|
INPATIENT MS-DRG 946: REHABILITATION WITHOUT CC/MCC
|
Facility
|
IP
|
$33,937.89
|
|
|
Service Code
|
MSDRG 946
|
| Min. Negotiated Rate |
$2,739.00 |
| Max. Negotiated Rate |
$33,937.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,701.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,937.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,139.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,139.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,139.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,675.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,686.50
|
| Rate for Payer: Multiplan WC |
$23,054.25
|
| Rate for Payer: Prime Health Services WC |
$22,819.00
|
| 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
|
|
|
INPATIENT MS-DRG 947: SIGNS AND SYMPTOMS WITH MCC
|
Facility
|
IP
|
$37,943.51
|
|
|
Service Code
|
MSDRG 947
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$37,943.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37,943.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,513.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,788.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,788.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,788.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,013.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,236.05
|
| 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 |
$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 948: SIGNS AND SYMPTOMS WITHOUT MCC
|
Facility
|
IP
|
$30,769.00
|
|
|
Service Code
|
MSDRG 948
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$30,769.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,283.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,769.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,791.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,791.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,791.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,717.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,541.08
|
| Rate for Payer: Multiplan WC |
$15,969.17
|
| Rate for Payer: Prime Health Services WC |
$15,806.22
|
| 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 949: AFTERCARE WITH CC/MCC
|
Facility
|
IP
|
$34,837.52
|
|
|
Service Code
|
MSDRG 949
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$34,837.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,410.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,837.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,805.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25,805.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,805.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,515.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,579.46
|
| Rate for Payer: Multiplan WC |
$24,479.48
|
| Rate for Payer: Prime Health Services WC |
$24,229.69
|
| 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 950: AFTERCARE WITHOUT CC/MCC
|
Facility
|
IP
|
$28,338.04
|
|
|
Service Code
|
MSDRG 950
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$28,338.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19,044.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,338.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20,991.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,991.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,991.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,448.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,128.13
|
| Rate for Payer: Multiplan WC |
$14,570.63
|
| Rate for Payer: Prime Health Services WC |
$14,421.95
|
| 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 951: OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
|
IP
|
$27,610.56
|
|
|
Service Code
|
MSDRG 951
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$27,610.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17,886.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,610.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20,452.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20,452.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,452.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,769.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,406.04
|
| Rate for Payer: Multiplan WC |
$11,689.36
|
| Rate for Payer: Prime Health Services WC |
$11,570.08
|
| 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 955: CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$184,630.50
|
|
|
Service Code
|
MSDRG 955
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$184,630.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$184,630.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$109,942.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$81,438.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$81,438.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81,438.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102,612.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109,127.78
|
| Rate for Payer: Multiplan WC |
$138,333.70
|
| Rate for Payer: Prime Health Services WC |
$136,922.13
|
| 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 956: LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$117,571.51
|
|
|
Service Code
|
MSDRG 956
|
| Min. Negotiated Rate |
$25,608.00 |
| Max. Negotiated Rate |
$117,571.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$117,571.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$76,831.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$56,911.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$25,608.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56,911.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56,911.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71,709.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76,261.99
|
| Rate for Payer: Multiplan WC |
$78,124.86
|
| Rate for Payer: Prime Health Services WC |
$77,327.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$86,845.00
|
| Rate for Payer: United Healthcare All Other HMO |
$56,323.00
|
| Rate for Payer: United Healthcare HMO Rider |
$42,781.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39,121.00
|
|
|
INPATIENT MS-DRG 957: OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC
|
Facility
|
IP
|
$219,260.47
|
|
|
Service Code
|
MSDRG 957
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$219,260.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$219,260.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$127,041.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$94,104.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$94,104.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94,104.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$118,571.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$126,100.02
|
| Rate for Payer: Multiplan WC |
$152,185.55
|
| Rate for Payer: Prime Health Services WC |
$150,632.64
|
| 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 958: OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC
|
Facility
|
IP
|
$122,622.16
|
|
|
Service Code
|
MSDRG 958
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$122,622.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$122,622.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$79,324.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$58,759.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58,759.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58,759.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74,036.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78,737.31
|
| Rate for Payer: Multiplan WC |
$85,647.37
|
| Rate for Payer: Prime Health Services WC |
$84,773.42
|
| 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 959: OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC
|
Facility
|
IP
|
$76,772.24
|
|
|
Service Code
|
MSDRG 959
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$76,772.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76,772.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$56,686.03
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$41,989.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41,989.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41,989.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52,906.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56,266.13
|
| Rate for Payer: Multiplan WC |
$52,752.05
|
| Rate for Payer: Prime Health Services WC |
$52,213.76
|
| 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 963: OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC
|
Facility
|
IP
|
$82,893.04
|
|
|
Service Code
|
MSDRG 963
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$82,893.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$82,893.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$59,708.25
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$44,228.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$44,228.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44,228.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55,727.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59,265.96
|
| Rate for Payer: Multiplan WC |
$56,951.76
|
| Rate for Payer: Prime Health Services WC |
$56,370.62
|
| 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 964: OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC
|
Facility
|
IP
|
$45,504.32
|
|
|
Service Code
|
MSDRG 964
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$45,504.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45,504.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,247.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30,553.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30,553.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,553.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38,497.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40,941.65
|
| Rate for Payer: Multiplan WC |
$30,075.67
|
| Rate for Payer: Prime Health Services WC |
$29,768.78
|
| 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 965: OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC
|
Facility
|
IP
|
$33,087.66
|
|
|
Service Code
|
MSDRG 965
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$33,087.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28,979.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,087.66
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24,509.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,509.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,509.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,881.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,842.57
|
| Rate for Payer: Multiplan WC |
$18,686.14
|
| Rate for Payer: Prime Health Services WC |
$18,495.47
|
| 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 969: HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$208,349.74
|
|
|
Service Code
|
MSDRG 969
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$208,349.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$208,349.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$121,653.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$90,113.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90,113.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90,113.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113,543.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$120,752.63
|
| Rate for Payer: Multiplan WC |
$148,840.17
|
| Rate for Payer: Prime Health Services WC |
$147,321.39
|
| 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 970: HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$72,891.79
|
|
|
Service Code
|
MSDRG 970
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$72,891.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$72,891.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$60,386.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$44,730.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$44,730.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44,730.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56,360.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59,939.03
|
| Rate for Payer: Multiplan WC |
$63,424.86
|
| Rate for Payer: Prime Health Services WC |
$62,777.66
|
| 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 974: HIV WITH MAJOR RELATED CONDITION WITH MCC
|
Facility
|
IP
|
$88,416.61
|
|
|
Service Code
|
MSDRG 974
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$88,416.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$88,416.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$62,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$46,248.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$46,248.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46,248.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58,273.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61,973.08
|
| Rate for Payer: Multiplan WC |
$59,001.29
|
| Rate for Payer: Prime Health Services WC |
$58,399.24
|
| 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 975: HIV WITH MAJOR RELATED CONDITION WITH CC
|
Facility
|
IP
|
$41,329.80
|
|
|
Service Code
|
MSDRG 975
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$41,329.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41,329.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$39,185.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29,026.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29,026.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,026.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,573.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,895.70
|
| Rate for Payer: Multiplan WC |
$28,252.03
|
| Rate for Payer: Prime Health Services WC |
$27,963.74
|
| 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 976: HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC
|
Facility
|
IP
|
$31,432.13
|
|
|
Service Code
|
MSDRG 976
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$31,432.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,626.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,432.13
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,283.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,283.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,283.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,336.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,199.30
|
| Rate for Payer: Multiplan WC |
$18,951.06
|
| Rate for Payer: Prime Health Services WC |
$18,757.69
|
| 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 977: HIV WITH OR WITHOUT OTHER RELATED CONDITION
|
Facility
|
IP
|
$42,930.49
|
|
|
Service Code
|
MSDRG 977
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$42,930.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42,930.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$39,976.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29,612.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29,612.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,612.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37,311.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39,680.20
|
| Rate for Payer: Multiplan WC |
$26,695.37
|
| Rate for Payer: Prime Health Services WC |
$26,422.96
|
| 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 981: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$143,709.97
|
|
|
Service Code
|
MSDRG 981
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$143,709.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$143,709.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$89,737.23
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$66,472.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$66,472.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66,472.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83,754.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89,072.51
|
| Rate for Payer: Multiplan WC |
$94,065.28
|
| Rate for Payer: Prime Health Services WC |
$93,105.43
|
| 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 982: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC
|
Facility
|
IP
|
$75,365.58
|
|
|
Service Code
|
MSDRG 982
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$75,365.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$75,365.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$55,991.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$41,475.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41,475.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41,475.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52,258.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55,576.73
|
| Rate for Payer: Multiplan WC |
$51,509.59
|
| Rate for Payer: Prime Health Services WC |
$50,983.99
|
| 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 983: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$49,572.72
|
|
|
Service Code
|
MSDRG 983
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$49,572.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49,572.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$43,256.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$32,041.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32,041.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,041.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40,372.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42,935.58
|
| Rate for Payer: Multiplan WC |
$34,300.02
|
| Rate for Payer: Prime Health Services WC |
$33,950.02
|
| 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 987: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$102,368.04
|
|
|
Service Code
|
MSDRG 987
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$102,368.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$102,368.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$69,324.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$51,351.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51,351.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51,351.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64,702.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68,810.70
|
| Rate for Payer: Multiplan WC |
$68,148.24
|
| Rate for Payer: Prime Health Services WC |
$67,452.85
|
| 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 988: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC
|
Facility
|
IP
|
$51,446.25
|
|
|
Service Code
|
MSDRG 988
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$51,446.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$51,446.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$44,181.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$32,726.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32,726.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,726.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41,235.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43,853.80
|
| Rate for Payer: Multiplan WC |
$34,838.08
|
| Rate for Payer: Prime Health Services WC |
$34,482.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
