|
MS-DRG 42.00: SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$48,742.06
|
|
|
Service Code
|
MSDRG 512
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$48,742.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48,742.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$47,689.02
|
| Rate for Payer: EPIC Health Plan Senior |
$35,325.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35,325.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35,325.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47,335.77
|
| Rate for Payer: Multiplan WC |
$30,036.04
|
| Rate for Payer: Prime Health Services WC |
$29,729.55
|
| 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
|
|
|
MS-DRG 42.00: SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
|
IP
|
$43,980.07
|
|
|
Service Code
|
MSDRG 555
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$43,980.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40,823.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$43,980.07
|
| Rate for Payer: EPIC Health Plan Senior |
$32,577.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32,577.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,577.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43,654.29
|
| Rate for Payer: Multiplan WC |
$25,156.44
|
| Rate for Payer: Prime Health Services WC |
$24,899.74
|
| 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
|
|
|
MS-DRG 42.00: SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC
|
Facility
|
IP
|
$36,452.79
|
|
|
Service Code
|
MSDRG 556
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$36,452.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,753.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,452.79
|
| Rate for Payer: EPIC Health Plan Senior |
$27,002.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,002.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,002.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36,182.77
|
| Rate for Payer: Multiplan WC |
$15,253.41
|
| Rate for Payer: Prime Health Services WC |
$15,097.76
|
| 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
|
|
|
MS-DRG 42.00: SIGNS AND SYMPTOMS WITH MCC
|
Facility
|
IP
|
$43,122.40
|
|
|
Service Code
|
MSDRG 947
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$43,122.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$38,992.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$43,122.40
|
| Rate for Payer: EPIC Health Plan Senior |
$31,942.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,942.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,942.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42,802.98
|
| Rate for Payer: Multiplan WC |
$24,028.09
|
| Rate for Payer: Prime Health Services WC |
$23,782.91
|
| 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
|
|
|
MS-DRG 42.00: SIGNS AND SYMPTOMS WITHOUT MCC
|
Facility
|
IP
|
$36,140.40
|
|
|
Service Code
|
MSDRG 948
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$36,140.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,086.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,140.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26,770.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26,770.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,770.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35,872.70
|
| Rate for Payer: Multiplan WC |
$14,842.41
|
| Rate for Payer: Prime Health Services WC |
$14,690.96
|
| 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
|
|
|
MS-DRG 42.00: SIMPLE PNEUMONIA AND PLEURISY WITH CC
|
Facility
|
IP
|
$36,502.50
|
|
|
Service Code
|
MSDRG 194
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$36,502.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,859.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,502.50
|
| Rate for Payer: EPIC Health Plan Senior |
$27,038.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,038.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,038.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36,232.11
|
| Rate for Payer: Multiplan WC |
$15,318.79
|
| Rate for Payer: Prime Health Services WC |
$15,162.48
|
| 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
|
|
|
MS-DRG 42.00: SIMPLE PNEUMONIA AND PLEURISY WITH MCC
|
Facility
|
IP
|
$43,569.70
|
|
|
Service Code
|
MSDRG 193
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$43,569.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,947.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$43,569.70
|
| Rate for Payer: EPIC Health Plan Senior |
$32,273.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32,273.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,273.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43,246.96
|
| Rate for Payer: Multiplan WC |
$24,616.55
|
| Rate for Payer: Prime Health Services WC |
$24,365.36
|
| 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
|
|
|
MS-DRG 42.00: SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC
|
Facility
|
IP
|
$33,700.89
|
|
|
Service Code
|
MSDRG 195
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$33,700.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18,877.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,700.89
|
| Rate for Payer: EPIC Health Plan Senior |
$24,963.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,963.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,963.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,451.25
|
| Rate for Payer: Multiplan WC |
$11,632.94
|
| Rate for Payer: Prime Health Services WC |
$11,514.24
|
| 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
|
|
|
MS-DRG 42.00: SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT
|
Facility
|
IP
|
$171,250.00
|
|
|
Service Code
|
MSDRG 008
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$171,250.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$164,952.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$171,250.00
|
| Rate for Payer: Blue Distinction Transplant |
$138,317.00
|
| Rate for Payer: Blue Shield of California Transplant |
$102,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$102,120.79
|
| Rate for Payer: EPIC Health Plan Senior |
$75,645.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Transplant |
$90,300.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$96,050.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75,645.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75,645.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101,364.34
|
| Rate for Payer: Multiplan WC |
$101,647.66
|
| Rate for Payer: OptumHealth Care Solutions (URN) Commercial |
$153,846.00
|
| Rate for Payer: Prime Health Services WC |
$100,610.44
|
| 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
|
|
|
MS-DRG 42.00: SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS
|
Facility
|
IP
|
$240,324.03
|
|
|
Service Code
|
MSDRG 019
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$240,324.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$171,250.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$240,324.03
|
| Rate for Payer: Blue Distinction Transplant |
$138,317.00
|
| Rate for Payer: Blue Shield of California Transplant |
$102,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$137,424.13
|
| Rate for Payer: EPIC Health Plan Senior |
$101,795.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Transplant |
$90,300.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$96,050.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$101,795.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$101,795.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$136,406.17
|
| Rate for Payer: Multiplan WC |
$148,093.49
|
| Rate for Payer: OptumHealth Care Solutions (URN) Commercial |
$153,846.00
|
| Rate for Payer: Prime Health Services WC |
$146,582.34
|
| 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
|
|
|
MS-DRG 42.00: SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$118,602.26
|
|
|
Service Code
|
MSDRG 402
|
| Min. Negotiated Rate |
$59,563.60 |
| Max. Negotiated Rate |
$118,602.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$118,602.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$80,410.86
|
| Rate for Payer: EPIC Health Plan Senior |
$59,563.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59,563.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59,563.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79,815.22
|
| Rate for Payer: Multiplan WC |
$73,085.59
|
| Rate for Payer: Prime Health Services WC |
$72,339.82
|
|
|
MS-DRG 42.00: SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE
|
Facility
|
IP
|
$156,130.43
|
|
|
Service Code
|
MSDRG 450
|
| Min. Negotiated Rate |
$72,584.22 |
| Max. Negotiated Rate |
$156,130.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$156,130.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$97,988.70
|
| Rate for Payer: EPIC Health Plan Senior |
$72,584.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$72,584.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72,584.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$97,262.85
|
| Rate for Payer: Multiplan WC |
$96,211.35
|
| Rate for Payer: Prime Health Services WC |
$95,229.60
|
|
|
MS-DRG 42.00: SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC
|
Facility
|
IP
|
$93,555.18
|
|
|
Service Code
|
MSDRG 451
|
| Min. Negotiated Rate |
$50,873.37 |
| Max. Negotiated Rate |
$93,555.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$93,555.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$68,679.05
|
| Rate for Payer: EPIC Health Plan Senior |
$50,873.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50,873.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50,873.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68,170.32
|
| Rate for Payer: Multiplan WC |
$57,650.97
|
| Rate for Payer: Prime Health Services WC |
$57,062.69
|
|
|
MS-DRG 42.00: SINUS AND MASTOID PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$73,094.91
|
|
|
Service Code
|
MSDRG 135
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$73,094.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$73,094.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$59,095.66
|
| Rate for Payer: EPIC Health Plan Senior |
$43,774.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$43,774.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43,774.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58,657.91
|
| Rate for Payer: Multiplan WC |
$45,042.86
|
| Rate for Payer: Prime Health Services WC |
$44,583.24
|
| 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
|
|
|
MS-DRG 42.00: SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$38,748.87
|
|
|
Service Code
|
MSDRG 136
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$38,748.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29,655.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,748.87
|
| Rate for Payer: EPIC Health Plan Senior |
$28,702.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,702.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,702.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,461.85
|
| Rate for Payer: Multiplan WC |
$18,274.20
|
| Rate for Payer: Prime Health Services WC |
$18,087.73
|
| 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
|
|
|
MS-DRG 42.00: SKIN DEBRIDEMENT WITH CC
|
Facility
|
IP
|
$50,758.08
|
|
|
Service Code
|
MSDRG 571
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$50,758.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$50,758.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$48,633.30
|
| Rate for Payer: EPIC Health Plan Senior |
$36,024.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36,024.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36,024.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48,273.06
|
| Rate for Payer: Multiplan WC |
$31,278.36
|
| Rate for Payer: Prime Health Services WC |
$30,959.19
|
| 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
|
|
|
MS-DRG 42.00: SKIN DEBRIDEMENT WITH MCC
|
Facility
|
IP
|
$91,257.22
|
|
|
Service Code
|
MSDRG 570
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$91,257.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$91,257.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$67,602.72
|
| Rate for Payer: EPIC Health Plan Senior |
$50,076.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50,076.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50,076.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67,101.96
|
| Rate for Payer: Multiplan WC |
$56,234.91
|
| Rate for Payer: Prime Health Services WC |
$55,661.08
|
| 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
|
|
|
MS-DRG 42.00: SKIN DEBRIDEMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$41,080.47
|
|
|
Service Code
|
MSDRG 572
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$41,080.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$34,633.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,080.47
|
| Rate for Payer: EPIC Health Plan Senior |
$30,429.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30,429.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,429.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40,776.17
|
| Rate for Payer: Multiplan WC |
$21,341.70
|
| Rate for Payer: Prime Health Services WC |
$21,123.92
|
| 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
|
|
|
MS-DRG 42.00: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC
|
Facility
|
IP
|
$80,725.44
|
|
|
Service Code
|
MSDRG 577
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$80,725.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$80,725.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$62,669.71
|
| Rate for Payer: EPIC Health Plan Senior |
$46,422.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$46,422.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46,422.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62,205.49
|
| Rate for Payer: Multiplan WC |
$49,744.98
|
| Rate for Payer: Prime Health Services WC |
$49,237.37
|
| 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
|
|
|
MS-DRG 42.00: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC
|
Facility
|
IP
|
$163,563.91
|
|
|
Service Code
|
MSDRG 576
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$163,563.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$163,563.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$101,470.46
|
| Rate for Payer: EPIC Health Plan Senior |
$75,163.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75,163.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75,163.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$100,718.82
|
| Rate for Payer: Multiplan WC |
$100,792.05
|
| Rate for Payer: Prime Health Services WC |
$99,763.56
|
| 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
|
|
|
MS-DRG 42.00: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$51,246.17
|
|
|
Service Code
|
MSDRG 578
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$51,246.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$51,246.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$48,861.91
|
| Rate for Payer: EPIC Health Plan Senior |
$36,194.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36,194.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36,194.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48,499.97
|
| Rate for Payer: Multiplan WC |
$31,579.13
|
| Rate for Payer: Prime Health Services WC |
$31,256.89
|
| 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
|
|
|
MS-DRG 42.00: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC
|
Facility
|
IP
|
$105,041.91
|
|
|
Service Code
|
MSDRG 574
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$105,041.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$105,041.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$74,059.33
|
| Rate for Payer: EPIC Health Plan Senior |
$54,858.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$54,858.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54,858.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73,510.74
|
| Rate for Payer: Multiplan WC |
$64,729.37
|
| Rate for Payer: Prime Health Services WC |
$64,068.87
|
| 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
|
|
|
MS-DRG 42.00: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC
|
Facility
|
IP
|
$186,691.99
|
|
|
Service Code
|
MSDRG 573
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$186,691.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$186,691.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$112,303.42
|
| Rate for Payer: EPIC Health Plan Senior |
$83,187.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$83,187.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83,187.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$111,471.54
|
| Rate for Payer: Multiplan WC |
$115,044.13
|
| Rate for Payer: Prime Health Services WC |
$113,870.21
|
| 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
|
|
|
MS-DRG 42.00: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$60,531.96
|
|
|
Service Code
|
MSDRG 575
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$60,531.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$60,531.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$53,211.30
|
| Rate for Payer: EPIC Health Plan Senior |
$39,415.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$39,415.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39,415.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52,817.15
|
| Rate for Payer: Multiplan WC |
$37,301.26
|
| Rate for Payer: Prime Health Services WC |
$36,920.63
|
| 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
|
|
|
MS-DRG 42.00: SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC
|
Facility
|
IP
|
$57,988.44
|
|
|
Service Code
|
MSDRG 623
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$57,988.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$57,988.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$52,019.94
|
| Rate for Payer: EPIC Health Plan Senior |
$38,533.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38,533.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38,533.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,634.61
|
| Rate for Payer: Multiplan WC |
$35,733.89
|
| Rate for Payer: Prime Health Services WC |
$35,369.26
|
| 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
|
|
