|
OTHER SIGNIFICANT HIP AND FEMUR SURGERY
|
Facility
IP
|
$64,931.68
|
|
|
Service Code
|
APR-DRG 3094
|
| Min. Negotiated Rate |
$49,809.44 |
| Max. Negotiated Rate |
$64,931.68 |
| Rate for Payer: IEHP Medi-Cal |
$49,809.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64,931.68
|
|
|
OTHER SIGNIFICANT HIP AND FEMUR SURGERY
|
Facility
IP
|
$40,592.72
|
|
|
Service Code
|
APR-DRG 3093
|
| Min. Negotiated Rate |
$31,138.89 |
| Max. Negotiated Rate |
$40,592.72 |
| Rate for Payer: IEHP Medi-Cal |
$31,138.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40,592.72
|
|
|
OTHER SIGNIFICANT HIP AND FEMUR SURGERY
|
Facility
IP
|
$28,542.07
|
|
|
Service Code
|
APR-DRG 3092
|
| Min. Negotiated Rate |
$21,894.77 |
| Max. Negotiated Rate |
$28,542.07 |
| Rate for Payer: IEHP Medi-Cal |
$21,894.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28,542.07
|
|
|
OTHER SIGNIFICANT HIP AND FEMUR SURGERY
|
Facility
IP
|
$21,460.63
|
|
|
Service Code
|
APR-DRG 3091
|
| Min. Negotiated Rate |
$16,462.56 |
| Max. Negotiated Rate |
$21,460.63 |
| Rate for Payer: IEHP Medi-Cal |
$16,462.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21,460.63
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS
|
Facility
IP
|
$8,812.31
|
|
|
Service Code
|
APR-DRG 3852
|
| Min. Negotiated Rate |
$6,759.97 |
| Max. Negotiated Rate |
$8,812.31 |
| Rate for Payer: IEHP Medi-Cal |
$6,759.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,812.31
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS
|
Facility
IP
|
$27,449.62
|
|
|
Service Code
|
APR-DRG 3854
|
| Min. Negotiated Rate |
$21,056.75 |
| Max. Negotiated Rate |
$27,449.62 |
| Rate for Payer: IEHP Medi-Cal |
$21,056.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27,449.62
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS
|
Facility
IP
|
$13,682.24
|
|
|
Service Code
|
APR-DRG 3853
|
| Min. Negotiated Rate |
$10,495.72 |
| Max. Negotiated Rate |
$13,682.24 |
| Rate for Payer: IEHP Medi-Cal |
$10,495.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,682.24
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS
|
Facility
IP
|
$6,680.63
|
|
|
Service Code
|
APR-DRG 3851
|
| Min. Negotiated Rate |
$5,124.74 |
| Max. Negotiated Rate |
$6,680.63 |
| Rate for Payer: IEHP Medi-Cal |
$5,124.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,680.63
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES
|
Facility
IP
|
$16,319.38
|
|
|
Service Code
|
APR-DRG 3642
|
| Min. Negotiated Rate |
$12,518.69 |
| Max. Negotiated Rate |
$16,319.38 |
| Rate for Payer: IEHP Medi-Cal |
$12,518.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,319.38
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES
|
Facility
IP
|
$26,060.99
|
|
|
Service Code
|
APR-DRG 3643
|
| Min. Negotiated Rate |
$19,991.52 |
| Max. Negotiated Rate |
$26,060.99 |
| Rate for Payer: IEHP Medi-Cal |
$19,991.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26,060.99
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES
|
Facility
IP
|
$11,811.24
|
|
|
Service Code
|
APR-DRG 3641
|
| Min. Negotiated Rate |
$9,060.46 |
| Max. Negotiated Rate |
$11,811.24 |
| Rate for Payer: IEHP Medi-Cal |
$9,060.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,811.24
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES
|
Facility
IP
|
$46,581.69
|
|
|
Service Code
|
APR-DRG 3644
|
| Min. Negotiated Rate |
$35,733.06 |
| Max. Negotiated Rate |
$46,581.69 |
| Rate for Payer: IEHP Medi-Cal |
$35,733.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46,581.69
|
|
|
OTHER SMALL AND LARGE BOWEL PROCEDURES
|
Facility
IP
|
$24,693.65
|
|
|
Service Code
|
APR-DRG 2232
|
| Min. Negotiated Rate |
$18,942.63 |
| Max. Negotiated Rate |
$24,693.65 |
| Rate for Payer: IEHP Medi-Cal |
$18,942.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24,693.65
|
|
|
OTHER SMALL AND LARGE BOWEL PROCEDURES
|
Facility
IP
|
$61,248.21
|
|
|
Service Code
|
APR-DRG 2234
|
| Min. Negotiated Rate |
$46,983.82 |
| Max. Negotiated Rate |
$61,248.21 |
| Rate for Payer: IEHP Medi-Cal |
$46,983.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61,248.21
|
|
|
OTHER SMALL AND LARGE BOWEL PROCEDURES
|
Facility
IP
|
$34,706.62
|
|
|
Service Code
|
APR-DRG 2233
|
| Min. Negotiated Rate |
$26,623.63 |
| Max. Negotiated Rate |
$34,706.62 |
| Rate for Payer: IEHP Medi-Cal |
$26,623.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34,706.62
|
|
|
OTHER SMALL AND LARGE BOWEL PROCEDURES
|
Facility
IP
|
$16,322.92
|
|
|
Service Code
|
APR-DRG 2231
|
| Min. Negotiated Rate |
$12,521.40 |
| Max. Negotiated Rate |
$16,322.92 |
| Rate for Payer: IEHP Medi-Cal |
$12,521.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,322.92
|
|
|
OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES
|
Facility
IP
|
$63,725.73
|
|
|
Service Code
|
APR-DRG 2224
|
| Min. Negotiated Rate |
$48,884.35 |
| Max. Negotiated Rate |
$63,725.73 |
| Rate for Payer: IEHP Medi-Cal |
$48,884.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63,725.73
|
|
|
OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES
|
Facility
IP
|
$11,860.90
|
|
|
Service Code
|
APR-DRG 2221
|
| Min. Negotiated Rate |
$9,098.56 |
| Max. Negotiated Rate |
$11,860.90 |
| Rate for Payer: IEHP Medi-Cal |
$9,098.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,860.90
|
|
|
OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES
|
Facility
IP
|
$29,889.89
|
|
|
Service Code
|
APR-DRG 2223
|
| Min. Negotiated Rate |
$22,928.69 |
| Max. Negotiated Rate |
$29,889.89 |
| Rate for Payer: IEHP Medi-Cal |
$22,928.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29,889.89
|
|
|
OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES
|
Facility
IP
|
$20,009.94
|
|
|
Service Code
|
APR-DRG 2222
|
| Min. Negotiated Rate |
$15,349.73 |
| Max. Negotiated Rate |
$20,009.94 |
| Rate for Payer: IEHP Medi-Cal |
$15,349.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20,009.94
|
|
|
Otoplasty, protruding ear, with or without size reduction
|
Facility
OP
|
$9,590.00
|
|
|
Service Code
|
CPT 69300
|
| Min. Negotiated Rate |
$707.37 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,597.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,597.21
|
| Rate for Payer: IEHP Medi-Cal |
$6,516.76
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$6,516.76
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$707.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
Outdated MS-DRG 222
|
Facility
IP
|
$157,239.59
|
|
|
Service Code
|
MS-DRG 222
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$157,239.59 |
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,764.00
|
| Rate for Payer: Multiplan WC |
$157,239.59
|
| Rate for Payer: Prime Health Services WC |
$155,635.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$127,379.00
|
| Rate for Payer: United Healthcare All Other HMO |
$127,379.00
|
| Rate for Payer: United Healthcare HMO Rider |
$127,379.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$127,379.00
|
|
|
Outdated MS-DRG 223
|
Facility
IP
|
$109,242.00
|
|
|
Service Code
|
MS-DRG 223
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$109,242.00 |
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,764.00
|
| Rate for Payer: Multiplan WC |
$107,173.71
|
| Rate for Payer: Prime Health Services WC |
$106,080.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$109,242.00
|
| Rate for Payer: United Healthcare All Other HMO |
$109,242.00
|
| Rate for Payer: United Healthcare HMO Rider |
$109,242.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$109,242.00
|
|
|
Outdated MS-DRG 224
|
Facility
IP
|
$145,587.18
|
|
|
Service Code
|
MS-DRG 224
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$145,587.18 |
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,764.00
|
| Rate for Payer: Multiplan WC |
$145,587.18
|
| Rate for Payer: Prime Health Services WC |
$144,101.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114,283.00
|
| Rate for Payer: United Healthcare All Other HMO |
$114,283.00
|
| Rate for Payer: United Healthcare HMO Rider |
$114,283.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114,283.00
|
|
|
Outdated MS-DRG 225
|
Facility
IP
|
$103,867.34
|
|
|
Service Code
|
MS-DRG 225
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$103,867.34 |
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,764.00
|
| Rate for Payer: Multiplan WC |
$103,867.34
|
| Rate for Payer: Prime Health Services WC |
$102,807.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$99,952.00
|
| Rate for Payer: United Healthcare All Other HMO |
$99,952.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99,952.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99,952.00
|
|
