|
INPATIENT MS-DRG 100: SEIZURES WITH MCC
|
Facility
|
IP
|
$60,101.47
|
|
|
Service Code
|
MSDRG 100
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$60,101.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$60,101.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$48,454.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35,892.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35,892.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35,892.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45,224.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48,095.75
|
| Rate for Payer: Multiplan WC |
$39,450.57
|
| Rate for Payer: Prime Health Services WC |
$39,048.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 101: SEIZURES WITHOUT MCC
|
Facility
|
IP
|
$32,394.61
|
|
|
Service Code
|
MSDRG 101
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$32,394.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,575.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,394.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,996.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,996.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,996.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,234.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,154.65
|
| Rate for Payer: Multiplan WC |
$18,513.63
|
| Rate for Payer: Prime Health Services WC |
$18,324.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 102: HEADACHES WITH MCC
|
Facility
|
IP
|
$36,840.37
|
|
|
Service Code
|
MSDRG 102
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$36,840.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36,579.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,840.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,289.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,289.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,289.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,384.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36,567.47
|
| Rate for Payer: Multiplan WC |
$23,614.89
|
| Rate for Payer: Prime Health Services WC |
$23,373.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 103: HEADACHES WITHOUT MCC
|
Facility
|
IP
|
$31,388.72
|
|
|
Service Code
|
MSDRG 103
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$31,388.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,538.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,388.72
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,250.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,250.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,250.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,296.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,156.21
|
| Rate for Payer: Multiplan WC |
$17,096.62
|
| Rate for Payer: Prime Health Services WC |
$16,922.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 113: ORBITAL PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$76,011.31
|
|
|
Service Code
|
MSDRG 113
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$76,011.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76,011.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$56,310.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$41,711.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41,711.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41,711.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52,556.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55,893.20
|
| Rate for Payer: Multiplan WC |
$46,110.55
|
| Rate for Payer: Prime Health Services WC |
$45,640.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 114: ORBITAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$37,343.25
|
|
|
Service Code
|
MSDRG 114
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$37,343.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37,343.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,217.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,568.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,568.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,568.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,736.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36,941.88
|
| Rate for Payer: Multiplan WC |
$26,754.92
|
| Rate for Payer: Prime Health Services WC |
$26,481.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 115: EXTRAOCULAR PROCEDURES EXCEPT ORBIT
|
Facility
|
IP
|
$47,426.35
|
|
|
Service Code
|
MSDRG 115
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$47,426.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47,426.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,196.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31,256.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,256.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,256.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,383.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,883.64
|
| Rate for Payer: Multiplan WC |
$31,196.96
|
| Rate for Payer: Prime Health Services WC |
$30,878.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 116: INTRAOCULAR PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$55,502.53
|
|
|
Service Code
|
MSDRG 116
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$55,502.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55,502.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,183.90
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$34,210.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34,210.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,210.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43,104.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45,841.80
|
| Rate for Payer: Multiplan WC |
$38,742.07
|
| Rate for Payer: Prime Health Services WC |
$38,346.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 117: INTRAOCULAR PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$36,717.62
|
|
|
Service Code
|
MSDRG 117
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$36,717.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36,330.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,717.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,198.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,198.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,198.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,269.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36,445.64
|
| Rate for Payer: Multiplan WC |
$20,388.62
|
| Rate for Payer: Prime Health Services WC |
$20,180.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 121: ACUTE MAJOR EYE INFECTIONS WITH CC/MCC
|
Facility
|
IP
|
$38,840.86
|
|
|
Service Code
|
MSDRG 121
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$38,840.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$38,840.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,957.03
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$28,116.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,116.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,116.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,426.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,675.87
|
| Rate for Payer: Multiplan WC |
$25,163.34
|
| Rate for Payer: Prime Health Services WC |
$24,906.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 122: ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$29,923.26
|
|
|
Service Code
|
MSDRG 122
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$29,923.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,570.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,923.26
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,165.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,165.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,165.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,928.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,701.61
|
| Rate for Payer: Multiplan WC |
$14,186.60
|
| Rate for Payer: Prime Health Services WC |
$14,041.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 123: NEUROLOGICAL EYE DISORDERS
|
Facility
|
IP
|
$30,813.90
|
|
|
Service Code
|
MSDRG 123
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$30,813.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,374.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,813.90
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,825.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,825.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,825.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,759.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,585.65
|
| Rate for Payer: Multiplan WC |
$16,301.86
|
| Rate for Payer: Prime Health Services WC |
$16,135.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 124: OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT
|
Facility
|
IP
|
$40,074.72
|
|
|
Service Code
|
MSDRG 124
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$40,074.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40,074.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,566.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$28,567.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,567.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,567.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,995.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,280.60
|
| Rate for Payer: Multiplan WC |
$28,765.44
|
| Rate for Payer: Prime Health Services WC |
$28,471.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 125: OTHER DISORDERS OF THE EYE WITHOUT MCC
|
Facility
|
IP
|
$30,716.60
|
|
|
Service Code
|
MSDRG 125
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$30,716.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,177.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,716.60
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,753.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,753.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,753.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,668.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,489.07
|
| Rate for Payer: Multiplan WC |
$17,704.49
|
| Rate for Payer: Prime Health Services WC |
$17,523.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 135: SINUS AND MASTOID PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$80,401.06
|
|
|
Service Code
|
MSDRG 135
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$80,401.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$80,401.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$58,477.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$43,316.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$43,316.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54,579.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58,044.65
|
| Rate for Payer: Multiplan WC |
$50,328.74
|
| Rate for Payer: Prime Health Services WC |
$49,815.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 136: SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$34,410.92
|
|
|
Service Code
|
MSDRG 136
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$34,410.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28,469.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,410.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,489.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,489.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,489.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,116.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,156.02
|
| Rate for Payer: Multiplan WC |
$23,828.47
|
| Rate for Payer: Prime Health Services WC |
$23,585.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 137: MOUTH PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$45,616.49
|
|
|
Service Code
|
MSDRG 137
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$45,616.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45,616.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,302.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30,594.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30,594.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,594.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38,549.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40,996.62
|
| Rate for Payer: Multiplan WC |
$30,796.50
|
| Rate for Payer: Prime Health Services WC |
$30,482.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 138: MOUTH PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$31,737.47
|
|
|
Service Code
|
MSDRG 138
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$31,737.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26,244.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,737.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,509.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,509.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,509.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,621.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,502.38
|
| Rate for Payer: Multiplan WC |
$18,160.41
|
| Rate for Payer: Prime Health Services WC |
$17,975.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 139: SALIVARY GLAND PROCEDURES
|
Facility
|
IP
|
$36,557.43
|
|
|
Service Code
|
MSDRG 139
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$36,557.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36,006.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,557.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,079.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,079.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,079.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,120.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36,286.64
|
| Rate for Payer: Multiplan WC |
$25,824.62
|
| Rate for Payer: Prime Health Services WC |
$25,561.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 140: MAJOR HEAD AND NECK PROCEDURES WITH MCC
|
Facility
|
IP
|
$114,536.88
|
|
|
Service Code
|
MSDRG 140
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$114,536.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$114,536.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$75,332.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$55,802.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55,802.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55,802.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70,310.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74,774.69
|
| Rate for Payer: Multiplan WC |
$85,355.76
|
| Rate for Payer: Prime Health Services WC |
$84,484.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 141: MAJOR HEAD AND NECK PROCEDURES WITH CC
|
Facility
|
IP
|
$62,805.66
|
|
|
Service Code
|
MSDRG 141
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$62,805.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62,805.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$49,789.90
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$36,881.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36,881.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36,881.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46,470.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49,421.09
|
| Rate for Payer: Multiplan WC |
$45,849.74
|
| Rate for Payer: Prime Health Services WC |
$45,381.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 142: MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$46,838.22
|
|
|
Service Code
|
MSDRG 142
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$46,838.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46,838.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,905.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31,041.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,041.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,041.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,112.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,595.41
|
| Rate for Payer: Multiplan WC |
$34,946.92
|
| Rate for Payer: Prime Health Services WC |
$34,590.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 143: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$100,818.89
|
|
|
Service Code
|
MSDRG 143
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$100,818.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100,818.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$68,559.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50,784.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50,784.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50,784.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63,988.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68,051.46
|
| Rate for Payer: Multiplan WC |
$65,154.03
|
| Rate for Payer: Prime Health Services WC |
$64,489.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 144: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$52,461.84
|
|
|
Service Code
|
MSDRG 144
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$52,461.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52,461.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$44,682.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33,098.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,098.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,098.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41,703.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44,351.53
|
| Rate for Payer: Multiplan WC |
$37,156.65
|
| Rate for Payer: Prime Health Services WC |
$36,777.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 145: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$37,057.41
|
|
|
Service Code
|
MSDRG 145
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$37,057.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37,018.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,057.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,449.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,449.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,449.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,586.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36,782.91
|
| Rate for Payer: Multiplan WC |
$24,803.96
|
| Rate for Payer: Prime Health Services WC |
$24,550.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
