|
Percutaneous nephrolithotomy or pyelolithotomy, lithotripsy, stone extraction, antegrade ureteroscopy, antegrade stent placement and nephrostomy tube placement, when performed, including imaging guidance; simple (eg, stone[s] up to 2 cm in single location of kidney or renal pelvis, nonbranching stones)
|
Facility
|
OP
|
$25,512.00
|
|
|
Service Code
|
CPT 50080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,073.78 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,510.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,265.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,661.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,510.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$15,736.05
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$11,510.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,265.26
|
| Rate for Payer: Dignity Health Media |
$11,510.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,661.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,538.73
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11,510.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$11,510.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18,876.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18,991.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,510.17
|
| Rate for Payer: InnovAge PACE Commercial |
$17,265.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,073.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,510.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,423.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,423.63
|
| Rate for Payer: Multiplan WC |
$15,736.05
|
| Rate for Payer: Preferred Health Network WC |
$16,057.19
|
| Rate for Payer: Prime Health Services Medicare |
$12,200.78
|
| Rate for Payer: Prime Health Services WC |
$15,575.47
|
| Rate for Payer: Riverside University Health System MISP |
$12,661.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,265.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,661.19
|
| Rate for Payer: Vantage Medical Group Senior |
$11,510.17
|
|
|
Percutaneous skeletal fixation of distal phalangeal fracture, finger or thumb, each
|
Facility
|
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 26756
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$693.94 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| 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/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,672.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$693.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| 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 skeletal fixation of distal radial fracture or epiphyseal separation
|
Facility
|
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 25606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$987.96 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| 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/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,672.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| 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 |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| 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 skeletal fixation of interphalangeal joint dislocation, single, with manipulation
|
Facility
|
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 26776
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$393.30 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| 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/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,672.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$393.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| 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 skeletal fixation of metacarpal fracture, each bone
|
Facility
|
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 26608
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$443.52 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| 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/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,672.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| 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 skeletal fixation of metatarsophalangeal joint dislocation, with manipulation
|
Facility
|
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 28636
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$55.88 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| 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 Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| 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/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,672.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| 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 skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns that disrupt the pelvic ring, unilateral (includes ipsilateral ilium, sacroiliac joint and/or sacrum)
|
Facility
|
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 27216
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$883.50 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,958.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$883.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
|
|
Percutaneous skeletal fixation of unstable phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, with manipulation, each
|
Facility
|
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 26727
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$414.52 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| 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 Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| 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/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,672.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| 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
|
$75,746.26
|
|
|
Service Code
|
APR-DRG 1833
|
| Min. Negotiated Rate |
$47,839.74 |
| Max. Negotiated Rate |
$75,746.26 |
| Rate for Payer: Adventist Health Medi-Cal |
$47,839.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57,009.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75,746.26
|
|
|
PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES
|
Facility
|
IP
|
$63,239.81
|
|
|
Service Code
|
APR-DRG 1831
|
| Min. Negotiated Rate |
$39,940.93 |
| Max. Negotiated Rate |
$63,239.81 |
| Rate for Payer: Adventist Health Medi-Cal |
$39,940.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47,596.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63,239.81
|
|
|
PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES
|
Facility
|
IP
|
$65,052.30
|
|
|
Service Code
|
APR-DRG 1832
|
| Min. Negotiated Rate |
$41,085.66 |
| Max. Negotiated Rate |
$65,052.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$41,085.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$48,960.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65,052.30
|
|
|
PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES
|
Facility
|
IP
|
$107,828.14
|
|
|
Service Code
|
APR-DRG 1834
|
| Min. Negotiated Rate |
$68,101.98 |
| Max. Negotiated Rate |
$107,828.14 |
| Rate for Payer: Adventist Health Medi-Cal |
$68,101.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$81,154.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107,828.14
|
|
|
Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation
|
Facility
|
OP
|
$8,958.72
|
|
|
Service Code
|
CPT 33340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,289.53 |
| Max. Negotiated Rate |
$8,958.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,334.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,958.72
|
| Rate for Payer: Blue Shield of California EPN |
$6,434.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,289.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
|
|
Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure)
|
Facility
|
OP
|
$9,194.24
|
|
|
Service Code
|
CPT 22515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$370.67 |
| Max. Negotiated Rate |
$9,194.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$370.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
|
|
Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; lumbar
|
Facility
|
OP
|
$27,445.00
|
|
|
Service Code
|
CPT 22514
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$165.53 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,938.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,220.24
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$8,938.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,659.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,748.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: InnovAge PACE Commercial |
$13,407.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,977.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Preferred Health Network WC |
$12,469.63
|
| Rate for Payer: Prime Health Services Medicare |
$9,474.84
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Riverside University Health System MISP |
$9,832.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic
|
Facility
|
OP
|
$27,445.00
|
|
|
Service Code
|
CPT 22513
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$887.03 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,938.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,220.24
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$8,938.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,659.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,748.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: InnovAge PACE Commercial |
$13,407.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$887.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,977.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Preferred Health Network WC |
$12,469.63
|
| Rate for Payer: Prime Health Services Medicare |
$9,474.84
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Riverside University Health System MISP |
$9,832.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
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 |
$11.23 |
| Max. Negotiated Rate |
$261.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$261.26
|
| 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 Exchange |
$84.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.56
|
| Rate for Payer: Blue Distinction Transplant |
$33.70
|
| Rate for Payer: Blue Shield of California Commercial |
$35.32
|
| Rate for Payer: Blue Shield of California EPN |
$27.46
|
| Rate for Payer: Cash Price |
$25.27
|
| Rate for Payer: Cash Price |
$25.27
|
| Rate for Payer: Central Health Plan Commercial |
$44.93
|
| 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 Management Network EPO/PPO |
$50.54
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$42.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.79
|
| 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 |
$11.23
|
| Rate for Payer: Multiplan Commercial |
$42.12
|
| Rate for Payer: Networks By Design Commercial |
$28.08
|
| Rate for Payer: Prime Health Services Commercial |
$47.74
|
| Rate for Payer: Riverside University Health System MISP |
$22.46
|
| 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 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 |
$11.23 |
| Max. Negotiated Rate |
$50.54 |
| Rate for Payer: Blue Shield of California Commercial |
$42.12
|
| Rate for Payer: Blue Shield of California EPN |
$29.99
|
| Rate for Payer: Cash Price |
$25.27
|
| Rate for Payer: Central Health Plan Commercial |
$44.93
|
| 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: Health Management Network EPO/PPO |
$50.54
|
| 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 |
$11.23
|
| Rate for Payer: Multiplan Commercial |
$42.12
|
| 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
|
|
|
Peri-implant capsulectomy, breast, complete, including removal of all intracapsular contents
|
Facility
|
OP
|
$19,907.00
|
|
|
Service Code
|
CPT 19371
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$801.46 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,762.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,762.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$4,762.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Dignity Health Media |
$4,762.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,238.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,429.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,762.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,762.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,810.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,858.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,762.51
|
| Rate for Payer: InnovAge PACE Commercial |
$7,143.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$801.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,762.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,381.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,381.76
|
| Rate for Payer: Prime Health Services Medicare |
$5,048.26
|
| Rate for Payer: Riverside University Health System MISP |
$5,238.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4,762.51
|
|
|
Perineoplasty, repair of perineum, nonobstetrical (separate procedure)
|
Facility
|
OP
|
$15,354.00
|
|
|
Service Code
|
CPT 56810
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$471.73 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,906.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Caremore Medicare Advantage |
$3,906.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,445.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: InnovAge PACE Commercial |
$5,859.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$471.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,234.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Riverside University Health System MISP |
$4,296.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
PERIPHERAL AND OTHER VASCULAR DISORDERS
|
Facility
|
IP
|
$7,482.22
|
|
|
Service Code
|
APR-DRG 1971
|
| Min. Negotiated Rate |
$4,725.61 |
| Max. Negotiated Rate |
$7,482.22 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,725.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,631.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,482.22
|
|
|
PERIPHERAL AND OTHER VASCULAR DISORDERS
|
Facility
|
IP
|
$13,818.80
|
|
|
Service Code
|
APR-DRG 1973
|
| Min. Negotiated Rate |
$8,727.66 |
| Max. Negotiated Rate |
$13,818.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,727.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10,400.46
|
| 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 |
$15,905.14 |
| Max. Negotiated Rate |
$25,183.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,905.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18,953.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25,183.13
|
|
|
PERIPHERAL AND OTHER VASCULAR DISORDERS
|
Facility
|
IP
|
$9,993.45
|
|
|
Service Code
|
APR-DRG 1972
|
| Min. Negotiated Rate |
$6,311.65 |
| Max. Negotiated Rate |
$9,993.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,311.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,521.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,993.45
|
|
|
PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS
|
Facility
|
IP
|
$14,937.86
|
|
|
Service Code
|
APR-DRG 0483
|
| Min. Negotiated Rate |
$9,434.44 |
| Max. Negotiated Rate |
$14,937.86 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,434.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,242.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,937.86
|
|
