|
INPATIENT MS-DRG 121: ACUTE MAJOR EYE INFECTIONS WITH CC/MCC
|
Facility
IP
|
$38,840.86
|
|
|
Service Code
|
MS-DRG 121
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$38,840.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$38,840.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,957.03
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$28,116.32
|
| Rate for Payer: IEHP Medicare Advantage |
$28,116.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,116.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,426.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,675.87
|
| Rate for Payer: Multiplan WC |
$25,163.34
|
| Rate for Payer: Prime Health Services WC |
$24,906.57
|
| 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 122: ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC
|
Facility
IP
|
$29,923.26
|
|
|
Service Code
|
MS-DRG 122
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$29,923.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,570.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,923.26
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,165.38
|
| Rate for Payer: IEHP Medicare Advantage |
$22,165.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,165.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,928.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,701.61
|
| Rate for Payer: Multiplan WC |
$14,186.60
|
| Rate for Payer: Prime Health Services WC |
$14,041.84
|
| 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 123: NEUROLOGICAL EYE DISORDERS
|
Facility
IP
|
$30,813.90
|
|
|
Service Code
|
MS-DRG 123
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$30,813.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,374.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,813.90
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,825.11
|
| Rate for Payer: IEHP Medicare Advantage |
$22,825.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,825.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,759.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,585.65
|
| Rate for Payer: Multiplan WC |
$16,301.86
|
| Rate for Payer: Prime Health Services WC |
$16,135.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 124: OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT
|
Facility
IP
|
$40,074.72
|
|
|
Service Code
|
MS-DRG 124
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$40,074.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40,074.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,566.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$28,567.61
|
| Rate for Payer: IEHP Medicare Advantage |
$28,567.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,567.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,995.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,280.60
|
| Rate for Payer: Multiplan WC |
$28,765.44
|
| Rate for Payer: Prime Health Services WC |
$28,471.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 125: OTHER DISORDERS OF THE EYE WITHOUT MCC
|
Facility
IP
|
$30,716.60
|
|
|
Service Code
|
MS-DRG 125
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$30,716.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,177.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,716.60
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,753.04
|
| Rate for Payer: IEHP Medicare Advantage |
$22,753.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,753.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,668.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,489.07
|
| Rate for Payer: Multiplan WC |
$17,704.49
|
| Rate for Payer: Prime Health Services WC |
$17,523.84
|
| 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 135: SINUS AND MASTOID PROCEDURES WITH CC/MCC
|
Facility
IP
|
$80,401.06
|
|
|
Service Code
|
MS-DRG 135
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$80,401.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$80,401.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$58,477.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$43,316.90
|
| Rate for Payer: IEHP Medicare Advantage |
$43,316.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43,316.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54,579.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58,044.65
|
| Rate for Payer: Multiplan WC |
$50,328.74
|
| Rate for Payer: Prime Health Services WC |
$49,815.18
|
| 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 136: SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$34,410.92
|
|
|
Service Code
|
MS-DRG 136
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$34,410.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28,469.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,410.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,489.57
|
| Rate for Payer: IEHP Medicare Advantage |
$25,489.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,489.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,116.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,156.02
|
| Rate for Payer: Multiplan WC |
$23,828.47
|
| Rate for Payer: Prime Health Services WC |
$23,585.33
|
| 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 137: MOUTH PROCEDURES WITH CC/MCC
|
Facility
IP
|
$45,616.49
|
|
|
Service Code
|
MS-DRG 137
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$45,616.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45,616.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,302.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30,594.49
|
| Rate for Payer: IEHP Medicare Advantage |
$30,594.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,594.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38,549.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40,996.62
|
| Rate for Payer: Multiplan WC |
$30,796.50
|
| Rate for Payer: Prime Health Services WC |
$30,482.25
|
| 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 138: MOUTH PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$31,737.47
|
|
|
Service Code
|
MS-DRG 138
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$31,737.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26,244.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,737.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,509.24
|
| Rate for Payer: IEHP Medicare Advantage |
$23,509.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,509.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,621.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,502.38
|
| Rate for Payer: Multiplan WC |
$18,160.41
|
| Rate for Payer: Prime Health Services WC |
$17,975.10
|
| 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 139: SALIVARY GLAND PROCEDURES
|
Facility
IP
|
$36,557.43
|
|
|
Service Code
|
MS-DRG 139
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$36,557.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36,006.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,557.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,079.58
|
| Rate for Payer: IEHP Medicare Advantage |
$27,079.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,079.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,120.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36,286.64
|
| Rate for Payer: Multiplan WC |
$25,824.62
|
| Rate for Payer: Prime Health Services WC |
$25,561.10
|
| 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 140: MAJOR HEAD AND NECK PROCEDURES WITH MCC
|
Facility
IP
|
$114,536.88
|
|
|
Service Code
|
MS-DRG 140
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$114,536.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$114,536.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$75,332.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$55,802.01
|
| Rate for Payer: IEHP Medicare Advantage |
$55,802.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55,802.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70,310.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74,774.69
|
| Rate for Payer: Multiplan WC |
$85,355.76
|
| Rate for Payer: Prime Health Services WC |
$84,484.78
|
| 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 141: MAJOR HEAD AND NECK PROCEDURES WITH CC
|
Facility
IP
|
$62,805.66
|
|
|
Service Code
|
MS-DRG 141
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$62,805.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62,805.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$49,789.90
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$36,881.41
|
| Rate for Payer: IEHP Medicare Advantage |
$36,881.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36,881.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46,470.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49,421.09
|
| Rate for Payer: Multiplan WC |
$45,849.74
|
| Rate for Payer: Prime Health Services WC |
$45,381.89
|
| 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 142: MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$46,838.22
|
|
|
Service Code
|
MS-DRG 142
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$46,838.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46,838.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,905.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31,041.35
|
| Rate for Payer: IEHP Medicare Advantage |
$31,041.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,041.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,112.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,595.41
|
| Rate for Payer: Multiplan WC |
$34,946.92
|
| Rate for Payer: Prime Health Services WC |
$34,590.32
|
| 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 143: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC
|
Facility
IP
|
$100,818.89
|
|
|
Service Code
|
MS-DRG 143
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$100,818.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100,818.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$68,559.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50,784.67
|
| Rate for Payer: IEHP Medicare Advantage |
$50,784.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50,784.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63,988.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68,051.46
|
| Rate for Payer: Multiplan WC |
$65,154.03
|
| Rate for Payer: Prime Health Services WC |
$64,489.19
|
| 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 144: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC
|
Facility
IP
|
$52,461.84
|
|
|
Service Code
|
MS-DRG 144
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$52,461.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52,461.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$44,682.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33,098.16
|
| Rate for Payer: IEHP Medicare Advantage |
$33,098.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,098.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41,703.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44,351.53
|
| Rate for Payer: Multiplan WC |
$37,156.65
|
| Rate for Payer: Prime Health Services WC |
$36,777.50
|
| 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 145: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$37,057.41
|
|
|
Service Code
|
MS-DRG 145
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$37,057.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37,018.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,057.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,449.93
|
| Rate for Payer: IEHP Medicare Advantage |
$27,449.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,449.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,586.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36,782.91
|
| Rate for Payer: Multiplan WC |
$24,803.96
|
| Rate for Payer: Prime Health Services WC |
$24,550.86
|
| 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 146: EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC
|
Facility
IP
|
$63,997.08
|
|
|
Service Code
|
MS-DRG 146
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$63,997.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$63,997.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$50,378.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37,317.16
|
| Rate for Payer: IEHP Medicare Advantage |
$37,317.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37,317.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47,019.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50,004.99
|
| Rate for Payer: Multiplan WC |
$41,364.58
|
| Rate for Payer: Prime Health Services WC |
$40,942.49
|
| 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 147: EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC
|
Facility
IP
|
$37,464.51
|
|
|
Service Code
|
MS-DRG 147
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$37,464.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37,464.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,277.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,612.91
|
| Rate for Payer: IEHP Medicare Advantage |
$27,612.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,612.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,792.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,001.30
|
| Rate for Payer: Multiplan WC |
$24,871.72
|
| Rate for Payer: Prime Health Services WC |
$24,617.93
|
| 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 148: EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC
|
Facility
IP
|
$32,096.74
|
|
|
Service Code
|
MS-DRG 148
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$32,096.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26,972.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,096.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,775.36
|
| Rate for Payer: IEHP Medicare Advantage |
$23,775.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,775.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,956.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,858.98
|
| Rate for Payer: Multiplan WC |
$16,790.62
|
| Rate for Payer: Prime Health Services WC |
$16,619.29
|
| 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 149: DYSEQUILIBRIUM
|
Facility
IP
|
$29,926.25
|
|
|
Service Code
|
MS-DRG 149
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$29,926.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,576.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,926.25
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,167.59
|
| Rate for Payer: IEHP Medicare Advantage |
$22,167.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,167.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,931.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,704.57
|
| Rate for Payer: Multiplan WC |
$15,505.04
|
| Rate for Payer: Prime Health Services WC |
$15,346.83
|
| 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 150: EPISTAXIS WITH MCC
|
Facility
IP
|
$39,850.38
|
|
|
Service Code
|
MS-DRG 150
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$39,850.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,850.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,455.49
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$28,485.55
|
| Rate for Payer: IEHP Medicare Advantage |
$28,485.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,485.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,891.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,170.64
|
| Rate for Payer: Multiplan WC |
$28,325.96
|
| Rate for Payer: Prime Health Services WC |
$28,036.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 151: EPISTAXIS WITHOUT MCC
|
Facility
IP
|
$30,315.44
|
|
|
Service Code
|
MS-DRG 151
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$30,315.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23,364.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,315.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,455.88
|
| Rate for Payer: IEHP Medicare Advantage |
$22,455.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,455.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,294.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,090.88
|
| Rate for Payer: Multiplan WC |
$15,833.62
|
| Rate for Payer: Prime Health Services WC |
$15,672.06
|
| 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 152: OTITIS MEDIA AND URI WITH MCC
|
Facility
IP
|
$36,564.93
|
|
|
Service Code
|
MS-DRG 152
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$36,564.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36,021.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,564.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,085.13
|
| Rate for Payer: IEHP Medicare Advantage |
$27,085.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,085.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,127.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36,294.07
|
| Rate for Payer: Multiplan WC |
$24,596.54
|
| Rate for Payer: Prime Health Services WC |
$24,345.55
|
| 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 153: OTITIS MEDIA AND URI WITHOUT MCC
|
Facility
IP
|
$29,778.06
|
|
|
Service Code
|
MS-DRG 153
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$29,778.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,276.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,778.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,057.82
|
| Rate for Payer: IEHP Medicare Advantage |
$22,057.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,057.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,792.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,557.48
|
| Rate for Payer: Multiplan WC |
$14,180.43
|
| Rate for Payer: Prime Health Services WC |
$14,035.74
|
| 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 154: OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC
|
Facility
IP
|
$46,632.07
|
|
|
Service Code
|
MS-DRG 154
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$46,632.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46,632.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,804.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30,965.93
|
| Rate for Payer: IEHP Medicare Advantage |
$30,965.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,965.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,017.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,494.35
|
| Rate for Payer: Multiplan WC |
$30,864.27
|
| Rate for Payer: Prime Health Services WC |
$30,549.33
|
| 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
|
|
