|
OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1821
|
| Min. Negotiated Rate |
$18,498.12 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,498.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$22,043.59
|
|
|
OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1822
|
| Min. Negotiated Rate |
$20,086.39 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$20,086.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$23,936.28
|
|
|
OTHER PNEUMONIA
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1391
|
| Min. Negotiated Rate |
$4,482.56 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,482.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$5,341.72
|
|
|
OTHER PNEUMONIA
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1392
|
| Min. Negotiated Rate |
$6,217.56 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,217.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$7,409.26
|
|
|
OTHER PNEUMONIA
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1393
|
| Min. Negotiated Rate |
$8,617.90 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,617.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$10,269.66
|
|
|
OTHER PNEUMONIA
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1394
|
| Min. Negotiated Rate |
$12,960.44 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,960.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$15,444.53
|
|
|
OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 4052
|
| Min. Negotiated Rate |
$14,632.73 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,632.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$17,437.33
|
|
|
OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS
|
Facility
IP
|
$52,558.92
|
|
|
Service Code
|
APR-DRG 4054
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$52,558.92 |
| Rate for Payer: Adventist Health Medi-Cal |
$44,105.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$52,558.92
|
|
|
OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 4053
|
| Min. Negotiated Rate |
$22,226.87 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,226.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$26,487.02
|
|
|
OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 4051
|
| Min. Negotiated Rate |
$12,978.37 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,978.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$15,465.89
|
|
|
OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS
|
Facility
IP
|
$56,951.62
|
|
|
Service Code
|
APR-DRG 6514
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$56,951.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$47,791.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$56,951.62
|
|
|
OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 6512
|
| Min. Negotiated Rate |
$15,383.18 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,383.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$18,331.63
|
|
|
OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 6511
|
| Min. Negotiated Rate |
$10,508.59 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,508.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$12,522.74
|
|
|
OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 6513
|
| Min. Negotiated Rate |
$20,799.89 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$20,799.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$24,786.53
|
|
|
OTHER RESPIRATORY AND CHEST PROCEDURES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1212
|
| Min. Negotiated Rate |
$17,195.47 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,195.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$20,491.27
|
|
|
OTHER RESPIRATORY AND CHEST PROCEDURES
|
Facility
IP
|
$51,758.06
|
|
|
Service Code
|
APR-DRG 1214
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$51,758.06 |
| Rate for Payer: Adventist Health Medi-Cal |
$43,433.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$51,758.06
|
|
|
OTHER RESPIRATORY AND CHEST PROCEDURES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1213
|
| Min. Negotiated Rate |
$26,154.98 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$26,154.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$31,168.02
|
|
|
OTHER RESPIRATORY AND CHEST PROCEDURES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1211
|
| Min. Negotiated Rate |
$13,300.96 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,300.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$15,850.31
|
|
|
OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1434
|
| Min. Negotiated Rate |
$15,574.72 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,574.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$18,559.87
|
|
|
OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1431
|
| Min. Negotiated Rate |
$4,987.72 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,987.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$5,943.69
|
|
|
OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1432
|
| Min. Negotiated Rate |
$7,067.70 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,067.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$8,422.34
|
|
|
OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1433
|
| Min. Negotiated Rate |
$10,112.09 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,112.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$12,050.24
|
|
|
OTHER RESPIRATORY PROBLEMS AFTER BIRTH
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 609
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 205
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 206
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
