|
INPATIENT MS-DRG 785: CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$31,746.45
|
|
|
Service Code
|
MSDRG 785
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$31,746.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26,262.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,746.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,515.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,515.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,515.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,630.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,511.29
|
| Rate for Payer: Multiplan WC |
$18,731.32
|
| Rate for Payer: Prime Health Services WC |
$18,540.18
|
| 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 786: CESAREAN SECTION WITHOUT STERILIZATION WITH MCC
|
Facility
|
IP
|
$53,037.84
|
|
|
Service Code
|
MSDRG 786
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$53,037.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53,037.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$44,966.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33,308.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,308.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,308.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41,969.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44,633.83
|
| Rate for Payer: Multiplan WC |
$33,166.40
|
| Rate for Payer: Prime Health Services WC |
$32,827.97
|
| 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 787: CESAREAN SECTION WITHOUT STERILIZATION WITH CC
|
Facility
|
IP
|
$34,512.71
|
|
|
Service Code
|
MSDRG 787
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$34,512.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,865.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,512.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,564.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,564.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,564.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,211.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,257.06
|
| Rate for Payer: Multiplan WC |
$21,877.51
|
| Rate for Payer: Prime Health Services WC |
$21,654.27
|
| 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 788: CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$31,577.31
|
|
|
Service Code
|
MSDRG 788
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$31,577.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,920.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,577.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,390.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,390.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,390.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,472.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,343.40
|
| Rate for Payer: Multiplan WC |
$17,916.02
|
| Rate for Payer: Prime Health Services WC |
$17,733.20
|
| 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 789: NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY
|
Facility
|
IP
|
$55,156.93
|
|
|
Service Code
|
MSDRG 789
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$55,156.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55,156.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,013.25
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$34,083.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34,083.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,083.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42,945.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45,672.41
|
| Rate for Payer: Multiplan WC |
$37,495.50
|
| Rate for Payer: Prime Health Services WC |
$37,112.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,260.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,191.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 790: EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE
|
Facility
|
IP
|
$181,899.03
|
|
|
Service Code
|
MSDRG 790
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$181,899.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$181,899.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$108,593.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$80,439.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$80,439.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80,439.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101,353.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$107,789.08
|
| Rate for Payer: Multiplan WC |
$123,652.18
|
| Rate for Payer: Prime Health Services WC |
$122,390.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,260.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,191.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 791: PREMATURITY WITH MAJOR PROBLEMS
|
Facility
|
IP
|
$124,225.87
|
|
|
Service Code
|
MSDRG 791
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$124,225.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124,225.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$80,116.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59,345.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59,345.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59,345.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74,775.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79,523.30
|
| Rate for Payer: Multiplan WC |
$84,448.04
|
| Rate for Payer: Prime Health Services WC |
$83,586.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,260.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,191.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 792: PREMATURITY WITHOUT MAJOR PROBLEMS
|
Facility
|
IP
|
$74,956.31
|
|
|
Service Code
|
MSDRG 792
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$74,956.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$74,956.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$55,789.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$41,325.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41,325.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41,325.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52,070.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55,376.16
|
| Rate for Payer: Multiplan WC |
$50,955.10
|
| Rate for Payer: Prime Health Services WC |
$50,435.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,260.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,191.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 793: FULL TERM NEONATE WITH MAJOR PROBLEMS
|
Facility
|
IP
|
$127,609.14
|
|
|
Service Code
|
MSDRG 793
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$127,609.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$127,609.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$81,787.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$60,583.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60,583.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60,583.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76,334.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81,181.45
|
| Rate for Payer: Multiplan WC |
$86,746.07
|
| Rate for Payer: Prime Health Services WC |
$85,860.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,260.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,191.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 794: NEONATE WITH OTHER SIGNIFICANT PROBLEMS
|
Facility
|
IP
|
$45,167.81
|
|
|
Service Code
|
MSDRG 794
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$45,167.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45,167.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,081.03
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30,430.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30,430.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,430.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38,342.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40,776.72
|
| Rate for Payer: Multiplan WC |
$30,704.09
|
| Rate for Payer: Prime Health Services WC |
$30,390.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,260.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,191.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 795: NORMAL NEWBORN
|
Facility
|
IP
|
$21,798.17
|
|
|
Service Code
|
MSDRG 795
|
| Min. Negotiated Rate |
$1,001.00 |
| Max. Negotiated Rate |
$21,798.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,114.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,798.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16,146.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,146.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,146.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,344.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,636.70
|
| Rate for Payer: Multiplan WC |
$4,156.58
|
| Rate for Payer: Prime Health Services WC |
$4,114.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,566.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,278.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,094.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,001.00
|
|
|
INPATIENT MS-DRG 796: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC
|
Facility
|
IP
|
$43,000.21
|
|
|
Service Code
|
MSDRG 796
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$43,000.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$43,000.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$40,010.75
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29,637.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29,637.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,637.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37,343.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39,714.37
|
| Rate for Payer: Multiplan WC |
$26,964.40
|
| Rate for Payer: Prime Health Services WC |
$26,689.25
|
| 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 797: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC
|
Facility
|
IP
|
$33,686.43
|
|
|
Service Code
|
MSDRG 797
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$33,686.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,191.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,686.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24,952.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,952.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,952.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,440.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,436.90
|
| Rate for Payer: Multiplan WC |
$19,055.80
|
| Rate for Payer: Prime Health Services WC |
$18,861.35
|
| 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 798: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$31,279.45
|
|
|
Service Code
|
MSDRG 798
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$31,279.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,592.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,279.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,169.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,169.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,169.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,194.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,047.75
|
| Rate for Payer: Multiplan WC |
$19,055.80
|
| Rate for Payer: Prime Health Services WC |
$18,861.35
|
| 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 799: SPLENIC PROCEDURES WITH MCC
|
Facility
|
IP
|
$150,203.65
|
|
|
Service Code
|
MSDRG 799
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$150,203.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$150,203.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$92,943.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$68,847.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$68,847.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68,847.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$86,747.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92,255.09
|
| Rate for Payer: Multiplan WC |
$106,947.81
|
| Rate for Payer: Prime Health Services WC |
$105,856.51
|
| 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 800: SPLENIC PROCEDURES WITH CC
|
Facility
|
IP
|
$85,421.39
|
|
|
Service Code
|
MSDRG 800
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$85,421.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$85,421.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$60,956.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$45,153.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$45,153.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45,153.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56,892.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60,505.11
|
| Rate for Payer: Multiplan WC |
$54,596.22
|
| Rate for Payer: Prime Health Services WC |
$54,039.12
|
| 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 801: SPLENIC PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$54,256.55
|
|
|
Service Code
|
MSDRG 801
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$54,256.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$54,256.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,568.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33,754.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,754.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,754.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42,530.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45,231.14
|
| Rate for Payer: Multiplan WC |
$36,883.52
|
| Rate for Payer: Prime Health Services WC |
$36,507.15
|
| 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 802: OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC
|
Facility
|
IP
|
$102,780.33
|
|
|
Service Code
|
MSDRG 802
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$102,780.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$102,780.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$70,134.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$51,951.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51,951.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51,951.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$65,458.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69,614.53
|
| Rate for Payer: Multiplan WC |
$78,285.05
|
| Rate for Payer: Prime Health Services WC |
$77,486.22
|
| 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 803: OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC
|
Facility
|
IP
|
$56,333.19
|
|
|
Service Code
|
MSDRG 803
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$56,333.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$56,333.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,594.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$34,514.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34,514.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,514.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43,487.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46,248.89
|
| Rate for Payer: Multiplan WC |
$42,167.55
|
| Rate for Payer: Prime Health Services WC |
$41,737.27
|
| 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 804: OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC
|
Facility
|
IP
|
$36,897.24
|
|
|
Service Code
|
MSDRG 804
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$36,897.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36,694.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,897.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,331.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,331.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,331.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,437.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36,623.93
|
| Rate for Payer: Multiplan WC |
$25,912.92
|
| Rate for Payer: Prime Health Services WC |
$25,648.51
|
| 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 805: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC
|
Facility
|
IP
|
$33,870.53
|
|
|
Service Code
|
MSDRG 805
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$33,870.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,564.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,870.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,089.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,089.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,089.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,612.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,619.64
|
| Rate for Payer: Multiplan WC |
$20,651.48
|
| Rate for Payer: Prime Health Services WC |
$20,440.75
|
| 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 806: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC
|
Facility
|
IP
|
$29,956.20
|
|
|
Service Code
|
MSDRG 806
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$29,956.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,636.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,956.20
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,189.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,189.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,189.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,959.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,734.31
|
| Rate for Payer: Multiplan WC |
$14,330.35
|
| Rate for Payer: Prime Health Services WC |
$14,184.13
|
| 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 807: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$28,573.07
|
|
|
Service Code
|
MSDRG 807
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$28,573.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19,835.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,573.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,165.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,165.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,165.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,668.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,361.42
|
| Rate for Payer: Multiplan WC |
$12,966.73
|
| Rate for Payer: Prime Health Services WC |
$12,834.42
|
| 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 808: MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC
|
Facility
|
IP
|
$66,395.07
|
|
|
Service Code
|
MSDRG 808
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$66,395.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$66,395.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$51,562.20
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$38,194.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38,194.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38,194.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48,124.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,180.25
|
| Rate for Payer: Multiplan WC |
$43,968.59
|
| Rate for Payer: Prime Health Services WC |
$43,519.93
|
| 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 809: MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC
|
Facility
|
IP
|
$36,807.41
|
|
|
Service Code
|
MSDRG 809
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$36,807.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36,512.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,807.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,264.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,264.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,264.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,353.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36,534.76
|
| Rate for Payer: Multiplan WC |
$24,966.20
|
| Rate for Payer: Prime Health Services WC |
$24,711.44
|
| 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
|
|
