rate for Payer: IEHP Medi-Cal |
$46,489.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60,604.45
|
|
|
MASTECTOMY PROCEDURES
|
Facility
IP
|
$34,130.23
|
|
|
Service Code
|
APR-DRG 3623
|
| Min. Negotiated Rate |
$26,181.48 |
| Max. Negotiated Rate |
$34,130.23 |
| Rate for Payer: IEHP Medi-Cal |
$26,181.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34,130.23
|
|
