|
Percutaneous Cardiovascular Procedure (PTCA)
|
Facility
|
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 02723ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Percutaneous Cardiovascular Procedure (PTCA)
|
Facility
|
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 02734DZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Percutaneous Cardiovascular Procedure (PTCA)
|
Facility
|
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 027144Z
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Percutaneous Cardiovascular Procedure (PTCA)
|
Facility
|
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 02714D6
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Percutaneous Cardiovascular Procedure (PTCA)
|
Facility
|
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 027G4ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Percutaneous Cardiovascular Procedure (PTCA)
|
Facility
|
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 02703Z6
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Percutaneous Cardiovascular Procedure (PTCA)
|
Facility
|
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 027G3ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Percutaneous Cardiovascular Procedure (PTCA)
|
Facility
|
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 02724DZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$29,483.78
|
|
|
Service Code
|
APR-DRG 0301
|
| Min. Negotiated Rate |
$22,617.16 |
| Max. Negotiated Rate |
$29,483.78 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22,617.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29,483.78
|
|
|
PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$71,459.80
|
|
|
Service Code
|
APR-DRG 0304
|
| Min. Negotiated Rate |
$54,817.19 |
| Max. Negotiated Rate |
$71,459.80 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54,817.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71,459.80
|
|
|
PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$39,507.36
|
|
|
Service Code
|
APR-DRG 0302
|
| Min. Negotiated Rate |
$30,306.31 |
| Max. Negotiated Rate |
$39,507.36 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30,306.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39,507.36
|
|
|
PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$54,126.00
|
|
|
Service Code
|
APR-DRG 0303
|
| Min. Negotiated Rate |
$41,520.34 |
| Max. Negotiated Rate |
$54,126.00 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41,520.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54,126.00
|
|
|
Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation
|
Facility
|
OP
|
$9,590.00
|
|
|
Service Code
|
CPT 25606
|
| Min. Negotiated Rate |
$987.96 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,551.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,551.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$987.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES
|
Facility
|
IP
|
$63,239.81
|
|
|
Service Code
|
APR-DRG 1831
|
| Min. Negotiated Rate |
$48,511.59 |
| Max. Negotiated Rate |
$63,239.81 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48,511.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63,239.81
|
|
|
PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES
|
Facility
|
IP
|
$107,828.14
|
|
|
Service Code
|
APR-DRG 1834
|
| Min. Negotiated Rate |
$82,715.53 |
| Max. Negotiated Rate |
$107,828.14 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$82,715.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107,828.14
|
|
|
PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES
|
Facility
|
IP
|
$65,052.30
|
|
|
Service Code
|
APR-DRG 1832
|
| Min. Negotiated Rate |
$49,901.96 |
| Max. Negotiated Rate |
$65,052.30 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$49,901.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65,052.30
|
|
|
PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES
|
Facility
|
IP
|
$75,746.26
|
|
|
Service Code
|
APR-DRG 1833
|
| Min. Negotiated Rate |
$58,105.35 |
| Max. Negotiated Rate |
$75,746.26 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58,105.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75,746.26
|
|
|
PERFLUTREN PROTEIN-TYPE A MICROSPHERES 0.22 MG/ML INTRAVENOUS SUSP [82177]
|
Facility
|
OP
|
$56.16
|
|
|
Service Code
|
CPT Q9956
|
| Hospital Charge Code |
NDG82177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.48 |
| Max. Negotiated Rate |
$265.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$265.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$47.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.04
|
| Rate for Payer: Blue Distinction Transplant |
$33.70
|
| Rate for Payer: Blue Shield of California Commercial |
$41.39
|
| Rate for Payer: Blue Shield of California EPN |
$32.80
|
| Rate for Payer: Cash Price |
$25.27
|
| Rate for Payer: Cash Price |
$25.27
|
| Rate for Payer: Cigna of CA HMO |
$39.31
|
| Rate for Payer: Cigna of CA PPO |
$39.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.74
|
| Rate for Payer: Dignity Health Media |
$47.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.46
|
| Rate for Payer: Galaxy Health WC |
$47.74
|
| Rate for Payer: Global Benefits Group Commercial |
$33.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$42.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.48
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: Networks By Design Commercial |
$28.08
|
| Rate for Payer: Prime Health Services Commercial |
$47.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.08
|
| Rate for Payer: United Healthcare All Other HMO |
$28.08
|
| Rate for Payer: United Healthcare HMO Rider |
$28.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.74
|
| Rate for Payer: Vantage Medical Group Senior |
$47.74
|
|
|
PERFLUTREN PROTEIN-TYPE A MICROSPHERES 0.22 MG/ML INTRAVENOUS SUSP [82177]
|
Facility
|
IP
|
$56.16
|
|
|
Service Code
|
CPT Q9956
|
| Hospital Charge Code |
NDG82177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.48 |
| Max. Negotiated Rate |
$47.74 |
| Rate for Payer: Blue Shield of California Commercial |
$39.99
|
| Rate for Payer: Blue Shield of California EPN |
$28.75
|
| Rate for Payer: Cash Price |
$25.27
|
| Rate for Payer: Cigna of CA HMO |
$39.31
|
| Rate for Payer: Cigna of CA PPO |
$39.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.46
|
| Rate for Payer: Galaxy Health WC |
$47.74
|
| Rate for Payer: Global Benefits Group Commercial |
$33.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.48
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: Networks By Design Commercial |
$28.08
|
| Rate for Payer: Prime Health Services Commercial |
$47.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.21
|
| Rate for Payer: United Healthcare All Other HMO |
$20.71
|
| Rate for Payer: United Healthcare HMO Rider |
$20.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.53
|
|
|
PERIPHERAL AND OTHER VASCULAR DISORDERS
|
Facility
|
IP
|
$9,993.45
|
|
|
Service Code
|
APR-DRG 1972
|
| Min. Negotiated Rate |
$7,666.03 |
| Max. Negotiated Rate |
$9,993.45 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,666.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,993.45
|
|
|
PERIPHERAL AND OTHER VASCULAR DISORDERS
|
Facility
|
IP
|
$13,818.80
|
|
|
Service Code
|
APR-DRG 1973
|
| Min. Negotiated Rate |
$10,600.47 |
| Max. Negotiated Rate |
$13,818.80 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10,600.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,818.80
|
|
|
PERIPHERAL AND OTHER VASCULAR DISORDERS
|
Facility
|
IP
|
$25,183.13
|
|
|
Service Code
|
APR-DRG 1974
|
| Min. Negotiated Rate |
$19,318.11 |
| Max. Negotiated Rate |
$25,183.13 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19,318.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25,183.13
|
|
|
PERIPHERAL AND OTHER VASCULAR DISORDERS
|
Facility
|
IP
|
$7,482.22
|
|
|
Service Code
|
APR-DRG 1971
|
| Min. Negotiated Rate |
$5,739.65 |
| Max. Negotiated Rate |
$7,482.22 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,739.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,482.22
|
|
|
PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS
|
Facility
|
IP
|
$11,006.09
|
|
|
Service Code
|
APR-DRG 0482
|
| Min. Negotiated Rate |
$8,442.83 |
| Max. Negotiated Rate |
$11,006.09 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,442.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,006.09
|
|
|
PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS
|
Facility
|
IP
|
$27,696.13
|
|
|
Service Code
|
APR-DRG 0484
|
| Min. Negotiated Rate |
$21,245.85 |
| Max. Negotiated Rate |
$27,696.13 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21,245.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27,696.13
|
|
