|
INPATIENT MS-DRG 272: OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$73,955.88
|
|
|
Service Code
|
MSDRG 272
|
| Min. Negotiated Rate |
$25,651.00 |
| Max. Negotiated Rate |
$73,955.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$73,955.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$55,295.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$40,959.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$25,651.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,959.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40,959.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,609.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54,885.85
|
| Rate for Payer: Multiplan WC |
$53,320.91
|
| Rate for Payer: Prime Health Services WC |
$52,776.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$43,259.00
|
| Rate for Payer: United Healthcare All Other HMO |
$38,161.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28,986.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26,505.00
|
|
|
INPATIENT MS-DRG 273: PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC
|
Facility
|
IP
|
$118,141.45
|
|
|
Service Code
|
MSDRG 273
|
| Min. Negotiated Rate |
$7,978.00 |
| Max. Negotiated Rate |
$118,141.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$118,141.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$77,112.51
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$57,120.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,978.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57,120.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57,120.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71,971.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76,541.31
|
| Rate for Payer: Multiplan WC |
$82,412.87
|
| Rate for Payer: Prime Health Services WC |
$81,571.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$58,981.00
|
| Rate for Payer: United Healthcare All Other HMO |
$49,688.00
|
| Rate for Payer: United Healthcare HMO Rider |
$34,951.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31,961.00
|
|
|
INPATIENT MS-DRG 274: PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$98,248.09
|
|
|
Service Code
|
MSDRG 274
|
| Min. Negotiated Rate |
$7,978.00 |
| Max. Negotiated Rate |
$98,248.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$98,248.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$67,289.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$49,844.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,978.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49,844.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49,844.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62,803.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66,791.52
|
| Rate for Payer: Multiplan WC |
$68,992.29
|
| Rate for Payer: Prime Health Services WC |
$68,288.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$40,202.00
|
| Rate for Payer: United Healthcare All Other HMO |
$33,869.00
|
| Rate for Payer: United Healthcare HMO Rider |
$23,824.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21,785.00
|
|
|
INPATIENT MS-DRG 275: CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC
|
Facility
|
IP
|
$213,297.31
|
|
|
Service Code
|
MSDRG 275
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$213,297.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$213,297.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$124,096.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$91,923.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$91,923.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91,923.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$115,823.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$123,177.45
|
| 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 276: CARDIAC DEFIBRILLATOR IMPLANT WITH MCC
|
Facility
|
IP
|
$188,268.42
|
|
|
Service Code
|
MSDRG 276
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$188,268.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$188,268.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$111,738.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$82,769.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$82,769.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82,769.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$104,289.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$110,910.73
|
| 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 277: CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC
|
Facility
|
IP
|
$144,983.24
|
|
|
Service Code
|
MSDRG 277
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$144,983.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$144,983.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$90,365.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$66,937.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$66,937.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66,937.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84,341.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89,696.53
|
| 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 278: ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC
|
Facility
|
IP
|
$135,221.49
|
|
|
Service Code
|
MSDRG 278
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$135,221.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$135,221.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$85,545.95
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$63,367.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$63,367.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63,367.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79,842.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84,912.28
|
| 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 279: ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC
|
Facility
|
IP
|
$97,029.39
|
|
|
Service Code
|
MSDRG 279
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$97,029.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$97,029.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$66,688.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$49,398.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49,398.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49,398.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62,242.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66,194.23
|
| 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 280: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC
|
Facility
|
IP
|
$48,096.33
|
|
|
Service Code
|
MSDRG 280
|
| Min. Negotiated Rate |
$19,520.00 |
| Max. Negotiated Rate |
$48,096.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48,096.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,527.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31,501.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,501.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,501.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,691.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42,212.00
|
| Rate for Payer: Multiplan WC |
$32,989.80
|
| Rate for Payer: Prime Health Services WC |
$32,653.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$25,665.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,106.00
|
| Rate for Payer: United Healthcare HMO Rider |
$21,346.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19,520.00
|
|
|
INPATIENT MS-DRG 281: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC
|
Facility
|
IP
|
$32,445.51
|
|
|
Service Code
|
MSDRG 281
|
| Min. Negotiated Rate |
$14,736.00 |
| Max. Negotiated Rate |
$32,445.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,678.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,445.51
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24,033.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,033.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,033.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,282.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,205.17
|
| Rate for Payer: Multiplan WC |
$18,864.80
|
| Rate for Payer: Prime Health Services WC |
$18,672.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$25,122.00
|
| Rate for Payer: United Healthcare All Other HMO |
$21,212.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,114.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,736.00
|
|
|
INPATIENT MS-DRG 282: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC
|
Facility
|
IP
|
$29,528.08
|
|
|
Service Code
|
MSDRG 282
|
| Min. Negotiated Rate |
$11,917.00 |
| Max. Negotiated Rate |
$29,528.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21,769.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,528.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,872.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,872.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,872.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,559.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,309.35
|
| Rate for Payer: Multiplan WC |
$14,718.49
|
| Rate for Payer: Prime Health Services WC |
$14,568.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$26,661.00
|
| Rate for Payer: United Healthcare All Other HMO |
$17,160.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,033.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,917.00
|
|
|
INPATIENT MS-DRG 283: ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC
|
Facility
|
IP
|
$59,764.96
|
|
|
Service Code
|
MSDRG 283
|
| Min. Negotiated Rate |
$17,720.00 |
| Max. Negotiated Rate |
$59,764.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$59,764.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$48,288.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35,769.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35,769.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35,769.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45,069.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47,930.84
|
| Rate for Payer: Multiplan WC |
$39,401.28
|
| Rate for Payer: Prime Health Services WC |
$38,999.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$27,534.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,511.00
|
| Rate for Payer: United Healthcare HMO Rider |
$19,377.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17,720.00
|
|
|
INPATIENT MS-DRG 284: ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC
|
Facility
|
IP
|
$29,851.40
|
|
|
Service Code
|
MSDRG 284
|
| Min. Negotiated Rate |
$13,549.00 |
| Max. Negotiated Rate |
$29,851.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,424.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,851.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,112.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,112.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,112.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,861.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,630.28
|
| Rate for Payer: Multiplan WC |
$15,102.53
|
| Rate for Payer: Prime Health Services WC |
$14,948.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$26,839.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,513.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14,817.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,549.00
|
|
|
INPATIENT MS-DRG 285: ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC
|
Facility
|
IP
|
$26,450.00
|
|
|
Service Code
|
MSDRG 285
|
| Min. Negotiated Rate |
$11,013.13 |
| Max. Negotiated Rate |
$26,450.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14,815.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,094.23
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$19,329.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19,329.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,329.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24,354.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,900.94
|
| Rate for Payer: Multiplan WC |
$11,126.67
|
| Rate for Payer: Prime Health Services WC |
$11,013.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$26,450.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,841.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,697.00
|
|
|
INPATIENT MS-DRG 286: CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$65,349.17
|
|
|
Service Code
|
MSDRG 286
|
| Min. Negotiated Rate |
$4,504.00 |
| Max. Negotiated Rate |
$65,349.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$65,349.17
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$51,045.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37,811.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,504.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37,811.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37,811.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47,642.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50,667.66
|
| Rate for Payer: Multiplan WC |
$43,557.86
|
| Rate for Payer: Prime Health Services WC |
$43,113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19,771.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,058.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14,478.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,239.00
|
|
|
INPATIENT MS-DRG 287: CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC
|
Facility
|
IP
|
$34,969.25
|
|
|
Service Code
|
MSDRG 287
|
| Min. Negotiated Rate |
$4,504.00 |
| Max. Negotiated Rate |
$34,969.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,789.79
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,969.25
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,903.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,504.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,903.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,903.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,637.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,710.22
|
| Rate for Payer: Multiplan WC |
$22,594.23
|
| Rate for Payer: Prime Health Services WC |
$22,363.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$25,632.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18,442.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,809.00
|
|
|
INPATIENT MS-DRG 288: ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC
|
Facility
|
IP
|
$78,609.39
|
|
|
Service Code
|
MSDRG 288
|
| Min. Negotiated Rate |
$32,712.00 |
| Max. Negotiated Rate |
$78,609.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$78,609.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$57,593.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$42,661.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42,661.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42,661.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53,753.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57,166.53
|
| Rate for Payer: Multiplan WC |
$55,376.61
|
| Rate for Payer: Prime Health Services WC |
$54,811.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$35,642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$47,097.00
|
| Rate for Payer: United Healthcare HMO Rider |
$35,774.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32,712.00
|
|
|
INPATIENT MS-DRG 289: ACUTE AND SUBACUTE ENDOCARDITIS WITH CC
|
Facility
|
IP
|
$44,797.95
|
|
|
Service Code
|
MSDRG 289
|
| Min. Negotiated Rate |
$25,901.00 |
| Max. Negotiated Rate |
$44,797.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$44,797.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$40,898.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30,295.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30,295.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,295.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38,171.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40,595.46
|
| Rate for Payer: Multiplan WC |
$33,004.18
|
| Rate for Payer: Prime Health Services WC |
$32,667.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,362.00
|
| Rate for Payer: United Healthcare All Other HMO |
$37,290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28,325.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25,901.00
|
|
|
INPATIENT MS-DRG 290: ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$35,021.66
|
|
|
Service Code
|
MSDRG 290
|
| Min. Negotiated Rate |
$22,150.00 |
| Max. Negotiated Rate |
$35,021.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,079.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,021.66
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,941.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,941.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,941.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,686.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,762.24
|
| Rate for Payer: Multiplan WC |
$24,760.83
|
| Rate for Payer: Prime Health Services WC |
$24,508.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,362.00
|
| Rate for Payer: United Healthcare All Other HMO |
$31,886.00
|
| Rate for Payer: United Healthcare HMO Rider |
$24,225.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22,150.00
|
|
|
INPATIENT MS-DRG 291: HEART FAILURE AND SHOCK WITH MCC
|
Facility
|
IP
|
$38,922.71
|
|
|
Service Code
|
MSDRG 291
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$38,922.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$38,922.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,997.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$28,146.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,146.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,146.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,464.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,715.98
|
| Rate for Payer: Multiplan WC |
$26,282.58
|
| Rate for Payer: Prime Health Services WC |
$26,014.39
|
| 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 292: HEART FAILURE AND SHOCK WITH CC
|
Facility
|
IP
|
$31,599.76
|
|
|
Service Code
|
MSDRG 292
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$31,599.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,965.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,599.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,407.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,407.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,407.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,493.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,365.69
|
| Rate for Payer: Multiplan WC |
$17,718.87
|
| Rate for Payer: Prime Health Services WC |
$17,538.07
|
| 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 293: HEART FAILURE AND SHOCK WITHOUT CC/MCC
|
Facility
|
IP
|
$27,183.95
|
|
|
Service Code
|
MSDRG 293
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$27,183.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17,022.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,183.95
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20,136.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,136.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,136.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,371.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26,982.59
|
| Rate for Payer: Multiplan WC |
$11,506.59
|
| Rate for Payer: Prime Health Services WC |
$11,389.18
|
| 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 294: DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC
|
Facility
|
IP
|
$35,150.38
|
|
|
Service Code
|
MSDRG 294
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$35,150.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$33,156.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,150.38
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$26,037.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26,037.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,037.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,807.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,890.01
|
| Rate for Payer: Multiplan WC |
$23,709.37
|
| Rate for Payer: Prime Health Services WC |
$23,467.43
|
| 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 295: DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$30,710.61
|
|
|
Service Code
|
MSDRG 295
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$30,710.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19,144.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,710.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,748.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,748.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,748.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,663.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,483.12
|
| Rate for Payer: Multiplan WC |
$18,189.15
|
| Rate for Payer: Prime Health Services WC |
$18,003.55
|
| 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 296: CARDIAC ARREST, UNEXPLAINED WITH MCC
|
Facility
|
IP
|
$48,602.61
|
|
|
Service Code
|
MSDRG 296
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$48,602.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48,602.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,777.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31,686.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,686.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,686.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,925.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42,460.14
|
| Rate for Payer: Multiplan WC |
$33,644.91
|
| Rate for Payer: Prime Health Services WC |
$33,301.59
|
| 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
|
|
