|
EXEMESTANE 25 MG TABLET [26551]
|
Facility
|
IP
|
$13.03
|
|
|
Service Code
|
NDC 0054008013
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.73 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Blue Shield of California Commercial |
$10.45
|
| Rate for Payer: Blue Shield of California EPN |
$6.57
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Central Health Plan Commercial |
$10.42
|
| Rate for Payer: Cigna of CA HMO |
$9.12
|
| Rate for Payer: Cigna of CA PPO |
$9.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.21
|
| Rate for Payer: EPIC Health Plan Senior |
$5.21
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$9.77
|
| Rate for Payer: Networks By Design Commercial |
$8.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
|
|
EXEMESTANE 25 MG TABLET [26551]
|
Facility
|
OP
|
$13.03
|
|
|
Service Code
|
NDC 0054008013
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.73 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.58
|
| Rate for Payer: Blue Shield of California Commercial |
$8.26
|
| Rate for Payer: Blue Shield of California EPN |
$5.20
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Central Health Plan Commercial |
$10.42
|
| Rate for Payer: Cigna of CA HMO |
$9.12
|
| Rate for Payer: Cigna of CA PPO |
$9.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.21
|
| Rate for Payer: EPIC Health Plan Senior |
$5.21
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.12
|
| Rate for Payer: Multiplan Commercial |
$9.77
|
| Rate for Payer: Networks By Design Commercial |
$8.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
| Rate for Payer: Riverside University Health System MISP |
$5.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.51
|
| Rate for Payer: United Healthcare All Other HMO |
$6.51
|
| Rate for Payer: United Healthcare HMO Rider |
$6.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.08
|
| Rate for Payer: Vantage Medical Group Senior |
$11.08
|
|
|
EXEMESTANE 25 MG TABLET [26551]
|
Facility
|
IP
|
$48.35
|
|
|
Service Code
|
NDC 0009766304
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$43.52 |
| Rate for Payer: Adventist Health Commercial |
$9.67
|
| Rate for Payer: Blue Shield of California Commercial |
$38.78
|
| Rate for Payer: Blue Shield of California EPN |
$24.37
|
| Rate for Payer: Cash Price |
$21.76
|
| Rate for Payer: Central Health Plan Commercial |
$38.68
|
| Rate for Payer: Cigna of CA HMO |
$33.84
|
| Rate for Payer: Cigna of CA PPO |
$33.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.34
|
| Rate for Payer: EPIC Health Plan Senior |
$19.34
|
| Rate for Payer: Galaxy Health WC |
$41.10
|
| Rate for Payer: Global Benefits Group Commercial |
$29.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.67
|
| Rate for Payer: Multiplan Commercial |
$36.26
|
| Rate for Payer: Networks By Design Commercial |
$31.43
|
| Rate for Payer: Prime Health Services Commercial |
$41.10
|
|
|
EXPLORATION FOR POSTOPERATIVE HEMORRHAGE, THROMBOSIS OR INFECTION; NECK
|
Facility
|
OP
|
$28,817.00
|
|
|
Service Code
|
CPT 35800
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$682.62 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,156.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,808.82
|
| Rate for Payer: EPIC Health Plan Senior |
$7,872.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,737.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$682.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$754.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,019.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Prime Health Services Medicare |
$7,586.27
|
| Rate for Payer: Riverside University Health System MISP |
$7,872.55
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,156.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$55,559.42
|
|
|
Service Code
|
APR-DRG 9113
|
| Min. Negotiated Rate |
$35,090.16 |
| Max. Negotiated Rate |
$55,559.42 |
| Rate for Payer: Adventist Health Medi-Cal |
$35,090.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41,815.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55,559.42
|
|
|
EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$29,542.13
|
|
|
Service Code
|
APR-DRG 9111
|
| Min. Negotiated Rate |
$18,658.19 |
| Max. Negotiated Rate |
$29,542.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,658.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22,234.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29,542.13
|
|
|
EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$103,964.43
|
|
|
Service Code
|
APR-DRG 9114
|
| Min. Negotiated Rate |
$65,661.74 |
| Max. Negotiated Rate |
$103,964.43 |
| Rate for Payer: Adventist Health Medi-Cal |
$65,661.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78,246.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103,964.43
|
|
|
EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$35,864.67
|
|
|
Service Code
|
APR-DRG 9112
|
| Min. Negotiated Rate |
$22,651.37 |
| Max. Negotiated Rate |
$35,864.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,651.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26,992.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35,864.67
|
|
|
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$100,451.73
|
|
|
Service Code
|
MSDRG 933
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$100,451.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100,451.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$64,887.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90,845.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$90,107.49
|
| Rate for Payer: EPIC Health Plan Senior |
$60,071.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$54,610.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76,454.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$73,178.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$54,610.60
|
| Rate for Payer: Prime Health Services Medicare |
$57,887.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT
|
Facility
|
IP
|
$487,358.39
|
|
|
Service Code
|
MSDRG 927
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$487,358.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$485,064.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$313,331.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$438,675.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$487,358.39
|
| Rate for Payer: EPIC Health Plan Senior |
$324,905.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295,368.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$413,516.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$395,794.08
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$295,368.72
|
| Rate for Payer: Prime Health Services Medicare |
$313,090.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$73,620.67
|
|
|
Service Code
|
APR-DRG 7924
|
| Min. Negotiated Rate |
$46,497.26 |
| Max. Negotiated Rate |
$73,620.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$46,497.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$55,409.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$73,620.67
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$22,832.85
|
|
|
Service Code
|
APR-DRG 7921
|
| Min. Negotiated Rate |
$14,420.75 |
| Max. Negotiated Rate |
$22,832.85 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,420.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17,184.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22,832.85
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$29,086.91
|
|
|
Service Code
|
APR-DRG 7922
|
| Min. Negotiated Rate |
$18,370.68 |
| Max. Negotiated Rate |
$29,086.91 |
| Rate for Payer: Adventist Health Medi-Cal |
$18,370.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21,891.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29,086.91
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$42,654.51
|
|
|
Service Code
|
APR-DRG 7923
|
| Min. Negotiated Rate |
$26,939.69 |
| Max. Negotiated Rate |
$42,654.51 |
| Rate for Payer: Adventist Health Medi-Cal |
$26,939.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32,103.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42,654.51
|
|
|
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC
|
Facility
|
IP
|
$64,705.26
|
|
|
Service Code
|
MSDRG 982
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$64,705.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$64,705.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41,796.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58,517.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$57,435.41
|
| Rate for Payer: EPIC Health Plan Senior |
$38,290.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34,809.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48,733.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$46,644.52
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$34,809.34
|
| Rate for Payer: Prime Health Services Medicare |
$36,897.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$123,483.48
|
|
|
Service Code
|
MSDRG 981
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$123,483.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$123,483.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79,765.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111,674.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$108,258.38
|
| Rate for Payer: EPIC Health Plan Senior |
$72,172.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65,611.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91,855.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$87,918.93
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$65,611.14
|
| Rate for Payer: Prime Health Services Medicare |
$69,547.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$45,110.77
|
|
|
Service Code
|
MSDRG 983
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$45,110.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45,110.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29,139.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40,796.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$40,492.90
|
| Rate for Payer: EPIC Health Plan Senior |
$26,995.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,541.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34,357.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32,885.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24,541.15
|
| Rate for Payer: Prime Health Services Medicare |
$26,013.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$31,800.03
|
|
|
Service Code
|
APR-DRG 9502
|
| Min. Negotiated Rate |
$20,084.23 |
| Max. Negotiated Rate |
$31,800.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$20,084.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23,933.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31,800.03
|
|
|
EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$49,504.77
|
|
|
Service Code
|
APR-DRG 9503
|
| Min. Negotiated Rate |
$31,266.17 |
| Max. Negotiated Rate |
$49,504.77 |
| Rate for Payer: Adventist Health Medi-Cal |
$31,266.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37,258.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49,504.77
|
|
|
EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$85,014.93
|
|
|
Service Code
|
APR-DRG 9504
|
| Min. Negotiated Rate |
$53,693.64 |
| Max. Negotiated Rate |
$85,014.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$53,693.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$63,984.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85,014.93
|
|
|
EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$23,590.19
|
|
|
Service Code
|
APR-DRG 9501
|
| Min. Negotiated Rate |
$14,899.07 |
| Max. Negotiated Rate |
$23,590.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,899.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17,754.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23,590.19
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$11,287.52
|
|
|
Service Code
|
APR-DRG 8432
|
| Min. Negotiated Rate |
$7,128.96 |
| Max. Negotiated Rate |
$11,287.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,128.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,495.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,287.52
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$8,586.50
|
|
|
Service Code
|
APR-DRG 8431
|
| Min. Negotiated Rate |
$5,423.05 |
| Max. Negotiated Rate |
$8,586.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,423.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,462.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,586.50
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$22,208.45
|
|
|
Service Code
|
APR-DRG 8433
|
| Min. Negotiated Rate |
$14,026.39 |
| Max. Negotiated Rate |
$22,208.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,026.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16,714.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22,208.45
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$32,239.12
|
|
|
Service Code
|
APR-DRG 8434
|
| Min. Negotiated Rate |
$20,361.55 |
| Max. Negotiated Rate |
$32,239.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$20,361.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24,264.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32,239.12
|
|
