|
ANAL AND PERINEAL PROCEDURES
|
Facility
IP
|
$14,238.95
|
|
|
Service Code
|
APR-DRG 2263
|
| Min. Negotiated Rate |
$14,238.95 |
| Max. Negotiated Rate |
$14,238.95 |
| Rate for Payer: IEHP Medi-Cal |
$14,238.95
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
IP
|
$7,334.38
|
|
|
Service Code
|
APR-DRG 2261
|
| Min. Negotiated Rate |
$7,334.38 |
| Max. Negotiated Rate |
$7,334.38 |
| Rate for Payer: IEHP Medi-Cal |
$7,334.38
|
|
|
Anastomosis; facial-hypoglossal
|
Facility
OP
|
$7,436.00
|
|
|
Service Code
|
CPT 64868
|
| Min. Negotiated Rate |
$302.02 |
| Max. Negotiated Rate |
$7,436.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,206.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: IEHP Medi-Cal |
$302.02
|
|
|
ANASTROZOLE 1 MG TABLET [16205]
|
Facility
OP
|
$0.19
|
|
|
Service Code
|
CPT S0170
|
| Hospital Charge Code |
1711729
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$36.71 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.71
|
| Rate for Payer: Blue Shield of California Commercial |
$0.68
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California EPN |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.16
|
| Rate for Payer: Dignity Health Senior |
$0.51
|
| Rate for Payer: Dignity Health Senior |
$0.16
|
| Rate for Payer: Dignity Health Senior |
$0.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.67
|
| Rate for Payer: Heritage Provider Network Senior |
$0.37
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.16
|
| Rate for Payer: Vantage Medical Group Senior |
$0.93
|
| Rate for Payer: Vantage Medical Group Senior |
$0.51
|
|
|
ANASTROZOLE 1 MG TABLET [16205]
|
Facility
IP
|
$1.09
|
|
|
Service Code
|
CPT S0170
|
| Hospital Charge Code |
1711729
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Adventist Health Commercial |
$0.12
|
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.41
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.74
|
| Rate for Payer: Heritage Provider Network Senior |
$0.41
|
| Rate for Payer: Heritage Provider Network Senior |
$0.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.82
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
IP
|
$4,162.64
|
|
|
Service Code
|
APR-DRG 1981
|
| Min. Negotiated Rate |
$4,162.64 |
| Max. Negotiated Rate |
$4,162.64 |
| Rate for Payer: IEHP Medi-Cal |
$4,162.64
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
IP
|
$6,563.33
|
|
|
Service Code
|
APR-DRG 1983
|
| Min. Negotiated Rate |
$6,563.33 |
| Max. Negotiated Rate |
$6,563.33 |
| Rate for Payer: IEHP Medi-Cal |
$6,563.33
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
IP
|
$4,974.48
|
|
|
Service Code
|
APR-DRG 1982
|
| Min. Negotiated Rate |
$4,974.48 |
| Max. Negotiated Rate |
$4,974.48 |
| Rate for Payer: IEHP Medi-Cal |
$4,974.48
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
IP
|
$11,411.45
|
|
|
Service Code
|
APR-DRG 1984
|
| Min. Negotiated Rate |
$11,411.45 |
| Max. Negotiated Rate |
$11,411.45 |
| Rate for Payer: IEHP Medi-Cal |
$11,411.45
|
|
|
ANGIOTENSIN II 2.5 MG/ML INTRAVENOUS SOLUTION [220829]
|
Facility
OP
|
$1,800.00
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
NDG220829
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$325.80 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Adventist Health Commercial |
$360.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$962.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,236.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$990.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,350.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,117.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,056.60
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$828.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,530.00
|
| Rate for Payer: Dignity Health Senior |
$1,530.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$833.40
|
| Rate for Payer: Heritage Provider Network Senior |
$833.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$867.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.00
|
| Rate for Payer: Multiplan Commercial |
$1,350.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$656.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$601.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,530.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,530.00
|
|
|
ANGIOTENSIN II 2.5 MG/ML INTRAVENOUS SOLUTION [220829]
|
Facility
IP
|
$1,800.00
|
|
|
Service Code
|
CPT C9399
|
| Hospital Charge Code |
NDG220829
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$325.80 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Adventist Health Commercial |
$360.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,236.60
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$828.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$972.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,218.60
|
| Rate for Payer: Heritage Provider Network Senior |
$1,218.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.00
|
| Rate for Payer: Multiplan Commercial |
$1,350.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$656.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$601.38
|
|
|
ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION [88093]
|
Facility
IP
|
$229.07
|
|
|
Service Code
|
CPT J0348
|
| Hospital Charge Code |
1753552
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.46 |
| Max. Negotiated Rate |
$171.80 |
| Rate for Payer: Adventist Health Commercial |
$45.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.37
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.08
|
| Rate for Payer: Heritage Provider Network Senior |
$155.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.27
|
| Rate for Payer: Multiplan Commercial |
$171.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$83.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$76.53
|
|
|
ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION [88093]
|
Facility
OP
|
$229.07
|
|
|
Service Code
|
CPT J0348
|
| Hospital Charge Code |
1753552
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$194.71 |
| Rate for Payer: Adventist Health Commercial |
$45.81
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$194.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$125.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$171.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1.95
|
| Rate for Payer: Blue Shield of California EPN |
$1.95
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$194.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.71
|
| Rate for Payer: Dignity Health Senior |
$194.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.06
|
| Rate for Payer: Heritage Provider Network Senior |
$106.06
|
| Rate for Payer: IEHP Medi-Cal |
$7.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$110.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.27
|
| Rate for Payer: Multiplan Commercial |
$171.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$83.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$76.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.71
|
| Rate for Payer: Vantage Medical Group Senior |
$194.71
|
|
|
Anorectal exam, surgical, requiring anesthesia (general, spinal, or epidural), diagnostic
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 45990
|
| Min. Negotiated Rate |
$130.68 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,508.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,858.96
|
| Rate for Payer: Dignity Health Senior |
$3,508.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,508.15
|
| Rate for Payer: Humana Medicare |
$3,508.15
|
| Rate for Payer: IEHP Medi-Cal |
$130.68
|
| Rate for Payer: IEHP Medicare Advantage |
$3,508.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,665.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,139.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,420.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,420.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,858.96
|
| Rate for Payer: TriValley Medical Group Senior |
$3,508.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,508.15
|
|
|
Anoscopy; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 46600
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: IEHP Medi-Cal |
$34.27
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.56
|
| Rate for Payer: TriValley Medical Group Senior |
$159.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
Anoscopy; with biopsy, single or multiple
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 46606
|
| Min. Negotiated Rate |
$45.30 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: Dignity Health Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,474.42
|
| Rate for Payer: Humana Medicare |
$1,474.42
|
| Rate for Payer: IEHP Medi-Cal |
$45.30
|
| Rate for Payer: IEHP Medicare Advantage |
$1,474.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,801.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,857.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,857.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,621.86
|
| Rate for Payer: TriValley Medical Group Senior |
$1,474.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
ANOXIC AND OTHER SEVERE BRAIN DAMAGE
|
Facility
IP
|
$10,590.66
|
|
|
Service Code
|
APR-DRG 0593
|
| Min. Negotiated Rate |
$10,590.66 |
| Max. Negotiated Rate |
$10,590.66 |
| Rate for Payer: IEHP Medi-Cal |
$10,590.66
|
|
|
ANOXIC AND OTHER SEVERE BRAIN DAMAGE
|
Facility
IP
|
$14,657.80
|
|
|
Service Code
|
APR-DRG 0594
|
| Min. Negotiated Rate |
$14,657.80 |
| Max. Negotiated Rate |
$14,657.80 |
| Rate for Payer: IEHP Medi-Cal |
$14,657.80
|
|
|
ANOXIC AND OTHER SEVERE BRAIN DAMAGE
|
Facility
IP
|
$4,570.55
|
|
|
Service Code
|
APR-DRG 0591
|
| Min. Negotiated Rate |
$4,570.55 |
| Max. Negotiated Rate |
$4,570.55 |
| Rate for Payer: IEHP Medi-Cal |
$4,570.55
|
|
|
ANOXIC AND OTHER SEVERE BRAIN DAMAGE
|
Facility
IP
|
$7,507.49
|
|
|
Service Code
|
APR-DRG 0592
|
| Min. Negotiated Rate |
$7,507.49 |
| Max. Negotiated Rate |
$7,507.49 |
| Rate for Payer: IEHP Medi-Cal |
$7,507.49
|
|
|
ANTEPARTUM WITH O.R. PROCEDURE
|
Facility
IP
|
$7,514.45
|
|
|
Service Code
|
APR-DRG 5472
|
| Min. Negotiated Rate |
$7,514.45 |
| Max. Negotiated Rate |
$7,514.45 |
| Rate for Payer: IEHP Medi-Cal |
$7,514.45
|
|
|
ANTEPARTUM WITH O.R. PROCEDURE
|
Facility
IP
|
$5,374.43
|
|
|
Service Code
|
APR-DRG 5471
|
| Min. Negotiated Rate |
$5,374.43 |
| Max. Negotiated Rate |
$5,374.43 |
| Rate for Payer: IEHP Medi-Cal |
$5,374.43
|
|
|
ANTEPARTUM WITH O.R. PROCEDURE
|
Facility
IP
|
$11,165.72
|
|
|
Service Code
|
APR-DRG 5473
|
| Min. Negotiated Rate |
$11,165.72 |
| Max. Negotiated Rate |
$11,165.72 |
| Rate for Payer: IEHP Medi-Cal |
$11,165.72
|
|
|
ANTEPARTUM WITH O.R. PROCEDURE
|
Facility
IP
|
$21,941.33
|
|
|
Service Code
|
APR-DRG 5474
|
| Min. Negotiated Rate |
$21,941.33 |
| Max. Negotiated Rate |
$21,941.33 |
| Rate for Payer: IEHP Medi-Cal |
$21,941.33
|
|
|
ANTEPARTUM WITHOUT O.R. PROCEDURE
|
Facility
IP
|
$4,110.91
|
|
|
Service Code
|
APR-DRG 5663
|
| Min. Negotiated Rate |
$4,110.91 |
| Max. Negotiated Rate |
$4,110.91 |
| Rate for Payer: IEHP Medi-Cal |
$4,110.91
|
|
