|
INPATIENT MS-DRG 741: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$39,389.58
|
|
|
Service Code
|
MSDRG 741
|
| Min. Negotiated Rate |
$21,291.00 |
| Max. Negotiated Rate |
$39,389.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,389.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,227.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$28,317.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,317.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,317.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,679.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,944.79
|
| Rate for Payer: Multiplan WC |
$26,962.34
|
| Rate for Payer: Prime Health Services WC |
$26,687.21
|
| 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 742: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC
|
Facility
|
IP
|
$54,020.08
|
|
|
Service Code
|
MSDRG 742
|
| Min. Negotiated Rate |
$21,291.00 |
| Max. Negotiated Rate |
$54,020.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$54,020.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,451.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33,668.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,668.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,668.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42,421.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45,115.25
|
| Rate for Payer: Multiplan WC |
$37,008.79
|
| Rate for Payer: Prime Health Services WC |
$36,631.15
|
| 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 743: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$36,172.75
|
|
|
Service Code
|
MSDRG 743
|
| Min. Negotiated Rate |
$21,291.00 |
| Max. Negotiated Rate |
$36,172.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35,227.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,172.75
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$26,794.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26,794.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,794.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,761.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35,904.80
|
| Rate for Payer: Multiplan WC |
$24,040.00
|
| Rate for Payer: Prime Health Services WC |
$23,794.69
|
| 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 744: D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC
|
Facility
|
IP
|
$57,066.84
|
|
|
Service Code
|
MSDRG 744
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$57,066.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$57,066.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,956.29
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$34,782.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34,782.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,782.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43,825.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46,608.47
|
| Rate for Payer: Multiplan WC |
$38,984.39
|
| Rate for Payer: Prime Health Services WC |
$38,586.59
|
| 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 745: D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC
|
Facility
|
IP
|
$34,285.17
|
|
|
Service Code
|
MSDRG 745
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$34,285.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,404.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,285.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,396.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,396.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,396.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,999.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,031.20
|
| Rate for Payer: Multiplan WC |
$23,633.38
|
| Rate for Payer: Prime Health Services WC |
$23,392.22
|
| 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 746: VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$50,812.65
|
|
|
Service Code
|
MSDRG 746
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$50,812.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$50,812.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$43,868.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$32,494.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32,494.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,494.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40,943.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43,543.27
|
| Rate for Payer: Multiplan WC |
$32,106.73
|
| Rate for Payer: Prime Health Services WC |
$31,779.11
|
| 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 747: VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$32,059.30
|
|
|
Service Code
|
MSDRG 747
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$32,059.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26,896.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,059.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,747.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,747.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,747.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,922.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,821.82
|
| Rate for Payer: Multiplan WC |
$20,097.00
|
| Rate for Payer: Prime Health Services WC |
$19,891.93
|
| 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 748: FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$42,590.95
|
|
|
Service Code
|
MSDRG 748
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$42,590.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42,590.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$39,808.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29,487.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29,487.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,487.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37,154.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39,513.80
|
| Rate for Payer: Multiplan WC |
$29,104.29
|
| Rate for Payer: Prime Health Services WC |
$28,807.31
|
| 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 749: OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$76,311.44
|
|
|
Service Code
|
MSDRG 749
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$76,311.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76,311.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$56,458.50
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$41,821.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41,821.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41,821.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52,694.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56,040.29
|
| Rate for Payer: Multiplan WC |
$51,879.25
|
| Rate for Payer: Prime Health Services WC |
$51,349.87
|
| 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 750: OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$41,229.76
|
|
|
Service Code
|
MSDRG 750
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$41,229.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41,229.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$39,136.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$28,990.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,990.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,990.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,527.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,846.67
|
| Rate for Payer: Multiplan WC |
$29,305.55
|
| Rate for Payer: Prime Health Services WC |
$29,006.51
|
| 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 754: MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC
|
Facility
|
IP
|
$56,160.39
|
|
|
Service Code
|
MSDRG 754
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$56,160.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$56,160.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,508.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$34,450.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34,450.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,450.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43,408.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46,164.23
|
| Rate for Payer: Multiplan WC |
$35,669.80
|
| Rate for Payer: Prime Health Services WC |
$35,305.83
|
| 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 755: MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC
|
Facility
|
IP
|
$35,015.67
|
|
|
Service Code
|
MSDRG 755
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$35,015.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,883.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,015.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,937.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,937.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,937.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,681.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,756.29
|
| Rate for Payer: Multiplan WC |
$22,201.99
|
| Rate for Payer: Prime Health Services WC |
$21,975.44
|
| 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 756: MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC
|
Facility
|
IP
|
$33,593.62
|
|
|
Service Code
|
MSDRG 756
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$33,593.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,003.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,593.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24,884.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,884.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,884.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,354.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,344.77
|
| Rate for Payer: Multiplan WC |
$20,470.76
|
| Rate for Payer: Prime Health Services WC |
$20,261.87
|
| 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 757: INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC
|
Facility
|
IP
|
$45,219.35
|
|
|
Service Code
|
MSDRG 757
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$45,219.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45,219.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,106.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30,449.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30,449.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,449.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38,366.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40,801.98
|
| Rate for Payer: Multiplan WC |
$28,180.15
|
| Rate for Payer: Prime Health Services WC |
$27,892.60
|
| 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 758: INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC
|
Facility
|
IP
|
$33,637.03
|
|
|
Service Code
|
MSDRG 758
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$33,637.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,091.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,637.03
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24,916.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,916.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,916.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,394.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,387.87
|
| Rate for Payer: Multiplan WC |
$19,622.60
|
| Rate for Payer: Prime Health Services WC |
$19,422.37
|
| 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 759: INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC
|
Facility
|
IP
|
$28,451.82
|
|
|
Service Code
|
MSDRG 759
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$28,451.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19,590.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,451.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,075.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,075.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,075.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,555.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,241.06
|
| Rate for Payer: Multiplan WC |
$12,740.83
|
| Rate for Payer: Prime Health Services WC |
$12,610.82
|
| 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 760: MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC
|
Facility
|
IP
|
$33,678.94
|
|
|
Service Code
|
MSDRG 760
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$33,678.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,176.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,678.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24,947.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,947.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,947.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,433.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,429.46
|
| Rate for Payer: Multiplan WC |
$19,850.56
|
| Rate for Payer: Prime Health Services WC |
$19,648.00
|
| 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 761: MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$27,844.09
|
|
|
Service Code
|
MSDRG 761
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$27,844.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18,359.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,844.09
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20,625.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,625.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,625.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,987.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,637.84
|
| Rate for Payer: Multiplan WC |
$11,617.49
|
| Rate for Payer: Prime Health Services WC |
$11,498.94
|
| 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 768: VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$37,012.49
|
|
|
Service Code
|
MSDRG 768
|
| Min. Negotiated Rate |
$4,760.00 |
| Max. Negotiated Rate |
$37,012.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36,927.92
|
| Rate for Payer: Cigna of CA HMO |
$4,760.00
|
| Rate for Payer: Cigna of CA PPO |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,012.49
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,416.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,387.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,416.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,416.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,544.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36,738.32
|
| Rate for Payer: Multiplan WC |
$23,551.23
|
| Rate for Payer: Prime Health Services WC |
$23,310.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,210.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,461.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,443.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,977.00
|
|
|
INPATIENT MS-DRG 769: POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES
|
Facility
|
IP
|
$46,804.87
|
|
|
Service Code
|
MSDRG 769
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$46,804.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46,804.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,889.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31,029.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,029.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,029.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,096.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,579.05
|
| Rate for Payer: Multiplan WC |
$34,117.25
|
| Rate for Payer: Prime Health Services WC |
$33,769.11
|
| 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 770: ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$30,734.57
|
|
|
Service Code
|
MSDRG 770
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$30,734.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,213.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,734.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,766.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,766.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,766.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,685.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,506.91
|
| Rate for Payer: Multiplan WC |
$17,780.48
|
| Rate for Payer: Prime Health Services WC |
$17,599.05
|
| 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 776: POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES
|
Facility
|
IP
|
$29,507.13
|
|
|
Service Code
|
MSDRG 776
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$29,507.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21,727.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,507.13
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,857.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,857.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,857.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,539.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,288.55
|
| Rate for Payer: Multiplan WC |
$14,315.98
|
| Rate for Payer: Prime Health Services WC |
$14,169.90
|
| 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 779: ABORTION WITHOUT D&C
|
Facility
|
IP
|
$33,586.14
|
|
|
Service Code
|
MSDRG 779
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$33,586.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29,988.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,586.14
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24,878.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,878.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,878.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,347.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,337.35
|
| Rate for Payer: Multiplan WC |
$20,918.45
|
| Rate for Payer: Prime Health Services WC |
$20,705.00
|
| 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 783: CESAREAN SECTION WITH STERILIZATION WITH MCC
|
Facility
|
IP
|
$53,713.89
|
|
|
Service Code
|
MSDRG 783
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$53,713.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53,713.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,300.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33,556.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,556.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,556.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42,280.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44,965.17
|
| Rate for Payer: Multiplan WC |
$39,629.24
|
| Rate for Payer: Prime Health Services WC |
$39,224.86
|
| 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 784: CESAREAN SECTION WITH STERILIZATION WITH CC
|
Facility
|
IP
|
$34,108.55
|
|
|
Service Code
|
MSDRG 784
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$34,108.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,046.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,108.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,265.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,265.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,265.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,834.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,855.89
|
| Rate for Payer: Multiplan WC |
$21,440.08
|
| Rate for Payer: Prime Health Services WC |
$21,221.30
|
| 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
|
|
