|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
IP
|
$13,180.78
|
|
|
Service Code
|
APR-DRG 1932
|
| Min. Negotiated Rate |
$11,060.80 |
| Max. Negotiated Rate |
$13,180.78 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,060.80
|
| Rate for Payer: IEHP medi-cal |
$13,180.78
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
IP
|
$8,948.24
|
|
|
Service Code
|
APR-DRG 1931
|
| Min. Negotiated Rate |
$7,509.01 |
| Max. Negotiated Rate |
$8,948.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,509.01
|
| Rate for Payer: IEHP medi-cal |
$8,948.24
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
IP
|
$27,131.70
|
|
|
Service Code
|
APR-DRG 1934
|
| Min. Negotiated Rate |
$22,767.86 |
| Max. Negotiated Rate |
$27,131.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,767.86
|
| Rate for Payer: IEHP medi-cal |
$27,131.70
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
IP
|
$17,458.68
|
|
|
Service Code
|
APR-DRG 1933
|
| Min. Negotiated Rate |
$14,650.64 |
| Max. Negotiated Rate |
$17,458.68 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,650.64
|
| Rate for Payer: IEHP medi-cal |
$17,458.68
|
|
|
ACUTE ANXIETY AND DELIRIUM STATES
|
Facility
IP
|
$14,490.18
|
|
|
Service Code
|
APR-DRG 7564
|
| Min. Negotiated Rate |
$12,159.59 |
| Max. Negotiated Rate |
$14,490.18 |
| Rate for Payer: Adventist Health Medi-Cal |
$12,159.59
|
| Rate for Payer: IEHP medi-cal |
$14,490.18
|
|
|
ACUTE ANXIETY AND DELIRIUM STATES
|
Facility
IP
|
$7,012.83
|
|
|
Service Code
|
APR-DRG 7563
|
| Min. Negotiated Rate |
$5,884.90 |
| Max. Negotiated Rate |
$7,012.83 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,884.90
|
| Rate for Payer: IEHP medi-cal |
$7,012.83
|
|
|
ACUTE ANXIETY AND DELIRIUM STATES
|
Facility
IP
|
$6,764.57
|
|
|
Service Code
|
APR-DRG 7562
|
| Min. Negotiated Rate |
$5,676.56 |
| Max. Negotiated Rate |
$6,764.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,676.56
|
| Rate for Payer: IEHP medi-cal |
$6,764.57
|
|
|
ACUTE ANXIETY AND DELIRIUM STATES
|
Facility
IP
|
$5,173.54
|
|
|
Service Code
|
APR-DRG 7561
|
| Min. Negotiated Rate |
$4,341.43 |
| Max. Negotiated Rate |
$5,173.54 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,341.43
|
| Rate for Payer: IEHP medi-cal |
$5,173.54
|
|
|
ACUTE BRONCHITIS AND RELATED SYMPTOMS
|
Facility
IP
|
$5,520.57
|
|
|
Service Code
|
APR-DRG 1451
|
| Min. Negotiated Rate |
$4,632.65 |
| Max. Negotiated Rate |
$5,520.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,632.65
|
| Rate for Payer: IEHP medi-cal |
$5,520.57
|
|
|
ACUTE BRONCHITIS AND RELATED SYMPTOMS
|
Facility
IP
|
$9,104.41
|
|
|
Service Code
|
APR-DRG 1453
|
| Min. Negotiated Rate |
$7,640.06 |
| Max. Negotiated Rate |
$9,104.41 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,640.06
|
| Rate for Payer: IEHP medi-cal |
$9,104.41
|
|
|
ACUTE BRONCHITIS AND RELATED SYMPTOMS
|
Facility
IP
|
$7,056.89
|
|
|
Service Code
|
APR-DRG 1452
|
| Min. Negotiated Rate |
$5,921.87 |
| Max. Negotiated Rate |
$7,056.89 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,921.87
|
| Rate for Payer: IEHP medi-cal |
$7,056.89
|
|
|
ACUTE BRONCHITIS AND RELATED SYMPTOMS
|
Facility
IP
|
$13,869.51
|
|
|
Service Code
|
APR-DRG 1454
|
| Min. Negotiated Rate |
$11,638.75 |
| Max. Negotiated Rate |
$13,869.51 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,638.75
|
| Rate for Payer: IEHP medi-cal |
$13,869.51
|
|
|
ACUTE KIDNEY INJURY
|
Facility
IP
|
$7,119.63
|
|
|
Service Code
|
APR-DRG 4692
|
| Min. Negotiated Rate |
$5,974.51 |
| Max. Negotiated Rate |
$7,119.63 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,974.51
|
| Rate for Payer: IEHP medi-cal |
$7,119.63
|
|
|
ACUTE KIDNEY INJURY
|
Facility
IP
|
$20,790.26
|
|
|
Service Code
|
APR-DRG 4694
|
| Min. Negotiated Rate |
$17,446.37 |
| Max. Negotiated Rate |
$20,790.26 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,446.37
|
| Rate for Payer: IEHP medi-cal |
$20,790.26
|
|
|
ACUTE KIDNEY INJURY
|
Facility
IP
|
$11,111.90
|
|
|
Service Code
|
APR-DRG 4693
|
| Min. Negotiated Rate |
$9,324.67 |
| Max. Negotiated Rate |
$11,111.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,324.67
|
| Rate for Payer: IEHP medi-cal |
$11,111.90
|
|
|
ACUTE KIDNEY INJURY
|
Facility
IP
|
$5,489.87
|
|
|
Service Code
|
APR-DRG 4691
|
| Min. Negotiated Rate |
$4,606.88 |
| Max. Negotiated Rate |
$5,489.87 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,606.88
|
| Rate for Payer: IEHP medi-cal |
$5,489.87
|
|
|
ACUTE LEUKEMIA
|
Facility
IP
|
$62,980.75
|
|
|
Service Code
|
APR-DRG 6904
|
| Min. Negotiated Rate |
$52,850.98 |
| Max. Negotiated Rate |
$62,980.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$52,850.98
|
| Rate for Payer: IEHP medi-cal |
$62,980.75
|
|
|
ACUTE LEUKEMIA
|
Facility
IP
|
$19,419.46
|
|
|
Service Code
|
APR-DRG 6902
|
| Min. Negotiated Rate |
$16,296.05 |
| Max. Negotiated Rate |
$19,419.46 |
| Rate for Payer: Adventist Health Medi-Cal |
$16,296.05
|
| Rate for Payer: IEHP medi-cal |
$19,419.46
|
|
|
ACUTE LEUKEMIA
|
Facility
IP
|
$10,029.41
|
|
|
Service Code
|
APR-DRG 6901
|
| Min. Negotiated Rate |
$8,416.28 |
| Max. Negotiated Rate |
$10,029.41 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,416.28
|
| Rate for Payer: IEHP medi-cal |
$10,029.41
|
|
|
ACUTE LEUKEMIA
|
Facility
IP
|
$36,172.05
|
|
|
Service Code
|
APR-DRG 6903
|
| Min. Negotiated Rate |
$30,354.17 |
| Max. Negotiated Rate |
$36,172.05 |
| Rate for Payer: Adventist Health Medi-Cal |
$30,354.17
|
| Rate for Payer: IEHP medi-cal |
$36,172.05
|
|
|
ACUTE MYOCARDIAL INFARCTION
|
Facility
IP
|
$9,207.18
|
|
|
Service Code
|
APR-DRG 1901
|
| Min. Negotiated Rate |
$7,726.31 |
| Max. Negotiated Rate |
$9,207.18 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,726.31
|
| Rate for Payer: IEHP medi-cal |
$9,207.18
|
|
|
ACUTE MYOCARDIAL INFARCTION
|
Facility
IP
|
$18,651.96
|
|
|
Service Code
|
APR-DRG 1904
|
| Min. Negotiated Rate |
$15,652.00 |
| Max. Negotiated Rate |
$18,651.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,652.00
|
| Rate for Payer: IEHP medi-cal |
$18,651.96
|
|
|
ACUTE MYOCARDIAL INFARCTION
|
Facility
IP
|
$10,037.41
|
|
|
Service Code
|
APR-DRG 1902
|
| Min. Negotiated Rate |
$8,423.00 |
| Max. Negotiated Rate |
$10,037.41 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,423.00
|
| Rate for Payer: IEHP medi-cal |
$10,037.41
|
|
|
ACUTE MYOCARDIAL INFARCTION
|
Facility
IP
|
$12,853.76
|
|
|
Service Code
|
APR-DRG 1903
|
| Min. Negotiated Rate |
$10,786.37 |
| Max. Negotiated Rate |
$12,853.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$10,786.37
|
| Rate for Payer: IEHP medi-cal |
$12,853.76
|
|
|
ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION [8970]
|
Facility
IP
|
$0.90
|
|
|
Service Code
|
CPT J8499
|
| Hospital Charge Code |
1715057
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California Commercial |
$0.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.48
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Central Health Plan Commercial |
$0.16
|
| Rate for Payer: Central Health Plan Commercial |
$0.72
|
| Rate for Payer: Cigna of CA HMO |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.63
|
| Rate for Payer: Cigna of CA PPO |
$0.14
|
| Rate for Payer: Cigna of CA PPO |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Galaxy Health WC |
$0.17
|
| Rate for Payer: Global Benefits Group Commercial |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Networks By Design Commercial |
$0.13
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$0.17
|
|
