|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [118608]
|
Facility
|
OP
|
$79.32
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
1720633
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$431.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$431.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.75
|
| Rate for Payer: Blue Distinction Transplant |
$47.59
|
| Rate for Payer: Blue Shield of California Commercial |
$80.24
|
| Rate for Payer: Blue Shield of California EPN |
$72.94
|
| Rate for Payer: Cash Price |
$35.69
|
| Rate for Payer: Cash Price |
$35.69
|
| Rate for Payer: Central Health Plan Commercial |
$63.46
|
| Rate for Payer: Cigna of CA HMO |
$55.52
|
| Rate for Payer: Cigna of CA PPO |
$55.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.42
|
| Rate for Payer: Dignity Health Media |
$67.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.73
|
| Rate for Payer: Galaxy Health WC |
$67.42
|
| Rate for Payer: Global Benefits Group Commercial |
$47.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.39
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$59.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.86
|
| Rate for Payer: Multiplan Commercial |
$59.49
|
| Rate for Payer: Networks By Design Commercial |
$39.66
|
| Rate for Payer: Prime Health Services Commercial |
$67.42
|
| Rate for Payer: Riverside University Health System MISP |
$31.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.66
|
| Rate for Payer: United Healthcare All Other HMO |
$39.66
|
| Rate for Payer: United Healthcare HMO Rider |
$39.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.42
|
| Rate for Payer: Vantage Medical Group Senior |
$67.42
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [118608]
|
Facility
|
IP
|
$79.32
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
1720633
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$71.39 |
| Rate for Payer: Blue Shield of California Commercial |
$59.49
|
| Rate for Payer: Blue Shield of California EPN |
$42.36
|
| Rate for Payer: Cash Price |
$35.69
|
| Rate for Payer: Central Health Plan Commercial |
$63.46
|
| Rate for Payer: Cigna of CA HMO |
$55.52
|
| Rate for Payer: Cigna of CA PPO |
$55.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.73
|
| Rate for Payer: Galaxy Health WC |
$67.42
|
| Rate for Payer: Global Benefits Group Commercial |
$47.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.86
|
| Rate for Payer: Multiplan Commercial |
$59.49
|
| Rate for Payer: Networks By Design Commercial |
$39.66
|
| Rate for Payer: Prime Health Services Commercial |
$67.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.95
|
| Rate for Payer: United Healthcare All Other HMO |
$29.25
|
| Rate for Payer: United Healthcare HMO Rider |
$28.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.18
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 40 MCG/ML INTRAMUSCULAR SUSP [108150]
|
Facility
|
IP
|
$210.43
|
|
|
Service Code
|
CPT 90740
|
| Hospital Charge Code |
1722054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.09 |
| Max. Negotiated Rate |
$189.39 |
| Rate for Payer: Blue Shield of California Commercial |
$157.82
|
| Rate for Payer: Blue Shield of California EPN |
$112.37
|
| Rate for Payer: Cash Price |
$94.69
|
| Rate for Payer: Central Health Plan Commercial |
$168.34
|
| Rate for Payer: Cigna of CA HMO |
$147.30
|
| Rate for Payer: Cigna of CA PPO |
$147.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.17
|
| Rate for Payer: Galaxy Health WC |
$178.87
|
| Rate for Payer: Global Benefits Group Commercial |
$126.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.09
|
| Rate for Payer: Multiplan Commercial |
$157.82
|
| Rate for Payer: Networks By Design Commercial |
$105.22
|
| Rate for Payer: Prime Health Services Commercial |
$178.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.46
|
| Rate for Payer: United Healthcare All Other HMO |
$77.61
|
| Rate for Payer: United Healthcare HMO Rider |
$75.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.44
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 40 MCG/ML INTRAMUSCULAR SUSP [108150]
|
Facility
|
OP
|
$210.43
|
|
|
Service Code
|
CPT 90740
|
| Hospital Charge Code |
1722054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.09 |
| Max. Negotiated Rate |
$933.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$933.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$387.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$424.47
|
| Rate for Payer: Blue Distinction Transplant |
$126.26
|
| Rate for Payer: Blue Shield of California Commercial |
$219.01
|
| Rate for Payer: Blue Shield of California EPN |
$199.10
|
| Rate for Payer: Cash Price |
$94.69
|
| Rate for Payer: Cash Price |
$94.69
|
| Rate for Payer: Central Health Plan Commercial |
$168.34
|
| Rate for Payer: Cigna of CA HMO |
$147.30
|
| Rate for Payer: Cigna of CA PPO |
$147.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.87
|
| Rate for Payer: Dignity Health Media |
$178.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.17
|
| Rate for Payer: Galaxy Health WC |
$178.87
|
| Rate for Payer: Global Benefits Group Commercial |
$126.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.39
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$157.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$158.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.09
|
| Rate for Payer: Multiplan Commercial |
$157.82
|
| Rate for Payer: Networks By Design Commercial |
$105.22
|
| Rate for Payer: Prime Health Services Commercial |
$178.87
|
| Rate for Payer: Riverside University Health System MISP |
$84.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.22
|
| Rate for Payer: United Healthcare All Other HMO |
$105.22
|
| Rate for Payer: United Healthcare HMO Rider |
$105.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.87
|
| Rate for Payer: Vantage Medical Group Senior |
$178.87
|
|
|
HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [34550]
|
Facility
|
IP
|
$213.32
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
1721119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.66 |
| Max. Negotiated Rate |
$191.99 |
| Rate for Payer: Blue Shield of California Commercial |
$159.99
|
| Rate for Payer: Blue Shield of California EPN |
$113.91
|
| Rate for Payer: Cash Price |
$95.99
|
| Rate for Payer: Central Health Plan Commercial |
$170.66
|
| Rate for Payer: Cigna of CA HMO |
$149.32
|
| Rate for Payer: Cigna of CA PPO |
$149.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$85.33
|
| Rate for Payer: Galaxy Health WC |
$181.32
|
| Rate for Payer: Global Benefits Group Commercial |
$127.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$191.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.66
|
| Rate for Payer: Multiplan Commercial |
$159.99
|
| Rate for Payer: Networks By Design Commercial |
$106.66
|
| Rate for Payer: Prime Health Services Commercial |
$181.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$80.55
|
| Rate for Payer: United Healthcare All Other HMO |
$78.67
|
| Rate for Payer: United Healthcare HMO Rider |
$76.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.40
|
|
|
HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [34550]
|
Facility
|
OP
|
$213.32
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
1721119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.66 |
| Max. Negotiated Rate |
$585.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$585.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$181.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$117.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.11
|
| Rate for Payer: Blue Distinction Transplant |
$127.99
|
| Rate for Payer: Blue Shield of California Commercial |
$108.63
|
| Rate for Payer: Blue Shield of California EPN |
$98.75
|
| Rate for Payer: Cash Price |
$95.99
|
| Rate for Payer: Cash Price |
$95.99
|
| Rate for Payer: Central Health Plan Commercial |
$170.66
|
| Rate for Payer: Cigna of CA HMO |
$149.32
|
| Rate for Payer: Cigna of CA PPO |
$149.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$181.32
|
| Rate for Payer: Dignity Health Media |
$181.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$85.33
|
| Rate for Payer: Galaxy Health WC |
$181.32
|
| Rate for Payer: Global Benefits Group Commercial |
$127.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$191.99
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$159.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$142.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.66
|
| Rate for Payer: Multiplan Commercial |
$159.99
|
| Rate for Payer: Networks By Design Commercial |
$106.66
|
| Rate for Payer: Prime Health Services Commercial |
$181.32
|
| Rate for Payer: Riverside University Health System MISP |
$85.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.66
|
| Rate for Payer: United Healthcare All Other HMO |
$106.66
|
| Rate for Payer: United Healthcare HMO Rider |
$106.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.32
|
| Rate for Payer: Vantage Medical Group Senior |
$181.32
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL
|
Facility
|
IP
|
$18,614.24
|
|
|
Service Code
|
APR-DRG 2271
|
| Min. Negotiated Rate |
$11,756.36 |
| Max. Negotiated Rate |
$18,614.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,756.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,009.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,614.24
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL
|
Facility
|
IP
|
$32,910.09
|
|
|
Service Code
|
APR-DRG 2273
|
| Min. Negotiated Rate |
$20,785.32 |
| Max. Negotiated Rate |
$32,910.09 |
| Rate for Payer: Adventist Health Medi-Cal |
$20,785.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24,769.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32,910.09
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL
|
Facility
|
IP
|
$23,285.53
|
|
|
Service Code
|
APR-DRG 2272
|
| Min. Negotiated Rate |
$14,706.65 |
| Max. Negotiated Rate |
$23,285.53 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,706.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17,525.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,285.53
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL
|
Facility
|
IP
|
$59,951.82
|
|
|
Service Code
|
APR-DRG 2274
|
| Min. Negotiated Rate |
$37,864.31 |
| Max. Negotiated Rate |
$59,951.82 |
| Rate for Payer: Adventist Health Medi-Cal |
$37,864.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$45,121.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59,951.82
|
|
|
HETASTARCH 6 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [25174]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 0264-1965-10
|
| Hospital Charge Code |
1771089
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.04
|
| Rate for Payer: Blue Distinction Transplant |
$0.04
|
| Rate for Payer: Blue Shield of California Commercial |
$0.04
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.05
|
| Rate for Payer: Cigna of CA HMO |
$0.04
|
| Rate for Payer: Cigna of CA PPO |
$0.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.05
|
| Rate for Payer: Dignity Health Media |
$0.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
| Rate for Payer: Riverside University Health System MISP |
$0.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Other HMO |
$0.03
|
| Rate for Payer: United Healthcare HMO Rider |
$0.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.05
|
| Rate for Payer: Vantage Medical Group Senior |
$0.05
|
|
|
HETASTARCH 6 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [25174]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 0264-1965-10
|
| Hospital Charge Code |
1771089
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Central Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: Galaxy Health WC |
$0.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
| Rate for Payer: Networks By Design Commercial |
$0.04
|
| Rate for Payer: Prime Health Services Commercial |
$0.05
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$22,122.14
|
|
|
Service Code
|
APR-DRG 3081
|
| Min. Negotiated Rate |
$13,971.88 |
| Max. Negotiated Rate |
$22,122.14 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,971.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16,649.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,122.14
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$26,094.70
|
|
|
Service Code
|
APR-DRG 3082
|
| Min. Negotiated Rate |
$16,480.86 |
| Max. Negotiated Rate |
$26,094.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,480.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19,639.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26,094.70
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$33,504.20
|
|
|
Service Code
|
APR-DRG 3083
|
| Min. Negotiated Rate |
$21,160.55 |
| Max. Negotiated Rate |
$33,504.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,160.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25,216.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33,504.20
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$48,422.54
|
|
|
Service Code
|
APR-DRG 3084
|
| Min. Negotiated Rate |
$30,582.66 |
| Max. Negotiated Rate |
$48,422.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$30,582.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36,444.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48,422.54
|
|
|
Hip core decompression
|
Facility
|
OP
|
$8,939.53
|
|
|
Service Code
|
CPT S2325
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,465.14 |
| Max. Negotiated Rate |
$8,939.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,939.53
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
|
|
HIV WITH MAJOR HIV RELATED CONDITION
|
Facility
|
IP
|
$10,807.47
|
|
|
Service Code
|
APR-DRG 8921
|
| Min. Negotiated Rate |
$6,825.77 |
| Max. Negotiated Rate |
$10,807.47 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,825.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,134.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,807.47
|
|
|
HIV WITH MAJOR HIV RELATED CONDITION
|
Facility
|
IP
|
$11,481.38
|
|
|
Service Code
|
APR-DRG 8922
|
| Min. Negotiated Rate |
$7,251.40 |
| Max. Negotiated Rate |
$11,481.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,251.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,641.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,481.38
|
|
|
HIV WITH MAJOR HIV RELATED CONDITION
|
Facility
|
IP
|
$15,906.15
|
|
|
Service Code
|
APR-DRG 8923
|
| Min. Negotiated Rate |
$10,045.99 |
| Max. Negotiated Rate |
$15,906.15 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,045.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,971.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,906.15
|
|
|
HIV WITH MAJOR HIV RELATED CONDITION
|
Facility
|
IP
|
$24,741.53
|
|
|
Service Code
|
APR-DRG 8924
|
| Min. Negotiated Rate |
$15,626.23 |
| Max. Negotiated Rate |
$24,741.53 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,626.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18,621.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24,741.53
|
|
|
HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS
|
Facility
|
IP
|
$12,885.95
|
|
|
Service Code
|
APR-DRG 8901
|
| Min. Negotiated Rate |
$8,138.50 |
| Max. Negotiated Rate |
$12,885.95 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,138.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,698.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,885.95
|
|
|
HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS
|
Facility
|
IP
|
$20,236.96
|
|
|
Service Code
|
APR-DRG 8903
|
| Min. Negotiated Rate |
$12,781.24 |
| Max. Negotiated Rate |
$20,236.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,781.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15,230.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20,236.96
|
|
|
HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS
|
Facility
|
IP
|
$38,668.52
|
|
|
Service Code
|
APR-DRG 8904
|
| Min. Negotiated Rate |
$24,422.22 |
| Max. Negotiated Rate |
$38,668.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$24,422.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29,103.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38,668.52
|
|
|
HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS
|
Facility
|
IP
|
$13,565.20
|
|
|
Service Code
|
APR-DRG 8902
|
| Min. Negotiated Rate |
$8,567.50 |
| Max. Negotiated Rate |
$13,565.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,567.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,209.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,565.20
|
|
