|
INPATIENT MS-DRG 906: HAND PROCEDURES FOR INJURIES
|
Facility
|
IP
|
$57,042.59
|
|
|
Service Code
|
MSDRG 906
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$57,042.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$57,042.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,944.33
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$34,773.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34,773.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,773.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43,814.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46,596.60
|
| Rate for Payer: Multiplan WC |
$36,715.11
|
| Rate for Payer: Prime Health Services WC |
$36,340.47
|
| 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 907: OTHER O.R. PROCEDURES FOR INJURIES WITH MCC
|
Facility
|
IP
|
$112,760.36
|
|
|
Service Code
|
MSDRG 907
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$112,760.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$112,760.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$74,455.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$55,152.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55,152.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55,152.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69,491.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73,904.02
|
| Rate for Payer: Multiplan WC |
$79,387.86
|
| Rate for Payer: Prime Health Services WC |
$78,577.78
|
| 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 908: OTHER O.R. PROCEDURES FOR INJURIES WITH CC
|
Facility
|
IP
|
$60,756.30
|
|
|
Service Code
|
MSDRG 908
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$60,756.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$60,756.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$48,778.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$36,131.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36,131.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36,131.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45,526.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48,416.68
|
| Rate for Payer: Multiplan WC |
$42,233.27
|
| Rate for Payer: Prime Health Services WC |
$41,802.31
|
| 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 909: OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$41,117.59
|
|
|
Service Code
|
MSDRG 909
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$41,117.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41,117.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$39,081.20
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$28,949.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,949.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,949.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,475.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,791.71
|
| Rate for Payer: Multiplan WC |
$28,026.13
|
| Rate for Payer: Prime Health Services WC |
$27,740.15
|
| 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 913: TRAUMATIC INJURY WITH MCC
|
Facility
|
IP
|
$45,307.26
|
|
|
Service Code
|
MSDRG 913
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$45,307.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45,307.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,149.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30,481.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30,481.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,481.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38,406.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40,845.08
|
| Rate for Payer: Multiplan WC |
$31,094.28
|
| Rate for Payer: Prime Health Services WC |
$30,776.99
|
| 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 914: TRAUMATIC INJURY WITHOUT MCC
|
Facility
|
IP
|
$32,366.18
|
|
|
Service Code
|
MSDRG 914
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$32,366.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,517.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,366.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,974.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,974.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,974.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,208.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,126.43
|
| Rate for Payer: Multiplan WC |
$18,258.98
|
| Rate for Payer: Prime Health Services WC |
$18,072.66
|
| 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 915: ALLERGIC REACTIONS WITH MCC
|
Facility
|
IP
|
$53,780.58
|
|
|
Service Code
|
MSDRG 915
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$53,780.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53,780.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,333.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33,580.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,580.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,580.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42,311.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44,997.87
|
| Rate for Payer: Multiplan WC |
$37,378.44
|
| Rate for Payer: Prime Health Services WC |
$36,997.03
|
| 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 916: ALLERGIC REACTIONS WITHOUT MCC
|
Facility
|
IP
|
$28,640.41
|
|
|
Service Code
|
MSDRG 916
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$28,640.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19,972.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,640.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,215.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,215.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,215.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,731.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,428.26
|
| Rate for Payer: Multiplan WC |
$13,640.33
|
| Rate for Payer: Prime Health Services WC |
$13,501.14
|
| 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 917: POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC
|
Facility
|
IP
|
$48,381.30
|
|
|
Service Code
|
MSDRG 917
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$48,381.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48,381.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,667.72
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31,605.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,605.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,605.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,823.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42,351.66
|
| Rate for Payer: Multiplan WC |
$31,266.78
|
| Rate for Payer: Prime Health Services WC |
$30,947.73
|
| 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 918: POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC
|
Facility
|
IP
|
$31,665.63
|
|
|
Service Code
|
MSDRG 918
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$31,665.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26,099.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,665.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,456.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,456.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,456.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,554.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,431.07
|
| Rate for Payer: Multiplan WC |
$16,792.67
|
| Rate for Payer: Prime Health Services WC |
$16,621.32
|
| 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 919: COMPLICATIONS OF TREATMENT WITH MCC
|
Facility
|
IP
|
$55,317.61
|
|
|
Service Code
|
MSDRG 919
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$55,317.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55,317.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,092.59
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$34,142.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34,142.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,142.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43,019.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45,751.16
|
| Rate for Payer: Multiplan WC |
$36,834.22
|
| Rate for Payer: Prime Health Services WC |
$36,458.36
|
| 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 920: COMPLICATIONS OF TREATMENT WITH CC
|
Facility
|
IP
|
$34,253.74
|
|
|
Service Code
|
MSDRG 920
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$34,253.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,340.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,253.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,373.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,373.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,373.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,970.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,000.01
|
| Rate for Payer: Multiplan WC |
$20,984.17
|
| Rate for Payer: Prime Health Services WC |
$20,770.05
|
| 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 921: COMPLICATIONS OF TREATMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$29,224.21
|
|
|
Service Code
|
MSDRG 921
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$29,224.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21,154.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,224.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,647.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,647.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,647.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,275.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,007.73
|
| Rate for Payer: Multiplan WC |
$14,948.50
|
| Rate for Payer: Prime Health Services WC |
$14,795.96
|
| 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 922: OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC
|
Facility
|
IP
|
$52,898.39
|
|
|
Service Code
|
MSDRG 922
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$52,898.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52,898.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$44,898.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33,257.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33,257.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,257.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41,904.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44,565.51
|
| Rate for Payer: Multiplan WC |
$31,950.65
|
| Rate for Payer: Prime Health Services WC |
$31,624.62
|
| 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 923: OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC
|
Facility
|
IP
|
$33,918.45
|
|
|
Service Code
|
MSDRG 923
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$33,918.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,661.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,918.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,124.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,124.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,124.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,657.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,667.21
|
| Rate for Payer: Multiplan WC |
$19,370.00
|
| Rate for Payer: Prime Health Services WC |
$19,172.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 927: EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT
|
Facility
|
IP
|
$799,090.35
|
|
|
Service Code
|
MSDRG 927
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$799,090.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$799,090.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$413,337.98
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306,176.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306,176.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306,176.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385,782.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410,276.22
|
| Rate for Payer: Multiplan WC |
$389,827.50
|
| Rate for Payer: Prime Health Services WC |
$385,849.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 928: FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC
|
Facility
|
IP
|
$209,777.63
|
|
|
Service Code
|
MSDRG 928
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$209,777.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$209,777.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$122,358.79
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$90,636.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90,636.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90,636.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$114,201.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121,452.43
|
| Rate for Payer: Multiplan WC |
$127,147.48
|
| Rate for Payer: Prime Health Services WC |
$125,850.06
|
| 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 929: FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC
|
Facility
|
IP
|
$97,481.10
|
|
|
Service Code
|
MSDRG 929
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$97,481.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$97,481.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$66,911.26
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$49,563.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49,563.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49,563.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62,450.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66,415.63
|
| Rate for Payer: Multiplan WC |
$60,352.59
|
| Rate for Payer: Prime Health Services WC |
$59,736.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 933: EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$91,918.11
|
|
|
Service Code
|
MSDRG 933
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$91,918.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$91,918.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$64,164.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$47,529.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47,529.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47,529.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59,886.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63,689.17
|
| Rate for Payer: Multiplan WC |
$62,287.13
|
| Rate for Payer: Prime Health Services WC |
$61,651.55
|
| 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 934: FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY
|
Facility
|
IP
|
$63,436.23
|
|
|
Service Code
|
MSDRG 934
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$63,436.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$63,436.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$50,101.25
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37,112.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37,112.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37,112.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46,761.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49,730.13
|
| Rate for Payer: Multiplan WC |
$38,526.43
|
| Rate for Payer: Prime Health Services WC |
$38,133.30
|
| 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 935: NON-EXTENSIVE BURNS
|
Facility
|
IP
|
$61,877.99
|
|
|
Service Code
|
MSDRG 935
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$61,877.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$61,877.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$49,331.86
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$36,542.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36,542.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36,542.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46,043.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48,966.44
|
| Rate for Payer: Multiplan WC |
$41,567.89
|
| Rate for Payer: Prime Health Services WC |
$41,143.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 939: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC
|
Facility
|
IP
|
$97,475.03
|
|
|
Service Code
|
MSDRG 939
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$97,475.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$97,475.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$66,908.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$49,561.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49,561.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49,561.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62,447.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66,412.62
|
| Rate for Payer: Multiplan WC |
$63,603.52
|
| Rate for Payer: Prime Health Services WC |
$62,954.50
|
| 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 940: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC
|
Facility
|
IP
|
$65,682.65
|
|
|
Service Code
|
MSDRG 940
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$65,682.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$65,682.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$51,210.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37,933.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37,933.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37,933.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47,796.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50,831.10
|
| Rate for Payer: Multiplan WC |
$45,248.02
|
| Rate for Payer: Prime Health Services WC |
$44,786.31
|
| 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 941: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC
|
Facility
|
IP
|
$56,266.50
|
|
|
Service Code
|
MSDRG 941
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$56,266.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$56,266.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,561.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$34,489.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34,489.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,489.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43,457.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46,216.22
|
| Rate for Payer: Multiplan WC |
$38,760.55
|
| Rate for Payer: Prime Health Services WC |
$38,365.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 945: REHABILITATION WITH CC/MCC
|
Facility
|
IP
|
$45,762.00
|
|
|
Service Code
|
MSDRG 945
|
| Min. Negotiated Rate |
$2,739.00 |
| Max. Negotiated Rate |
$45,762.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45,762.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,374.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30,647.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30,647.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,647.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38,616.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,067.93
|
| Rate for Payer: Multiplan WC |
$30,911.50
|
| Rate for Payer: Prime Health Services WC |
$30,596.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,770.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,196.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,995.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,739.00
|
|
