|
N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE [207979]
|
Facility
OP
|
$429.49
|
|
|
Service Code
|
CPT 90621
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.08 |
| Max. Negotiated Rate |
$1,759.74 |
| Rate for Payer: Vantage Medical Group Senior |
$365.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,273.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$365.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$236.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$236.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,759.74
|
| Rate for Payer: BCBS Transplant Transplant |
$257.69
|
| Rate for Payer: Blue Shield of California Commercial |
$316.53
|
| Rate for Payer: Blue Shield of California EPN |
$179.72
|
| Rate for Payer: Cash Price |
$193.27
|
| Rate for Payer: Cash Price |
$193.27
|
| Rate for Payer: Cigna of CA HMO |
$300.64
|
| Rate for Payer: Cigna of CA PPO |
$300.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$365.07
|
| Rate for Payer: Dignity Health Media |
$365.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$171.80
|
| Rate for Payer: Galaxy Health WC |
$365.07
|
| Rate for Payer: Global Benefits Group Commercial |
$257.69
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$322.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.08
|
| Rate for Payer: Multiplan Commercial |
$343.59
|
| Rate for Payer: Networks By Design Commercial |
$214.74
|
| Rate for Payer: Prime Health Services Commercial |
$365.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$257.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$257.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$214.74
|
| Rate for Payer: United Healthcare All Other HMO |
$214.74
|
| Rate for Payer: United Healthcare HMO Rider |
$214.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$365.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$365.07
|
|
|
N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE [207979]
|
Facility
IP
|
$429.49
|
|
|
Service Code
|
CPT 90621
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.08 |
| Max. Negotiated Rate |
$365.07 |
| Rate for Payer: Blue Shield of California Commercial |
$305.80
|
| Rate for Payer: Blue Shield of California EPN |
$219.90
|
| Rate for Payer: Cash Price |
$193.27
|
| Rate for Payer: Cigna of CA HMO |
$300.64
|
| Rate for Payer: Cigna of CA PPO |
$300.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$171.80
|
| Rate for Payer: Galaxy Health WC |
$365.07
|
| Rate for Payer: Global Benefits Group Commercial |
$257.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.08
|
| Rate for Payer: Multiplan Commercial |
$343.59
|
| Rate for Payer: Networks By Design Commercial |
$214.74
|
| Rate for Payer: Prime Health Services Commercial |
$365.07
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
IP
|
$10,145.96
|
|
|
Service Code
|
APR-DRG 0501
|
| Min. Negotiated Rate |
$7,783.02 |
| Max. Negotiated Rate |
$10,145.96 |
| Rate for Payer: IEHP Medi-Cal |
$7,783.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,145.96
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
IP
|
$57,279.20
|
|
|
Service Code
|
APR-DRG 0504
|
| Min. Negotiated Rate |
$43,939.18 |
| Max. Negotiated Rate |
$57,279.20 |
| Rate for Payer: IEHP Medi-Cal |
$43,939.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57,279.20
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
IP
|
$17,629.97
|
|
|
Service Code
|
APR-DRG 0502
|
| Min. Negotiated Rate |
$13,524.04 |
| Max. Negotiated Rate |
$17,629.97 |
| Rate for Payer: IEHP Medi-Cal |
$13,524.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,629.97
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
IP
|
$27,963.92
|
|
|
Service Code
|
APR-DRG 0503
|
| Min. Negotiated Rate |
$21,451.27 |
| Max. Negotiated Rate |
$27,963.92 |
| Rate for Payer: IEHP Medi-Cal |
$21,451.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27,963.92
|
|
|
NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT
|
Facility
IP
|
$26,389.08
|
|
|
Service Code
|
APR-DRG 3231
|
| Min. Negotiated Rate |
$20,243.20 |
| Max. Negotiated Rate |
$26,389.08 |
| Rate for Payer: IEHP Medi-Cal |
$20,243.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26,389.08
|
|
|
NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT
|
Facility
IP
|
$55,009.18
|
|
|
Service Code
|
APR-DRG 3234
|
| Min. Negotiated Rate |
$42,197.83 |
| Max. Negotiated Rate |
$55,009.18 |
| Rate for Payer: IEHP Medi-Cal |
$42,197.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55,009.18
|
|
|
NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT
|
Facility
IP
|
$29,632.74
|
|
|
Service Code
|
APR-DRG 3232
|
| Min. Negotiated Rate |
$22,731.43 |
| Max. Negotiated Rate |
$29,632.74 |
| Rate for Payer: IEHP Medi-Cal |
$22,731.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29,632.74
|
|
|
NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT
|
Facility
IP
|
$39,438.20
|
|
|
Service Code
|
APR-DRG 3233
|
| Min. Negotiated Rate |
$30,253.25 |
| Max. Negotiated Rate |
$39,438.20 |
| Rate for Payer: IEHP Medi-Cal |
$30,253.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39,438.20
|
|
|
NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT
|
Facility
IP
|
$32,791.28
|
|
|
Service Code
|
APR-DRG 3251
|
| Min. Negotiated Rate |
$25,154.37 |
| Max. Negotiated Rate |
$32,791.28 |
| Rate for Payer: IEHP Medi-Cal |
$25,154.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32,791.28
|
|
|
NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT
|
Facility
IP
|
$38,171.95
|
|
|
Service Code
|
APR-DRG 3252
|
| Min. Negotiated Rate |
$29,281.90 |
| Max. Negotiated Rate |
$38,171.95 |
| Rate for Payer: IEHP Medi-Cal |
$29,281.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38,171.95
|
|
|
NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT
|
Facility
IP
|
$70,135.02
|
|
|
Service Code
|
APR-DRG 3254
|
| Min. Negotiated Rate |
$53,800.95 |
| Max. Negotiated Rate |
$70,135.02 |
| Rate for Payer: IEHP Medi-Cal |
$53,800.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70,135.02
|
|
|
NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT
|
Facility
IP
|
$50,383.99
|
|
|
Service Code
|
APR-DRG 3253
|
| Min. Negotiated Rate |
$38,649.82 |
| Max. Negotiated Rate |
$50,383.99 |
| Rate for Payer: IEHP Medi-Cal |
$38,649.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50,383.99
|
|
|
NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
IP
|
$25,032.39
|
|
|
Service Code
|
APR-DRG 7943
|
| Min. Negotiated Rate |
$19,202.48 |
| Max. Negotiated Rate |
$25,032.39 |
| Rate for Payer: IEHP Medi-Cal |
$19,202.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25,032.39
|
|
|
NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
IP
|
$13,386.07
|
|
|
Service Code
|
APR-DRG 7941
|
| Min. Negotiated Rate |
$10,268.52 |
| Max. Negotiated Rate |
$13,386.07 |
| Rate for Payer: IEHP Medi-Cal |
$10,268.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,386.07
|
|
|
NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
IP
|
$17,206.12
|
|
|
Service Code
|
APR-DRG 7942
|
| Min. Negotiated Rate |
$13,198.90 |
| Max. Negotiated Rate |
$17,206.12 |
| Rate for Payer: IEHP Medi-Cal |
$13,198.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,206.12
|
|
|
NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
IP
|
$44,802.91
|
|
|
Service Code
|
APR-DRG 7944
|
| Min. Negotiated Rate |
$34,368.55 |
| Max. Negotiated Rate |
$44,802.91 |
| Rate for Payer: IEHP Medi-Cal |
$34,368.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44,802.91
|
|
|
NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
IP
|
$30,996.54
|
|
|
Service Code
|
APR-DRG 9523
|
| Min. Negotiated Rate |
$23,777.61 |
| Max. Negotiated Rate |
$30,996.54 |
| Rate for Payer: IEHP Medi-Cal |
$23,777.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,996.54
|
|
|
NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
IP
|
$14,127.37
|
|
|
Service Code
|
APR-DRG 9521
|
| Min. Negotiated Rate |
$10,837.18 |
| Max. Negotiated Rate |
$14,127.37 |
| Rate for Payer: IEHP Medi-Cal |
$10,837.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,127.37
|
|
|
NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
IP
|
$19,456.63
|
|
|
Service Code
|
APR-DRG 9522
|
| Min. Negotiated Rate |
$14,925.28 |
| Max. Negotiated Rate |
$19,456.63 |
| Rate for Payer: IEHP Medi-Cal |
$14,925.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,456.63
|
|
|
NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
IP
|
$54,519.70
|
|
|
Service Code
|
APR-DRG 9524
|
| Min. Negotiated Rate |
$41,822.35 |
| Max. Negotiated Rate |
$54,519.70 |
| Rate for Payer: IEHP Medi-Cal |
$41,822.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54,519.70
|
|
|
NON-HYPOVOLEMIC SODIUM DISORDERS
|
Facility
IP
|
$24,957.91
|
|
|
Service Code
|
APR-DRG 4264
|
| Min. Negotiated Rate |
$19,145.34 |
| Max. Negotiated Rate |
$24,957.91 |
| Rate for Payer: IEHP Medi-Cal |
$19,145.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24,957.91
|
|
|
NON-HYPOVOLEMIC SODIUM DISORDERS
|
Facility
IP
|
$7,271.19
|
|
|
Service Code
|
APR-DRG 4261
|
| Min. Negotiated Rate |
$5,577.77 |
| Max. Negotiated Rate |
$7,271.19 |
| Rate for Payer: IEHP Medi-Cal |
$5,577.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,271.19
|
|
|
NON-HYPOVOLEMIC SODIUM DISORDERS
|
Facility
IP
|
$14,075.96
|
|
|
Service Code
|
APR-DRG 4263
|
| Min. Negotiated Rate |
$10,797.74 |
| Max. Negotiated Rate |
$14,075.96 |
| Rate for Payer: IEHP Medi-Cal |
$10,797.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,075.96
|
|
