|
INPATIENT MS-DRG 866: VIRAL ILLNESS WITHOUT MCC
|
Facility
|
IP
|
$32,515.86
|
|
|
Service Code
|
MSDRG 866
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$32,515.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,820.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,515.86
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24,085.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,085.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,085.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,348.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,275.00
|
| Rate for Payer: Multiplan WC |
$18,476.67
|
| Rate for Payer: Prime Health Services WC |
$18,288.13
|
| 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 867: OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC
|
Facility
|
IP
|
$63,430.17
|
|
|
Service Code
|
MSDRG 867
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$63,430.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$63,430.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$50,098.23
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37,109.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37,109.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37,109.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46,758.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49,727.13
|
| Rate for Payer: Multiplan WC |
$43,401.79
|
| Rate for Payer: Prime Health Services WC |
$42,958.91
|
| 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 868: OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC
|
Facility
|
IP
|
$35,027.63
|
|
|
Service Code
|
MSDRG 868
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$35,027.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,908.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,027.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,946.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,946.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,946.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,692.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,768.16
|
| Rate for Payer: Multiplan WC |
$21,680.35
|
| Rate for Payer: Prime Health Services WC |
$21,459.13
|
| 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 869: OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC
|
Facility
|
IP
|
$29,117.93
|
|
|
Service Code
|
MSDRG 869
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$29,117.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20,939.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,117.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,568.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,568.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,568.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,176.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,902.25
|
| Rate for Payer: Multiplan WC |
$15,213.42
|
| Rate for Payer: Prime Health Services WC |
$15,058.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 870: SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS
|
Facility
|
IP
|
$211,147.91
|
|
|
Service Code
|
MSDRG 870
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$211,147.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$211,147.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$123,035.38
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$91,137.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$91,137.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91,137.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$114,833.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$122,124.01
|
| Rate for Payer: Multiplan WC |
$139,461.15
|
| Rate for Payer: Prime Health Services WC |
$138,038.08
|
| 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 871: SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC
|
Facility
|
IP
|
$60,104.50
|
|
|
Service Code
|
MSDRG 871
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$60,104.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$60,104.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$48,456.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35,893.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35,893.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35,893.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45,225.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48,097.24
|
| Rate for Payer: Multiplan WC |
$40,193.99
|
| Rate for Payer: Prime Health Services WC |
$39,783.85
|
| 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 872: SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC
|
Facility
|
IP
|
$34,195.35
|
|
|
Service Code
|
MSDRG 872
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$34,195.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,222.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,195.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,329.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,329.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,329.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,915.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,942.05
|
| Rate for Payer: Multiplan WC |
$21,111.49
|
| Rate for Payer: Prime Health Services WC |
$20,896.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 876: O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS
|
Facility
|
IP
|
$113,124.15
|
|
|
Service Code
|
MSDRG 876
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$113,124.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$113,124.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$74,635.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$55,285.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55,285.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55,285.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69,659.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74,082.32
|
| Rate for Payer: Multiplan WC |
$65,640.74
|
| Rate for Payer: Prime Health Services WC |
$64,970.94
|
| 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 880: ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION
|
Facility
|
IP
|
$33,068.21
|
|
|
Service Code
|
MSDRG 880
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$33,068.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28,939.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,068.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24,494.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,494.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,494.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,863.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,823.26
|
| Rate for Payer: Multiplan WC |
$18,610.15
|
| Rate for Payer: Prime Health Services WC |
$18,420.25
|
| 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 881: DEPRESSIVE NEUROSES
|
Facility
|
IP
|
$32,348.21
|
|
|
Service Code
|
MSDRG 881
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$32,348.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,481.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,348.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,961.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,961.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,961.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,191.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,108.60
|
| Rate for Payer: Multiplan WC |
$17,568.96
|
| Rate for Payer: Prime Health Services WC |
$17,389.68
|
| 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 882: NEUROSES EXCEPT DEPRESSIVE
|
Facility
|
IP
|
$32,839.17
|
|
|
Service Code
|
MSDRG 882
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$32,839.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28,475.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,839.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24,325.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,325.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,325.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,649.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,595.92
|
| Rate for Payer: Multiplan WC |
$17,938.62
|
| Rate for Payer: Prime Health Services WC |
$17,755.57
|
| 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 883: DISORDERS OF PERSONALITY AND IMPULSE CONTROL
|
Facility
|
IP
|
$56,854.63
|
|
|
Service Code
|
MSDRG 883
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$56,854.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$56,854.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,851.51
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$34,704.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34,704.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,704.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43,728.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46,504.46
|
| Rate for Payer: Multiplan WC |
$33,156.14
|
| Rate for Payer: Prime Health Services WC |
$32,817.82
|
| 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 884: ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY
|
Facility
|
IP
|
$53,262.18
|
|
|
Service Code
|
MSDRG 884
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$53,262.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53,262.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,077.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33,390.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,390.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,390.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42,072.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44,743.79
|
| Rate for Payer: Multiplan WC |
$32,242.26
|
| Rate for Payer: Prime Health Services WC |
$31,913.26
|
| 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 885: PSYCHOSES
|
Facility
|
IP
|
$41,423.78
|
|
|
Service Code
|
MSDRG 885
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$41,423.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41,423.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$39,232.38
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29,061.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29,061.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,061.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,616.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,941.77
|
| Rate for Payer: Multiplan WC |
$26,605.00
|
| Rate for Payer: Prime Health Services WC |
$26,333.52
|
| 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 886: BEHAVIORAL AND DEVELOPMENTAL DISORDERS
|
Facility
|
IP
|
$50,982.42
|
|
|
Service Code
|
MSDRG 886
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$50,982.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$50,982.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$43,952.03
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$32,557.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32,557.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,557.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41,021.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43,626.46
|
| Rate for Payer: Multiplan WC |
$28,032.29
|
| Rate for Payer: Prime Health Services WC |
$27,746.25
|
| 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 887: OTHER MENTAL DISORDER DIAGNOSES
|
Facility
|
IP
|
$39,277.41
|
|
|
Service Code
|
MSDRG 887
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$39,277.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,277.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,172.59
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$28,275.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,275.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,275.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,627.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,889.83
|
| Rate for Payer: Multiplan WC |
$26,625.54
|
| Rate for Payer: Prime Health Services WC |
$26,353.85
|
| 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 894: ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA
|
Facility
|
IP
|
$27,378.55
|
|
|
Service Code
|
MSDRG 894
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$27,378.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17,416.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,378.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20,280.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,280.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,280.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,553.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,175.75
|
| Rate for Payer: Multiplan WC |
$11,742.76
|
| Rate for Payer: Prime Health Services WC |
$11,622.94
|
| 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 895: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY
|
Facility
|
IP
|
$48,772.38
|
|
|
Service Code
|
MSDRG 895
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$48,772.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48,772.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,860.81
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31,748.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,748.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,748.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40,003.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42,543.32
|
| Rate for Payer: Multiplan WC |
$32,010.21
|
| Rate for Payer: Prime Health Services WC |
$31,683.58
|
| 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 896: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC
|
Facility
|
IP
|
$53,904.88
|
|
|
Service Code
|
MSDRG 896
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$53,904.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53,904.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,395.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33,625.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,625.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,625.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42,368.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45,058.79
|
| Rate for Payer: Multiplan WC |
$36,053.84
|
| Rate for Payer: Prime Health Services WC |
$35,685.94
|
| 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 897: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC
|
Facility
|
IP
|
$31,586.30
|
|
|
Service Code
|
MSDRG 897
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$31,586.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,938.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,586.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,397.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,397.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,397.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,480.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,352.33
|
| Rate for Payer: Multiplan WC |
$17,482.70
|
| Rate for Payer: Prime Health Services WC |
$17,304.31
|
| 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 901: WOUND DEBRIDEMENTS FOR INJURIES WITH MCC
|
Facility
|
IP
|
$131,201.58
|
|
|
Service Code
|
MSDRG 901
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$131,201.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$131,201.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$83,561.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$61,897.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$61,897.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61,897.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77,990.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$82,942.11
|
| Rate for Payer: Multiplan WC |
$90,331.74
|
| Rate for Payer: Prime Health Services WC |
$89,409.99
|
| 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 902: WOUND DEBRIDEMENTS FOR INJURIES WITH CC
|
Facility
|
IP
|
$57,136.57
|
|
|
Service Code
|
MSDRG 902
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$57,136.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$57,136.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,990.73
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$34,807.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34,807.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,807.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43,858.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46,642.65
|
| Rate for Payer: Multiplan WC |
$40,699.18
|
| Rate for Payer: Prime Health Services WC |
$40,283.89
|
| 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 903: WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$37,637.31
|
|
|
Service Code
|
MSDRG 903
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$37,637.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37,637.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,362.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,676.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,676.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,676.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,871.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,086.01
|
| Rate for Payer: Multiplan WC |
$24,964.14
|
| Rate for Payer: Prime Health Services WC |
$24,709.40
|
| 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 904: SKIN GRAFTS FOR INJURIES WITH CC/MCC
|
Facility
|
IP
|
$98,714.96
|
|
|
Service Code
|
MSDRG 904
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$98,714.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$98,714.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$67,520.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50,015.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50,015.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50,015.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63,019.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67,020.33
|
| Rate for Payer: Multiplan WC |
$72,943.51
|
| Rate for Payer: Prime Health Services WC |
$72,199.19
|
| 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 905: SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$48,011.45
|
|
|
Service Code
|
MSDRG 905
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$48,011.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48,011.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,485.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31,470.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,470.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,470.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,652.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42,170.40
|
| Rate for Payer: Multiplan WC |
$32,034.85
|
| Rate for Payer: Prime Health Services WC |
$31,707.96
|
| 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
|
|
