|
INPATIENT MS-DRG 810: MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$33,815.16
|
|
|
Service Code
|
MSDRG 810
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$33,815.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,452.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,815.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,048.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,048.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,048.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,560.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,564.68
|
| Rate for Payer: Multiplan WC |
$19,279.65
|
| Rate for Payer: Prime Health Services WC |
$19,082.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 811: RED BLOOD CELL DISORDERS WITH MCC
|
Facility
|
IP
|
$42,551.54
|
|
|
Service Code
|
MSDRG 811
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$42,551.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42,551.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$39,789.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29,473.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29,473.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,473.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37,136.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39,494.48
|
| Rate for Payer: Multiplan WC |
$28,551.86
|
| Rate for Payer: Prime Health Services WC |
$28,260.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 812: RED BLOOD CELL DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$32,261.38
|
|
|
Service Code
|
MSDRG 812
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$32,261.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,305.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,261.38
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,897.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,897.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,897.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,110.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,022.41
|
| Rate for Payer: Multiplan WC |
$18,441.76
|
| Rate for Payer: Prime Health Services WC |
$18,253.58
|
| 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 813: COAGULATION DISORDERS
|
Facility
|
IP
|
$47,292.96
|
|
|
Service Code
|
MSDRG 813
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$47,292.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47,292.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,130.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31,207.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,207.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,207.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,321.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,818.26
|
| Rate for Payer: Multiplan WC |
$32,141.64
|
| Rate for Payer: Prime Health Services WC |
$31,813.66
|
| 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 814: RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC
|
Facility
|
IP
|
$64,515.48
|
|
|
Service Code
|
MSDRG 814
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$64,515.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$64,515.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$50,634.14
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37,506.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37,506.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37,506.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47,258.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50,259.07
|
| Rate for Payer: Multiplan WC |
$38,590.10
|
| Rate for Payer: Prime Health Services WC |
$38,196.32
|
| 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 815: RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC
|
Facility
|
IP
|
$33,660.98
|
|
|
Service Code
|
MSDRG 815
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$33,660.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,140.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,660.98
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24,934.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,934.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,934.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,416.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,411.64
|
| Rate for Payer: Multiplan WC |
$21,175.16
|
| Rate for Payer: Prime Health Services WC |
$20,959.09
|
| 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 816: RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$29,409.82
|
|
|
Service Code
|
MSDRG 816
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$29,409.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21,530.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,409.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,785.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,785.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,785.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,449.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,191.97
|
| Rate for Payer: Multiplan WC |
$14,971.09
|
| Rate for Payer: Prime Health Services WC |
$14,818.32
|
| 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 817: OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$68,362.58
|
|
|
Service Code
|
MSDRG 817
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$68,362.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$68,362.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$60,943.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$45,143.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$45,143.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45,143.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56,880.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60,491.74
|
| Rate for Payer: Multiplan WC |
$64,275.06
|
| Rate for Payer: Prime Health Services WC |
$63,619.20
|
| 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 818: OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$40,200.85
|
|
|
Service Code
|
MSDRG 818
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$40,200.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35,563.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$40,200.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29,778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29,778.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,778.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37,520.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39,903.07
|
| Rate for Payer: Multiplan WC |
$32,655.05
|
| Rate for Payer: Prime Health Services WC |
$32,321.84
|
| 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 819: OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$32,358.68
|
|
|
Service Code
|
MSDRG 819
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$32,358.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,502.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,358.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,969.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,969.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,969.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,201.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,118.98
|
| Rate for Payer: Multiplan WC |
$18,246.66
|
| Rate for Payer: Prime Health Services WC |
$18,060.47
|
| 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 820: LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$183,311.76
|
|
|
Service Code
|
MSDRG 820
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$183,311.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$183,311.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$109,291.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$80,956.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$80,956.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80,956.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102,004.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$108,481.46
|
| Rate for Payer: Multiplan WC |
$109,204.76
|
| Rate for Payer: Prime Health Services WC |
$108,090.43
|
| 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 821: LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$67,668.34
|
|
|
Service Code
|
MSDRG 821
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$67,668.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$67,668.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$52,190.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$38,659.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38,659.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38,659.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48,711.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,804.29
|
| Rate for Payer: Multiplan WC |
$44,408.07
|
| Rate for Payer: Prime Health Services WC |
$43,954.93
|
| 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 822: LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$37,555.46
|
|
|
Service Code
|
MSDRG 822
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$37,555.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37,555.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,322.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,646.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,646.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,646.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,834.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,045.88
|
| Rate for Payer: Multiplan WC |
$24,746.45
|
| Rate for Payer: Prime Health Services WC |
$24,493.94
|
| 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 823: LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC
|
Facility
|
IP
|
$136,479.60
|
|
|
Service Code
|
MSDRG 823
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$136,479.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$136,479.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$86,167.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$63,827.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$63,827.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63,827.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80,422.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85,528.88
|
| Rate for Payer: Multiplan WC |
$88,849.01
|
| Rate for Payer: Prime Health Services WC |
$87,942.39
|
| 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 824: LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC
|
Facility
|
IP
|
$67,692.60
|
|
|
Service Code
|
MSDRG 824
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$67,692.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$67,692.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$52,202.88
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$38,668.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38,668.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38,668.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48,722.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,816.19
|
| Rate for Payer: Multiplan WC |
$47,034.69
|
| Rate for Payer: Prime Health Services WC |
$46,554.74
|
| 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 825: LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$39,150.08
|
|
|
Service Code
|
MSDRG 825
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$39,150.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,150.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,109.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$28,229.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,229.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,229.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,569.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,827.41
|
| Rate for Payer: Multiplan WC |
$27,038.33
|
| Rate for Payer: Prime Health Services WC |
$26,762.43
|
| 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 826: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$133,050.86
|
|
|
Service Code
|
MSDRG 826
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$133,050.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$133,050.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$88,050.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$65,222.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65,222.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65,222.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$82,180.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87,398.02
|
| Rate for Payer: Multiplan WC |
$105,596.51
|
| Rate for Payer: Prime Health Services WC |
$104,518.99
|
| 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 827: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$70,248.24
|
|
|
Service Code
|
MSDRG 827
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$70,248.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$70,248.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$53,464.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$39,603.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$39,603.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39,603.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49,900.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53,068.70
|
| Rate for Payer: Multiplan WC |
$50,000.16
|
| Rate for Payer: Prime Health Services WC |
$49,489.95
|
| 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 828: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$49,730.37
|
|
|
Service Code
|
MSDRG 828
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$49,730.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49,730.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$43,333.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$32,099.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32,099.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,099.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40,444.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43,012.83
|
| Rate for Payer: Multiplan WC |
$35,714.98
|
| Rate for Payer: Prime Health Services WC |
$35,350.54
|
| 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 829: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$95,610.60
|
|
|
Service Code
|
MSDRG 829
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$95,610.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$95,610.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$65,987.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$48,879.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48,879.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48,879.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61,588.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$65,498.88
|
| Rate for Payer: Multiplan WC |
$64,991.79
|
| Rate for Payer: Prime Health Services WC |
$64,328.61
|
| 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 830: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$47,935.66
|
|
|
Service Code
|
MSDRG 830
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$47,935.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47,935.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,447.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31,442.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,442.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,442.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,617.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42,133.26
|
| Rate for Payer: Multiplan WC |
$30,198.89
|
| Rate for Payer: Prime Health Services WC |
$29,890.73
|
| 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 831: OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$34,874.96
|
|
|
Service Code
|
MSDRG 831
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$34,874.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,613.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,874.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,833.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,833.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,833.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,549.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,616.62
|
| Rate for Payer: Multiplan WC |
$24,536.99
|
| Rate for Payer: Prime Health Services WC |
$24,286.61
|
| 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 832: OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$29,821.46
|
|
|
Service Code
|
MSDRG 832
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$29,821.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,364.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,821.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,089.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,089.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,089.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,833.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,600.56
|
| Rate for Payer: Multiplan WC |
$14,385.80
|
| Rate for Payer: Prime Health Services WC |
$14,239.01
|
| 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 833: OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$26,440.01
|
|
|
Service Code
|
MSDRG 833
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$26,440.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15,515.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,440.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$19,585.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19,585.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,585.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24,677.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26,244.15
|
| Rate for Payer: Multiplan WC |
$10,350.39
|
| Rate for Payer: Prime Health Services WC |
$10,244.77
|
| 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 834: ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$169,739.28
|
|
|
Service Code
|
MSDRG 834
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$169,739.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$169,739.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$102,589.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$75,992.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75,992.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75,992.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95,750.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101,829.55
|
| Rate for Payer: Multiplan WC |
$113,566.71
|
| Rate for Payer: Prime Health Services WC |
$112,407.87
|
| 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
|
|
