|
INPATIENT MS-DRG 188: PLEURAL EFFUSION WITHOUT CC/MCC
|
Facility
IP
|
$29,953.18
|
|
|
Service Code
|
MS-DRG 188
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$29,953.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,630.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,953.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,187.54
|
| Rate for Payer: IEHP Medicare Advantage |
$22,187.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,187.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,956.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,731.30
|
| Rate for Payer: Multiplan WC |
$14,868.41
|
| Rate for Payer: Prime Health Services WC |
$14,716.69
|
| 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 189: PULMONARY EDEMA AND RESPIRATORY FAILURE
|
Facility
IP
|
$37,349.31
|
|
|
Service Code
|
MS-DRG 189
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$37,349.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37,349.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,220.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,570.79
|
| Rate for Payer: IEHP Medicare Advantage |
$27,570.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,570.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,739.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36,944.86
|
| Rate for Payer: Multiplan WC |
$24,787.52
|
| Rate for Payer: Prime Health Services WC |
$24,534.59
|
| 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 190: CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC
|
Facility
IP
|
$35,274.62
|
|
|
Service Code
|
MS-DRG 190
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$35,274.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$33,408.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,274.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$26,129.35
|
| Rate for Payer: IEHP Medicare Advantage |
$26,129.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,129.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,922.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35,013.33
|
| Rate for Payer: Multiplan WC |
$22,292.34
|
| Rate for Payer: Prime Health Services WC |
$22,064.87
|
| 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 191: CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC
|
Facility
IP
|
$31,487.49
|
|
|
Service Code
|
MS-DRG 191
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$31,487.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,738.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,487.49
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,324.07
|
| Rate for Payer: IEHP Medicare Advantage |
$23,324.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,324.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,388.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,254.25
|
| Rate for Payer: Multiplan WC |
$17,747.62
|
| Rate for Payer: Prime Health Services WC |
$17,566.53
|
| 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 192: CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC
|
Facility
IP
|
$28,385.96
|
|
|
Service Code
|
MS-DRG 192
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$28,385.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19,456.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,385.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,026.64
|
| Rate for Payer: IEHP Medicare Advantage |
$21,026.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,026.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,493.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,175.70
|
| Rate for Payer: Multiplan WC |
$13,391.84
|
| Rate for Payer: Prime Health Services WC |
$13,255.19
|
| 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 193: SIMPLE PNEUMONIA AND PLEURISY WITH MCC
|
Facility
IP
|
$40,217.21
|
|
|
Service Code
|
MS-DRG 193
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$40,217.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40,217.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,636.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$28,619.71
|
| Rate for Payer: IEHP Medicare Advantage |
$28,619.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,619.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,060.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,350.41
|
| Rate for Payer: Multiplan WC |
$26,670.72
|
| Rate for Payer: Prime Health Services WC |
$26,398.57
|
| 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 194: SIMPLE PNEUMONIA AND PLEURISY WITH CC
|
Facility
IP
|
$31,086.33
|
|
|
Service Code
|
MS-DRG 194
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$31,086.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,925.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,086.33
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,026.91
|
| Rate for Payer: IEHP Medicare Advantage |
$23,026.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,026.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,013.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,856.06
|
| Rate for Payer: Multiplan WC |
$17,254.75
|
| Rate for Payer: Prime Health Services WC |
$17,078.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 195: SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC
|
Facility
IP
|
$28,143.45
|
|
|
Service Code
|
MS-DRG 195
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$28,143.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18,965.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,143.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20,847.00
|
| Rate for Payer: IEHP Medicare Advantage |
$20,847.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,847.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,267.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,934.98
|
| Rate for Payer: Multiplan WC |
$13,180.31
|
| Rate for Payer: Prime Health Services WC |
$13,045.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 196: INTERSTITIAL LUNG DISEASE WITH MCC
|
Facility
IP
|
$57,460.95
|
|
|
Service Code
|
MS-DRG 196
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$57,460.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$57,460.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$47,150.88
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$34,926.58
|
| Rate for Payer: IEHP Medicare Advantage |
$34,926.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,926.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44,007.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46,801.62
|
| Rate for Payer: Multiplan WC |
$35,686.24
|
| Rate for Payer: Prime Health Services WC |
$35,322.09
|
| 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 197: INTERSTITIAL LUNG DISEASE WITH CC
|
Facility
IP
|
$33,710.35
|
|
|
Service Code
|
MS-DRG 197
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$33,710.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,240.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,710.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24,970.63
|
| Rate for Payer: IEHP Medicare Advantage |
$24,970.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,970.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,462.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,460.64
|
| Rate for Payer: Multiplan WC |
$20,199.68
|
| Rate for Payer: Prime Health Services WC |
$19,993.56
|
| 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 198: INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC
|
Facility
IP
|
$30,427.72
|
|
|
Service Code
|
MS-DRG 198
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$30,427.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23,591.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,427.72
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,539.05
|
| Rate for Payer: IEHP Medicare Advantage |
$22,539.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,539.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,399.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,202.33
|
| Rate for Payer: Multiplan WC |
$14,599.38
|
| Rate for Payer: Prime Health Services WC |
$14,450.41
|
| 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 199: PNEUMOTHORAX WITH MCC
|
Facility
IP
|
$53,783.62
|
|
|
Service Code
|
MS-DRG 199
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$53,783.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53,783.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,335.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33,581.61
|
| Rate for Payer: IEHP Medicare Advantage |
$33,581.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,581.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42,312.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44,999.36
|
| Rate for Payer: Multiplan WC |
$36,115.45
|
| Rate for Payer: Prime Health Services WC |
$35,746.92
|
| 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 200: PNEUMOTHORAX WITH CC
|
Facility
IP
|
$34,900.40
|
|
|
Service Code
|
MS-DRG 200
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$34,900.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,650.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,900.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,852.15
|
| Rate for Payer: IEHP Medicare Advantage |
$25,852.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,573.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,641.88
|
| Rate for Payer: Multiplan WC |
$22,015.10
|
| Rate for Payer: Prime Health Services WC |
$21,790.46
|
| 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 201: PNEUMOTHORAX WITHOUT CC/MCC
|
Facility
IP
|
$29,348.45
|
|
|
Service Code
|
MS-DRG 201
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$29,348.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21,406.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,348.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,739.59
|
| Rate for Payer: IEHP Medicare Advantage |
$21,739.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,739.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,391.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,131.05
|
| 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 202: BRONCHITIS AND ASTHMA WITH CC/MCC
|
Facility
IP
|
$33,111.61
|
|
|
Service Code
|
MS-DRG 202
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$33,111.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29,027.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,111.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24,527.12
|
| Rate for Payer: IEHP Medicare Advantage |
$24,527.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,527.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,904.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,866.34
|
| Rate for Payer: Multiplan WC |
$19,012.67
|
| Rate for Payer: Prime Health Services WC |
$18,818.66
|
| 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 203: BRONCHITIS AND ASTHMA WITHOUT CC/MCC
|
Facility
IP
|
$29,180.80
|
|
|
Service Code
|
MS-DRG 203
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$29,180.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21,066.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,180.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,615.41
|
| Rate for Payer: IEHP Medicare Advantage |
$21,615.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,615.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,235.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,964.65
|
| Rate for Payer: Multiplan WC |
$13,699.88
|
| Rate for Payer: Prime Health Services WC |
$13,560.09
|
| 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 204: RESPIRATORY SIGNS AND SYMPTOMS
|
Facility
IP
|
$31,096.82
|
|
|
Service Code
|
MS-DRG 204
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$31,096.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,947.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,096.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,034.68
|
| Rate for Payer: IEHP Medicare Advantage |
$23,034.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,034.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,023.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,866.47
|
| Rate for Payer: Multiplan WC |
$16,622.22
|
| Rate for Payer: Prime Health Services WC |
$16,452.61
|
| 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 205: OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC
|
Facility
IP
|
$54,881.05
|
|
|
Service Code
|
MS-DRG 205
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$54,881.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$54,881.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,877.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33,983.00
|
| Rate for Payer: IEHP Medicare Advantage |
$33,983.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,983.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42,818.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45,537.22
|
| Rate for Payer: Multiplan WC |
$36,575.46
|
| Rate for Payer: Prime Health Services WC |
$36,202.24
|
| 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 206: OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC
|
Facility
IP
|
$32,452.99
|
|
|
Service Code
|
MS-DRG 206
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$32,452.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,693.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,452.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24,039.25
|
| Rate for Payer: IEHP Medicare Advantage |
$24,039.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,039.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,289.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,212.60
|
| Rate for Payer: Multiplan WC |
$18,347.29
|
| Rate for Payer: Prime Health Services WC |
$18,160.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 207: RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS
|
Facility
IP
|
$209,422.93
|
|
|
Service Code
|
MS-DRG 207
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$209,422.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$209,422.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$122,183.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$90,506.43
|
| Rate for Payer: IEHP Medicare Advantage |
$90,506.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90,506.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$114,038.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121,278.62
|
| Rate for Payer: Multiplan WC |
$134,840.45
|
| Rate for Payer: Prime Health Services WC |
$133,464.53
|
| 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 208: RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS
|
Facility
IP
|
$81,968.40
|
|
|
Service Code
|
MS-DRG 208
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$81,968.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$81,968.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$59,251.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$43,890.15
|
| Rate for Payer: IEHP Medicare Advantage |
$43,890.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43,890.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55,301.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58,812.80
|
| Rate for Payer: Multiplan WC |
$53,396.89
|
| Rate for Payer: Prime Health Services WC |
$52,852.02
|
| 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 212: CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES
|
Facility
IP
|
$326,524.54
|
|
|
Service Code
|
MS-DRG 212
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$326,524.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$326,524.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$180,003.79
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$133,336.14
|
| Rate for Payer: IEHP Medicare Advantage |
$133,336.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133,336.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$168,003.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$178,670.43
|
| 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 215: OTHER HEART ASSIST SYSTEM IMPLANT
|
Facility
IP
|
$309,671.88
|
|
|
Service Code
|
MS-DRG 215
|
| Min. Negotiated Rate |
$127,172.31 |
| Max. Negotiated Rate |
$309,671.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$309,671.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$171,682.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$127,172.31
|
| Rate for Payer: IEHP Medicare Advantage |
$127,172.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$127,172.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$160,237.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170,410.90
|
| Rate for Payer: Multiplan WC |
$211,591.42
|
| Rate for Payer: Prime Health Services WC |
$209,432.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$190,538.00
|
| Rate for Payer: United Healthcare All Other HMO |
$197,963.00
|
| Rate for Payer: United Healthcare HMO Rider |
$150,369.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$137,500.00
|
|
|
INPATIENT MS-DRG 216: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC
|
Facility
IP
|
$294,225.87
|
|
|
Service Code
|
MS-DRG 216
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$294,225.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$294,225.87
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$164,056.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$121,522.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$30,123.00
|
| Rate for Payer: IEHP Medicare Advantage |
$121,522.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121,522.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$153,118.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162,840.77
|
| Rate for Payer: Multiplan WC |
$200,064.30
|
| Rate for Payer: Prime Health Services WC |
$198,022.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$147,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$150,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$114,207.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$104,433.00
|
|
|
INPATIENT MS-DRG 217: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC
|
Facility
IP
|
$192,970.43
|
|
|
Service Code
|
MS-DRG 217
|
| Min. Negotiated Rate |
$11,745.00 |
| Max. Negotiated Rate |
$192,970.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$192,970.43
|
| Rate for Payer: Cigna of CA HMO |
$11,745.00
|
| Rate for Payer: Cigna of CA PPO |
$14,790.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$114,060.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$84,488.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$30,123.00
|
| Rate for Payer: IEHP Medicare Advantage |
$84,488.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84,488.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106,456.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113,215.19
|
| Rate for Payer: Multiplan WC |
$130,381.98
|
| Rate for Payer: Prime Health Services WC |
$129,051.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$120,359.00
|
| Rate for Payer: United Healthcare All Other HMO |
$122,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$93,062.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85,097.00
|
|
