|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
IP
|
$6,669.78
|
|
|
Service Code
|
APR-DRG 1931
|
| Min. Negotiated Rate |
$6,669.78 |
| Max. Negotiated Rate |
$6,669.78 |
| Rate for Payer: IEHP Medi-Cal |
$6,669.78
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
IP
|
$13,013.24
|
|
|
Service Code
|
APR-DRG 1933
|
| Min. Negotiated Rate |
$13,013.24 |
| Max. Negotiated Rate |
$13,013.24 |
| Rate for Payer: IEHP Medi-Cal |
$13,013.24
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
IP
|
$9,824.60
|
|
|
Service Code
|
APR-DRG 1932
|
| Min. Negotiated Rate |
$9,824.60 |
| Max. Negotiated Rate |
$9,824.60 |
| Rate for Payer: IEHP Medi-Cal |
$9,824.60
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
IP
|
$20,223.25
|
|
|
Service Code
|
APR-DRG 1934
|
| Min. Negotiated Rate |
$20,223.25 |
| Max. Negotiated Rate |
$20,223.25 |
| Rate for Payer: IEHP Medi-Cal |
$20,223.25
|
|
|
ACUTE ANXIETY AND DELIRIUM STATES
|
Facility
IP
|
$3,856.22
|
|
|
Service Code
|
APR-DRG 7561
|
| Min. Negotiated Rate |
$3,856.22 |
| Max. Negotiated Rate |
$3,856.22 |
| Rate for Payer: IEHP Medi-Cal |
$3,856.22
|
|
|
ACUTE ANXIETY AND DELIRIUM STATES
|
Facility
IP
|
$5,042.13
|
|
|
Service Code
|
APR-DRG 7562
|
| Min. Negotiated Rate |
$5,042.13 |
| Max. Negotiated Rate |
$5,042.13 |
| Rate for Payer: IEHP Medi-Cal |
$5,042.13
|
|
|
ACUTE ANXIETY AND DELIRIUM STATES
|
Facility
IP
|
$10,800.59
|
|
|
Service Code
|
APR-DRG 7564
|
| Min. Negotiated Rate |
$10,800.59 |
| Max. Negotiated Rate |
$10,800.59 |
| Rate for Payer: IEHP Medi-Cal |
$10,800.59
|
|
|
ACUTE ANXIETY AND DELIRIUM STATES
|
Facility
IP
|
$5,227.18
|
|
|
Service Code
|
APR-DRG 7563
|
| Min. Negotiated Rate |
$5,227.18 |
| Max. Negotiated Rate |
$5,227.18 |
| Rate for Payer: IEHP Medi-Cal |
$5,227.18
|
|
|
ACUTE BRONCHITIS AND RELATED SYMPTOMS
|
Facility
IP
|
$4,114.89
|
|
|
Service Code
|
APR-DRG 1451
|
| Min. Negotiated Rate |
$4,114.89 |
| Max. Negotiated Rate |
$4,114.89 |
| Rate for Payer: IEHP Medi-Cal |
$4,114.89
|
|
|
ACUTE BRONCHITIS AND RELATED SYMPTOMS
|
Facility
IP
|
$5,260.01
|
|
|
Service Code
|
APR-DRG 1452
|
| Min. Negotiated Rate |
$5,260.01 |
| Max. Negotiated Rate |
$5,260.01 |
| Rate for Payer: IEHP Medi-Cal |
$5,260.01
|
|
|
ACUTE BRONCHITIS AND RELATED SYMPTOMS
|
Facility
IP
|
$10,337.97
|
|
|
Service Code
|
APR-DRG 1454
|
| Min. Negotiated Rate |
$10,337.97 |
| Max. Negotiated Rate |
$10,337.97 |
| Rate for Payer: IEHP Medi-Cal |
$10,337.97
|
|
|
ACUTE BRONCHITIS AND RELATED SYMPTOMS
|
Facility
IP
|
$6,786.19
|
|
|
Service Code
|
APR-DRG 1453
|
| Min. Negotiated Rate |
$6,786.19 |
| Max. Negotiated Rate |
$6,786.19 |
| Rate for Payer: IEHP Medi-Cal |
$6,786.19
|
|
|
ACUTE KIDNEY INJURY
|
Facility
IP
|
$8,282.51
|
|
|
Service Code
|
APR-DRG 4693
|
| Min. Negotiated Rate |
$8,282.51 |
| Max. Negotiated Rate |
$8,282.51 |
| Rate for Payer: IEHP Medi-Cal |
$8,282.51
|
|
|
ACUTE KIDNEY INJURY
|
Facility
IP
|
$15,496.50
|
|
|
Service Code
|
APR-DRG 4694
|
| Min. Negotiated Rate |
$15,496.50 |
| Max. Negotiated Rate |
$15,496.50 |
| Rate for Payer: IEHP Medi-Cal |
$15,496.50
|
|
|
ACUTE KIDNEY INJURY
|
Facility
IP
|
$4,092.01
|
|
|
Service Code
|
APR-DRG 4691
|
| Min. Negotiated Rate |
$4,092.01 |
| Max. Negotiated Rate |
$4,092.01 |
| Rate for Payer: IEHP Medi-Cal |
$4,092.01
|
|
|
ACUTE KIDNEY INJURY
|
Facility
IP
|
$5,306.77
|
|
|
Service Code
|
APR-DRG 4692
|
| Min. Negotiated Rate |
$5,306.77 |
| Max. Negotiated Rate |
$5,306.77 |
| Rate for Payer: IEHP Medi-Cal |
$5,306.77
|
|
|
ACUTE LEUKEMIA
|
Facility
IP
|
$7,475.65
|
|
|
Service Code
|
APR-DRG 6901
|
| Min. Negotiated Rate |
$7,475.65 |
| Max. Negotiated Rate |
$7,475.65 |
| Rate for Payer: IEHP Medi-Cal |
$7,475.65
|
|
|
ACUTE LEUKEMIA
|
Facility
IP
|
$26,961.68
|
|
|
Service Code
|
APR-DRG 6903
|
| Min. Negotiated Rate |
$26,961.68 |
| Max. Negotiated Rate |
$26,961.68 |
| Rate for Payer: IEHP Medi-Cal |
$26,961.68
|
|
|
ACUTE LEUKEMIA
|
Facility
IP
|
$14,474.74
|
|
|
Service Code
|
APR-DRG 6902
|
| Min. Negotiated Rate |
$14,474.74 |
| Max. Negotiated Rate |
$14,474.74 |
| Rate for Payer: IEHP Medi-Cal |
$14,474.74
|
|
|
ACUTE LEUKEMIA
|
Facility
IP
|
$46,944.17
|
|
|
Service Code
|
APR-DRG 6904
|
| Min. Negotiated Rate |
$46,944.17 |
| Max. Negotiated Rate |
$46,944.17 |
| Rate for Payer: IEHP Medi-Cal |
$46,944.17
|
|
|
ACUTE MYOCARDIAL INFARCTION
|
Facility
IP
|
$7,481.61
|
|
|
Service Code
|
APR-DRG 1902
|
| Min. Negotiated Rate |
$7,481.61 |
| Max. Negotiated Rate |
$7,481.61 |
| Rate for Payer: IEHP Medi-Cal |
$7,481.61
|
|
|
ACUTE MYOCARDIAL INFARCTION
|
Facility
IP
|
$6,862.80
|
|
|
Service Code
|
APR-DRG 1901
|
| Min. Negotiated Rate |
$6,862.80 |
| Max. Negotiated Rate |
$6,862.80 |
| Rate for Payer: IEHP Medi-Cal |
$6,862.80
|
|
|
ACUTE MYOCARDIAL INFARCTION
|
Facility
IP
|
$9,580.85
|
|
|
Service Code
|
APR-DRG 1903
|
| Min. Negotiated Rate |
$9,580.85 |
| Max. Negotiated Rate |
$9,580.85 |
| Rate for Payer: IEHP Medi-Cal |
$9,580.85
|
|
|
ACUTE MYOCARDIAL INFARCTION
|
Facility
IP
|
$13,902.68
|
|
|
Service Code
|
APR-DRG 1904
|
| Min. Negotiated Rate |
$13,902.68 |
| Max. Negotiated Rate |
$13,902.68 |
| Rate for Payer: IEHP Medi-Cal |
$13,902.68
|
|
|
ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION [8970]
|
Facility
OP
|
$0.20
|
|
|
Service Code
|
CPT J8499
|
| Hospital Charge Code |
1715057
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Adventist Health Commercial |
$0.04
|
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.56
|
| Rate for Payer: Blue Shield of California Commercial |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: Dignity Health Senior |
$0.77
|
| Rate for Payer: Dignity Health Senior |
$0.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.56
|
| Rate for Payer: Heritage Provider Network Senior |
$0.12
|
| Rate for Payer: Heritage Provider Network Senior |
$0.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: Multiplan Commercial |
$0.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$0.17
|
|
