|
INPATIENT MS-DRG 084: TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC
|
Facility
IP
|
$32,545.79
|
|
|
Service Code
|
MS-DRG 084
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$32,545.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,881.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,545.79
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24,107.99
|
| Rate for Payer: IEHP Medicare Advantage |
$24,107.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,107.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,376.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,304.71
|
| Rate for Payer: Multiplan WC |
$18,821.68
|
| Rate for Payer: Prime Health Services WC |
$18,629.63
|
| 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 085: TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC
|
Facility
IP
|
$68,902.20
|
|
|
Service Code
|
MS-DRG 085
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$68,902.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$68,902.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$52,800.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$39,111.20
|
| Rate for Payer: IEHP Medicare Advantage |
$39,111.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39,111.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49,280.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52,409.01
|
| Rate for Payer: Multiplan WC |
$47,967.05
|
| Rate for Payer: Prime Health Services WC |
$47,477.59
|
| 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 086: TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC
|
Facility
IP
|
$39,929.20
|
|
|
Service Code
|
MS-DRG 086
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$39,929.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,929.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,494.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$28,514.38
|
| Rate for Payer: IEHP Medicare Advantage |
$28,514.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,514.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,928.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,209.27
|
| Rate for Payer: Multiplan WC |
$26,691.26
|
| Rate for Payer: Prime Health Services WC |
$26,418.90
|
| 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 087: TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC
|
Facility
IP
|
$32,044.34
|
|
|
Service Code
|
MS-DRG 087
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$32,044.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26,866.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,044.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,736.55
|
| Rate for Payer: IEHP Medicare Advantage |
$23,736.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,736.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,908.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,806.98
|
| Rate for Payer: Multiplan WC |
$17,916.02
|
| Rate for Payer: Prime Health Services WC |
$17,733.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 088: CONCUSSION WITH MCC
|
Facility
IP
|
$46,498.68
|
|
|
Service Code
|
MS-DRG 088
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$46,498.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46,498.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,738.14
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30,917.14
|
| Rate for Payer: IEHP Medicare Advantage |
$30,917.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,917.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38,955.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,428.97
|
| Rate for Payer: Multiplan WC |
$32,371.64
|
| Rate for Payer: Prime Health Services WC |
$32,041.32
|
| 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 089: CONCUSSION WITH CC
|
Facility
IP
|
$35,991.61
|
|
|
Service Code
|
MS-DRG 089
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$35,991.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$34,860.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,991.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$26,660.45
|
| Rate for Payer: IEHP Medicare Advantage |
$26,660.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,660.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,592.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35,725.00
|
| Rate for Payer: Multiplan WC |
$23,980.44
|
| Rate for Payer: Prime Health Services WC |
$23,735.74
|
| 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 090: CONCUSSION WITHOUT CC/MCC
|
Facility
IP
|
$32,771.82
|
|
|
Service Code
|
MS-DRG 090
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$32,771.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28,339.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,771.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24,275.42
|
| Rate for Payer: IEHP Medicare Advantage |
$24,275.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,275.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,587.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,529.06
|
| Rate for Payer: Multiplan WC |
$16,903.57
|
| Rate for Payer: Prime Health Services WC |
$16,731.08
|
| 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 091: OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC
|
Facility
IP
|
$54,241.39
|
|
|
Service Code
|
MS-DRG 091
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$54,241.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$54,241.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,561.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33,749.05
|
| Rate for Payer: IEHP Medicare Advantage |
$33,749.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,749.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42,523.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45,223.73
|
| Rate for Payer: Multiplan WC |
$35,474.71
|
| Rate for Payer: Prime Health Services WC |
$35,112.72
|
| 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 092: OTHER DISORDERS OF NERVOUS SYSTEM WITH CC
|
Facility
IP
|
$34,138.49
|
|
|
Service Code
|
MS-DRG 092
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$34,138.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,107.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,138.49
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,287.77
|
| Rate for Payer: IEHP Medicare Advantage |
$25,287.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,287.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,862.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,885.61
|
| Rate for Payer: Multiplan WC |
$20,419.42
|
| Rate for Payer: Prime Health Services WC |
$20,211.06
|
| 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 093: OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC
|
Facility
IP
|
$30,370.82
|
|
|
Service Code
|
MS-DRG 093
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$30,370.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23,476.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,370.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,496.90
|
| Rate for Payer: IEHP Medicare Advantage |
$22,496.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,496.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,346.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,145.85
|
| Rate for Payer: Multiplan WC |
$15,706.29
|
| Rate for Payer: Prime Health Services WC |
$15,546.03
|
| 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 094: BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC
|
Facility
IP
|
$109,825.77
|
|
|
Service Code
|
MS-DRG 094
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$109,825.77 |
| Rate for Payer: IEHP Medicare Advantage |
$54,078.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$109,825.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$73,006.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$54,078.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54,078.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68,139.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$72,465.78
|
| Rate for Payer: Multiplan WC |
$73,387.09
|
| Rate for Payer: Prime Health Services WC |
$72,638.25
|
| 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 095: BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC
|
Facility
IP
|
$72,279.41
|
|
|
Service Code
|
MS-DRG 095
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$72,279.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$72,279.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$54,467.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$40,346.41
|
| Rate for Payer: IEHP Medicare Advantage |
$40,346.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40,346.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50,836.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54,064.19
|
| Rate for Payer: Multiplan WC |
$52,507.66
|
| Rate for Payer: Prime Health Services WC |
$51,971.87
|
| 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
|
|
|
INPATIENT MS-DRG 096: BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC
|
Facility
IP
|
$66,079.79
|
|
|
Service Code
|
MS-DRG 096
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$66,079.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$66,079.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$51,406.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$38,078.91
|
| Rate for Payer: IEHP Medicare Advantage |
$38,078.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38,078.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47,979.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,025.74
|
| Rate for Payer: Multiplan WC |
$46,911.47
|
| Rate for Payer: Prime Health Services WC |
$46,432.78
|
| 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 097: NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC
|
Facility
IP
|
$110,256.26
|
|
|
Service Code
|
MS-DRG 097
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$110,256.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$110,256.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$73,219.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$54,236.38
|
| Rate for Payer: IEHP Medicare Advantage |
$54,236.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54,236.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68,337.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$72,676.75
|
| Rate for Payer: Multiplan WC |
$79,849.93
|
| Rate for Payer: Prime Health Services WC |
$79,035.13
|
| 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 098: NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC
|
Facility
IP
|
$65,315.82
|
|
|
Service Code
|
MS-DRG 098
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$65,315.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$65,315.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$51,029.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37,799.50
|
| Rate for Payer: IEHP Medicare Advantage |
$37,799.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37,799.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47,627.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50,651.33
|
| Rate for Payer: Multiplan WC |
$42,802.13
|
| Rate for Payer: Prime Health Services WC |
$42,365.37
|
| 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 099: NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
IP
|
$40,023.18
|
|
|
Service Code
|
MS-DRG 099
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$40,023.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40,023.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,540.81
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$28,548.75
|
| Rate for Payer: IEHP Medicare Advantage |
$28,548.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,548.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,971.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,255.32
|
| Rate for Payer: Multiplan WC |
$28,720.26
|
| Rate for Payer: Prime Health Services WC |
$28,427.20
|
| 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 100: SEIZURES WITH MCC
|
Facility
IP
|
$60,101.47
|
|
|
Service Code
|
MS-DRG 100
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$60,101.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$60,101.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$48,454.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35,892.35
|
| Rate for Payer: IEHP Medicare Advantage |
$35,892.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35,892.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45,224.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48,095.75
|
| Rate for Payer: Multiplan WC |
$39,450.57
|
| Rate for Payer: Prime Health Services WC |
$39,048.01
|
| 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 101: SEIZURES WITHOUT MCC
|
Facility
IP
|
$32,394.61
|
|
|
Service Code
|
MS-DRG 101
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$32,394.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,575.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,394.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,996.01
|
| Rate for Payer: IEHP Medicare Advantage |
$23,996.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,996.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,234.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,154.65
|
| Rate for Payer: Multiplan WC |
$18,513.63
|
| Rate for Payer: Prime Health Services WC |
$18,324.72
|
| 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 102: HEADACHES WITH MCC
|
Facility
IP
|
$36,840.37
|
|
|
Service Code
|
MS-DRG 102
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$36,840.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36,579.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,840.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,289.16
|
| Rate for Payer: IEHP Medicare Advantage |
$27,289.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,289.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,384.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36,567.47
|
| Rate for Payer: Multiplan WC |
$23,614.89
|
| Rate for Payer: Prime Health Services WC |
$23,373.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 103: HEADACHES WITHOUT MCC
|
Facility
IP
|
$31,388.72
|
|
|
Service Code
|
MS-DRG 103
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$31,388.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,538.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,388.72
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,250.90
|
| Rate for Payer: IEHP Medicare Advantage |
$23,250.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,250.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,296.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,156.21
|
| Rate for Payer: Multiplan WC |
$17,096.62
|
| Rate for Payer: Prime Health Services WC |
$16,922.16
|
| 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 113: ORBITAL PROCEDURES WITH CC/MCC
|
Facility
IP
|
$76,011.31
|
|
|
Service Code
|
MS-DRG 113
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$76,011.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76,011.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$56,310.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$41,711.34
|
| Rate for Payer: IEHP Medicare Advantage |
$41,711.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41,711.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52,556.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55,893.20
|
| Rate for Payer: Multiplan WC |
$46,110.55
|
| Rate for Payer: Prime Health Services WC |
$45,640.03
|
| 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 114: ORBITAL PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$37,343.25
|
|
|
Service Code
|
MS-DRG 114
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$37,343.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37,343.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,217.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,568.57
|
| Rate for Payer: IEHP Medicare Advantage |
$27,568.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,568.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,736.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36,941.88
|
| Rate for Payer: Multiplan WC |
$26,754.92
|
| Rate for Payer: Prime Health Services WC |
$26,481.91
|
| 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 115: EXTRAOCULAR PROCEDURES EXCEPT ORBIT
|
Facility
IP
|
$47,426.35
|
|
|
Service Code
|
MS-DRG 115
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$47,426.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47,426.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,196.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31,256.45
|
| Rate for Payer: IEHP Medicare Advantage |
$31,256.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,256.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,383.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,883.64
|
| Rate for Payer: Multiplan WC |
$31,196.96
|
| Rate for Payer: Prime Health Services WC |
$30,878.62
|
| 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 116: INTRAOCULAR PROCEDURES WITH CC/MCC
|
Facility
IP
|
$55,502.53
|
|
|
Service Code
|
MS-DRG 116
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$55,502.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55,502.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,183.90
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$34,210.30
|
| Rate for Payer: IEHP Medicare Advantage |
$34,210.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,210.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43,104.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45,841.80
|
| Rate for Payer: Multiplan WC |
$38,742.07
|
| Rate for Payer: Prime Health Services WC |
$38,346.74
|
| 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 117: INTRAOCULAR PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$36,717.62
|
|
|
Service Code
|
MS-DRG 117
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$36,717.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36,330.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,717.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,198.24
|
| Rate for Payer: IEHP Medicare Advantage |
$27,198.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,198.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,269.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36,445.64
|
| Rate for Payer: Multiplan WC |
$20,388.62
|
| Rate for Payer: Prime Health Services WC |
$20,180.57
|
| 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
|
|
