|
INPATIENT MS-DRG 710: PENIS PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$38,198.03
|
|
|
Service Code
|
MSDRG 710
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$38,198.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37,419.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,198.03
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$28,294.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,294.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,294.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,651.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,915.09
|
| Rate for Payer: Multiplan WC |
$29,601.27
|
| Rate for Payer: Prime Health Services WC |
$29,299.22
|
| 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 711: TESTES PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$64,357.84
|
|
|
Service Code
|
MSDRG 711
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$64,357.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$64,357.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$50,556.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37,449.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37,449.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37,449.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47,185.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50,181.81
|
| Rate for Payer: Multiplan WC |
$41,964.24
|
| Rate for Payer: Prime Health Services WC |
$41,536.03
|
| 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 712: TESTES PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$36,567.94
|
|
|
Service Code
|
MSDRG 712
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$36,567.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36,027.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,567.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,087.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,087.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,087.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,130.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36,297.06
|
| Rate for Payer: Multiplan WC |
$25,498.09
|
| Rate for Payer: Prime Health Services WC |
$25,237.91
|
| 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 713: TRANSURETHRAL PROSTATECTOMY WITH CC/MCC
|
Facility
|
IP
|
$43,979.42
|
|
|
Service Code
|
MSDRG 713
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$43,979.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$43,979.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$40,494.25
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29,995.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29,995.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,995.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37,794.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40,194.29
|
| Rate for Payer: Multiplan WC |
$30,433.01
|
| Rate for Payer: Prime Health Services WC |
$30,122.47
|
| 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 714: TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$33,126.60
|
|
|
Service Code
|
MSDRG 714
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$33,126.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29,057.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,126.60
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24,538.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,538.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,538.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,918.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,881.21
|
| Rate for Payer: Multiplan WC |
$19,678.05
|
| Rate for Payer: Prime Health Services WC |
$19,477.25
|
| 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 715: OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC
|
Facility
|
IP
|
$66,922.57
|
|
|
Service Code
|
MSDRG 715
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$66,922.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$66,922.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$51,822.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$38,387.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38,387.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38,387.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48,367.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,438.79
|
| Rate for Payer: Multiplan WC |
$45,862.06
|
| Rate for Payer: Prime Health Services WC |
$45,394.08
|
| 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 716: OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$43,115.42
|
|
|
Service Code
|
MSDRG 716
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$43,115.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$43,115.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$40,067.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29,679.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29,679.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,679.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37,396.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39,770.84
|
| Rate for Payer: Multiplan WC |
$26,991.09
|
| Rate for Payer: Prime Health Services WC |
$26,715.67
|
| 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 717: OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC
|
Facility
|
IP
|
$54,984.13
|
|
|
Service Code
|
MSDRG 717
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$54,984.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$54,984.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,927.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$34,020.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34,020.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,020.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42,866.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45,587.72
|
| Rate for Payer: Multiplan WC |
$36,355.73
|
| Rate for Payer: Prime Health Services WC |
$35,984.75
|
| 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 718: OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$36,379.31
|
|
|
Service Code
|
MSDRG 718
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$36,379.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35,645.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,379.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$26,947.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26,947.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,947.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,954.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36,109.84
|
| Rate for Payer: Multiplan WC |
$26,060.79
|
| Rate for Payer: Prime Health Services WC |
$25,794.86
|
| 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
|
|
|
INPATIENT MS-DRG 722: MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC
|
Facility
|
IP
|
$56,836.44
|
|
|
Service Code
|
MSDRG 722
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$56,836.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$56,836.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,842.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$34,698.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34,698.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,698.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43,719.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46,495.55
|
| Rate for Payer: Multiplan WC |
$34,864.77
|
| Rate for Payer: Prime Health Services WC |
$34,509.01
|
| 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 723: MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC
|
Facility
|
IP
|
$35,458.72
|
|
|
Service Code
|
MSDRG 723
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$35,458.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$33,781.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,458.72
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$26,265.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26,265.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,265.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,094.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35,196.06
|
| Rate for Payer: Multiplan WC |
$23,666.24
|
| Rate for Payer: Prime Health Services WC |
$23,424.74
|
| 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 724: MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC
|
Facility
|
IP
|
$30,896.22
|
|
|
Service Code
|
MSDRG 724
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$30,896.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,540.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,896.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,886.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,886.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,886.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,836.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,667.36
|
| Rate for Payer: Multiplan WC |
$15,712.46
|
| Rate for Payer: Prime Health Services WC |
$15,552.13
|
| 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 725: BENIGN PROSTATIC HYPERTROPHY WITH MCC
|
Facility
|
IP
|
$37,619.12
|
|
|
Service Code
|
MSDRG 725
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$37,619.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37,619.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,353.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,669.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,669.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,669.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,863.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,077.09
|
| Rate for Payer: Multiplan WC |
$25,656.22
|
| Rate for Payer: Prime Health Services WC |
$25,394.43
|
| 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 726: BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC
|
Facility
|
IP
|
$29,719.68
|
|
|
Service Code
|
MSDRG 726
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$29,719.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,157.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,719.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,014.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,014.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,014.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,738.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,499.54
|
| Rate for Payer: Multiplan WC |
$15,845.94
|
| Rate for Payer: Prime Health Services WC |
$15,684.25
|
| 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 727: INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC
|
Facility
|
IP
|
$49,142.24
|
|
|
Service Code
|
MSDRG 727
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$49,142.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49,142.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$43,043.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31,884.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,884.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,884.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40,173.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42,724.61
|
| Rate for Payer: Multiplan WC |
$29,506.81
|
| Rate for Payer: Prime Health Services WC |
$29,205.72
|
| 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 728: INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC
|
Facility
|
IP
|
$30,755.52
|
|
|
Service Code
|
MSDRG 728
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$30,755.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,255.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,755.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,781.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,781.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,781.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,705.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,527.71
|
| Rate for Payer: Multiplan WC |
$16,874.83
|
| Rate for Payer: Prime Health Services WC |
$16,702.63
|
| 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 729: OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC
|
Facility
|
IP
|
$33,806.19
|
|
|
Service Code
|
MSDRG 729
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$33,806.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,434.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,806.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,041.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,041.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,041.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,552.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,555.77
|
| Rate for Payer: Multiplan WC |
$22,134.21
|
| Rate for Payer: Prime Health Services WC |
$21,908.35
|
| 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 730: OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC
|
Facility
|
IP
|
$28,083.59
|
|
|
Service Code
|
MSDRG 730
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$28,083.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18,844.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,083.59
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20,802.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,802.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,802.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,211.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,875.56
|
| Rate for Payer: Multiplan WC |
$13,467.82
|
| Rate for Payer: Prime Health Services WC |
$13,330.39
|
| 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 734: PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC
|
Facility
|
IP
|
$65,894.86
|
|
|
Service Code
|
MSDRG 734
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$65,894.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$65,894.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$51,315.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$38,011.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38,011.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38,011.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47,894.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50,935.10
|
| Rate for Payer: Multiplan WC |
$44,876.31
|
| Rate for Payer: Prime Health Services WC |
$44,418.39
|
| 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 735: PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$38,204.22
|
|
|
Service Code
|
MSDRG 735
|
| Min. Negotiated Rate |
$21,291.00 |
| Max. Negotiated Rate |
$38,204.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$38,204.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,642.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,883.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,883.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,883.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,133.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,363.84
|
| Rate for Payer: Multiplan WC |
$26,126.51
|
| Rate for Payer: Prime Health Services WC |
$25,859.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$23,727.00
|
| Rate for Payer: United Healthcare All Other HMO |
$23,328.00
|
| Rate for Payer: United Healthcare HMO Rider |
$23,284.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21,291.00
|
|
|
INPATIENT MS-DRG 736: UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC
|
Facility
|
IP
|
$117,844.36
|
|
|
Service Code
|
MSDRG 736
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$117,844.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$117,844.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$76,965.81
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$57,011.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57,011.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57,011.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71,834.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76,395.69
|
| Rate for Payer: Multiplan WC |
$87,592.17
|
| Rate for Payer: Prime Health Services WC |
$86,698.38
|
| 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 737: UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC
|
Facility
|
IP
|
$59,837.72
|
|
|
Service Code
|
MSDRG 737
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$59,837.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$59,837.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$48,324.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35,795.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35,795.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35,795.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45,102.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47,966.48
|
| Rate for Payer: Multiplan WC |
$41,555.56
|
| Rate for Payer: Prime Health Services WC |
$41,131.52
|
| 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 738: UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$41,369.21
|
|
|
Service Code
|
MSDRG 738
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$41,369.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41,369.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$39,205.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29,041.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29,041.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,041.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,591.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,915.02
|
| Rate for Payer: Multiplan WC |
$28,829.10
|
| Rate for Payer: Prime Health Services WC |
$28,534.93
|
| 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 739: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC
|
Facility
|
IP
|
$109,631.75
|
|
|
Service Code
|
MSDRG 739
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$109,631.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$109,631.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$72,910.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$54,007.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$54,007.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54,007.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68,050.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$72,370.68
|
| Rate for Payer: Multiplan WC |
$80,139.49
|
| Rate for Payer: Prime Health Services WC |
$79,321.74
|
| 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 740: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC
|
Facility
|
IP
|
$54,174.69
|
|
|
Service Code
|
MSDRG 740
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$54,174.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$54,174.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,528.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33,724.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,724.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,724.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42,493.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45,191.03
|
| Rate for Payer: Multiplan WC |
$37,014.94
|
| Rate for Payer: Prime Health Services WC |
$36,637.24
|
| 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
|
|
