|
EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
IP
|
$14,001.17
|
|
|
Service Code
|
APR-DRG 9111
|
| Min. Negotiated Rate |
$14,001.17 |
| Max. Negotiated Rate |
$14,001.17 |
| Rate for Payer: IEHP Medi-Cal |
$14,001.17
|
|
|
EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
IP
|
$18,966.70
|
|
|
Service Code
|
APR-DRG 9112
|
| Min. Negotiated Rate |
$18,966.70 |
| Max. Negotiated Rate |
$18,966.70 |
| Rate for Payer: IEHP Medi-Cal |
$18,966.70
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
IP
|
$22,805.01
|
|
|
Service Code
|
APR-DRG 7923
|
| Min. Negotiated Rate |
$22,805.01 |
| Max. Negotiated Rate |
$22,805.01 |
| Rate for Payer: IEHP Medi-Cal |
$22,805.01
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
IP
|
$12,100.92
|
|
|
Service Code
|
APR-DRG 7921
|
| Min. Negotiated Rate |
$12,100.92 |
| Max. Negotiated Rate |
$12,100.92 |
| Rate for Payer: IEHP Medi-Cal |
$12,100.92
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
IP
|
$15,305.48
|
|
|
Service Code
|
APR-DRG 7922
|
| Min. Negotiated Rate |
$15,305.48 |
| Max. Negotiated Rate |
$15,305.48 |
| Rate for Payer: IEHP Medi-Cal |
$15,305.48
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
IP
|
$42,808.38
|
|
|
Service Code
|
APR-DRG 7924
|
| Min. Negotiated Rate |
$42,808.38 |
| Max. Negotiated Rate |
$42,808.38 |
| Rate for Payer: IEHP Medi-Cal |
$42,808.38
|
|
|
EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
IP
|
$26,233.42
|
|
|
Service Code
|
APR-DRG 9503
|
| Min. Negotiated Rate |
$26,233.42 |
| Max. Negotiated Rate |
$26,233.42 |
| Rate for Payer: IEHP Medi-Cal |
$26,233.42
|
|
|
EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
IP
|
$47,862.46
|
|
|
Service Code
|
APR-DRG 9504
|
| Min. Negotiated Rate |
$47,862.46 |
| Max. Negotiated Rate |
$47,862.46 |
| Rate for Payer: IEHP Medi-Cal |
$47,862.46
|
|
|
EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
IP
|
$12,746.60
|
|
|
Service Code
|
APR-DRG 9501
|
| Min. Negotiated Rate |
$12,746.60 |
| Max. Negotiated Rate |
$12,746.60 |
| Rate for Payer: IEHP Medi-Cal |
$12,746.60
|
|
|
EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
IP
|
$17,326.12
|
|
|
Service Code
|
APR-DRG 9502
|
| Min. Negotiated Rate |
$17,326.12 |
| Max. Negotiated Rate |
$17,326.12 |
| Rate for Payer: IEHP Medi-Cal |
$17,326.12
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT
|
Facility
IP
|
$6,243.97
|
|
|
Service Code
|
APR-DRG 8432
|
| Min. Negotiated Rate |
$6,243.97 |
| Max. Negotiated Rate |
$6,243.97 |
| Rate for Payer: IEHP Medi-Cal |
$6,243.97
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT
|
Facility
IP
|
$17,423.62
|
|
|
Service Code
|
APR-DRG 8434
|
| Min. Negotiated Rate |
$17,423.62 |
| Max. Negotiated Rate |
$17,423.62 |
| Rate for Payer: IEHP Medi-Cal |
$17,423.62
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT
|
Facility
IP
|
$8,461.59
|
|
|
Service Code
|
APR-DRG 8433
|
| Min. Negotiated Rate |
$8,461.59 |
| Max. Negotiated Rate |
$8,461.59 |
| Rate for Payer: IEHP Medi-Cal |
$8,461.59
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT
|
Facility
IP
|
$4,068.13
|
|
|
Service Code
|
APR-DRG 8431
|
| Min. Negotiated Rate |
$4,068.13 |
| Max. Negotiated Rate |
$4,068.13 |
| Rate for Payer: IEHP Medi-Cal |
$4,068.13
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT
|
Facility
IP
|
$54,422.80
|
|
|
Service Code
|
APR-DRG 8413
|
| Min. Negotiated Rate |
$54,422.80 |
| Max. Negotiated Rate |
$54,422.80 |
| Rate for Payer: IEHP Medi-Cal |
$54,422.80
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT
|
Facility
IP
|
$15,932.27
|
|
|
Service Code
|
APR-DRG 8412
|
| Min. Negotiated Rate |
$15,932.27 |
| Max. Negotiated Rate |
$15,932.27 |
| Rate for Payer: IEHP Medi-Cal |
$15,932.27
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT
|
Facility
IP
|
$13,997.19
|
|
|
Service Code
|
APR-DRG 8411
|
| Min. Negotiated Rate |
$13,997.19 |
| Max. Negotiated Rate |
$13,997.19 |
| Rate for Payer: IEHP Medi-Cal |
$13,997.19
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT
|
Facility
IP
|
$148,295.22
|
|
|
Service Code
|
APR-DRG 8414
|
| Min. Negotiated Rate |
$148,295.22 |
| Max. Negotiated Rate |
$148,295.22 |
| Rate for Payer: IEHP Medi-Cal |
$148,295.22
|
|
|
EXTERNAL HEART ASSIST SYSTEMS
|
Facility
IP
|
$43,578.43
|
|
|
Service Code
|
APR-DRG 1781
|
| Min. Negotiated Rate |
$43,578.43 |
| Max. Negotiated Rate |
$43,578.43 |
| Rate for Payer: IEHP Medi-Cal |
$43,578.43
|
|
|
EXTERNAL HEART ASSIST SYSTEMS
|
Facility
IP
|
$70,887.33
|
|
|
Service Code
|
APR-DRG 1784
|
| Min. Negotiated Rate |
$70,887.33 |
| Max. Negotiated Rate |
$70,887.33 |
| Rate for Payer: IEHP Medi-Cal |
$70,887.33
|
|
|
EXTERNAL HEART ASSIST SYSTEMS
|
Facility
IP
|
$52,441.96
|
|
|
Service Code
|
APR-DRG 1783
|
| Min. Negotiated Rate |
$52,441.96 |
| Max. Negotiated Rate |
$52,441.96 |
| Rate for Payer: IEHP Medi-Cal |
$52,441.96
|
|
|
EXTERNAL HEART ASSIST SYSTEMS
|
Facility
IP
|
$48,859.34
|
|
|
Service Code
|
APR-DRG 1782
|
| Min. Negotiated Rate |
$48,859.34 |
| Max. Negotiated Rate |
$48,859.34 |
| Rate for Payer: IEHP Medi-Cal |
$48,859.34
|
|
|
Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; without endoscopic cyclophotocoagulation
|
Facility
OP
|
$9,792.00
|
|
|
Service Code
|
CPT 66982
|
| Min. Negotiated Rate |
$313.62 |
| Max. Negotiated Rate |
$9,792.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,792.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: Dignity Health Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,911.63
|
| Rate for Payer: Humana Medicare |
$2,911.63
|
| Rate for Payer: IEHP Medi-Cal |
$313.62
|
| Rate for Payer: IEHP Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,532.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,435.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,668.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,202.79
|
| Rate for Payer: TriValley Medical Group Senior |
$2,911.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more
|
Facility
OP
|
$12,407.40
|
|
|
Service Code
|
CPT 66991
|
| Min. Negotiated Rate |
$926.94 |
| Max. Negotiated Rate |
$12,407.40 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,245.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,795.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,183.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,530.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,792.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,795.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,183.23
|
| Rate for Payer: Dignity Health Senior |
$6,530.21
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,530.21
|
| Rate for Payer: Humana Medicare |
$6,530.21
|
| Rate for Payer: IEHP Medi-Cal |
$926.94
|
| Rate for Payer: IEHP Medicare Advantage |
$6,530.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,407.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,705.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,228.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,228.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,183.23
|
| Rate for Payer: TriValley Medical Group Senior |
$6,530.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,795.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,183.23
|
| Rate for Payer: Vantage Medical Group Senior |
$6,530.21
|
|
|
Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation
|
Facility
OP
|
$9,792.00
|
|
|
Service Code
|
CPT 66984
|
| Min. Negotiated Rate |
$313.62 |
| Max. Negotiated Rate |
$9,792.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,792.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: Dignity Health Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,911.63
|
| Rate for Payer: Humana Medicare |
$2,911.63
|
| Rate for Payer: IEHP Medi-Cal |
$313.62
|
| Rate for Payer: IEHP Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,532.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,435.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,668.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,202.79
|
| Rate for Payer: TriValley Medical Group Senior |
$2,911.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
