|
INPATIENT MS-DRG 554: BONE DISEASES AND ARTHROPATHIES WITHOUT MCC
|
Facility
IP
|
$31,080.33
|
|
|
Service Code
|
MS-DRG 554
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$31,080.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,913.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,080.33
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,022.47
|
| Rate for Payer: IEHP Medicare Advantage |
$23,022.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,022.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,008.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,850.11
|
| Rate for Payer: Multiplan WC |
$16,844.01
|
| Rate for Payer: Prime Health Services WC |
$16,672.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 555: SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
IP
|
$42,412.08
|
|
|
Service Code
|
MS-DRG 555
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$42,412.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42,412.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$39,720.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29,422.49
|
| Rate for Payer: IEHP Medicare Advantage |
$29,422.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,422.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37,072.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39,426.14
|
| Rate for Payer: Multiplan WC |
$27,338.16
|
| Rate for Payer: Prime Health Services WC |
$27,059.20
|
| 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 556: SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC
|
Facility
IP
|
$31,119.27
|
|
|
Service Code
|
MS-DRG 556
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$31,119.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,992.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,119.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,051.31
|
| Rate for Payer: IEHP Medicare Advantage |
$23,051.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,051.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,044.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,888.76
|
| Rate for Payer: Multiplan WC |
$16,593.48
|
| Rate for Payer: Prime Health Services WC |
$16,424.16
|
| 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 557: TENDONITIS, MYOSITIS AND BURSITIS WITH MCC
|
Facility
IP
|
$47,195.95
|
|
|
Service Code
|
MS-DRG 557
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$47,195.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47,195.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,082.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31,172.17
|
| Rate for Payer: IEHP Medicare Advantage |
$31,172.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,172.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,276.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,770.71
|
| Rate for Payer: Multiplan WC |
$29,406.18
|
| Rate for Payer: Prime Health Services WC |
$29,106.12
|
| 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 558: TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC
|
Facility
IP
|
$31,927.57
|
|
|
Service Code
|
MS-DRG 558
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$31,927.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26,629.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,927.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,650.05
|
| Rate for Payer: IEHP Medicare Advantage |
$23,650.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,650.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,799.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,691.07
|
| Rate for Payer: Multiplan WC |
$17,846.20
|
| Rate for Payer: Prime Health Services WC |
$17,664.10
|
| 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 559: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
IP
|
$56,099.76
|
|
|
Service Code
|
MS-DRG 559
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$56,099.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$56,099.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,478.79
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$34,428.73
|
| Rate for Payer: IEHP Medicare Advantage |
$34,428.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,428.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43,380.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46,134.50
|
| Rate for Payer: Multiplan WC |
$36,657.61
|
| Rate for Payer: Prime Health Services WC |
$36,283.55
|
| 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 560: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC
|
Facility
IP
|
$35,725.17
|
|
|
Service Code
|
MS-DRG 560
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$35,725.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$34,320.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,725.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$26,463.09
|
| Rate for Payer: IEHP Medicare Advantage |
$26,463.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,463.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,343.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35,460.54
|
| Rate for Payer: Multiplan WC |
$22,499.76
|
| Rate for Payer: Prime Health Services WC |
$22,270.17
|
| 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 561: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC
|
Facility
IP
|
$30,457.65
|
|
|
Service Code
|
MS-DRG 561
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$30,457.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23,652.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,457.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,561.22
|
| Rate for Payer: IEHP Medicare Advantage |
$22,561.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,561.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,427.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,232.03
|
| Rate for Payer: Multiplan WC |
$16,227.93
|
| Rate for Payer: Prime Health Services WC |
$16,062.34
|
| 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 562: FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC
|
Facility
IP
|
$46,101.54
|
|
|
Service Code
|
MS-DRG 562
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$46,101.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46,101.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,542.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30,771.91
|
| Rate for Payer: IEHP Medicare Advantage |
$30,771.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,771.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38,772.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,234.36
|
| Rate for Payer: Multiplan WC |
$30,040.75
|
| Rate for Payer: Prime Health Services WC |
$29,734.22
|
| 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 563: FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC
|
Facility
IP
|
$32,185.04
|
|
|
Service Code
|
MS-DRG 563
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$32,185.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,151.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,185.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,840.77
|
| Rate for Payer: IEHP Medicare Advantage |
$23,840.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,840.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,039.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,946.63
|
| Rate for Payer: Multiplan WC |
$17,686.01
|
| Rate for Payer: Prime Health Services WC |
$17,505.54
|
| 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 564: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC
|
Facility
IP
|
$47,350.56
|
|
|
Service Code
|
MS-DRG 564
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$47,350.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47,350.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,158.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31,228.72
|
| Rate for Payer: IEHP Medicare Advantage |
$31,228.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,228.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,348.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,846.48
|
| Rate for Payer: Multiplan WC |
$31,899.30
|
| Rate for Payer: Prime Health Services WC |
$31,573.80
|
| 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 565: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC
|
Facility
IP
|
$33,738.82
|
|
|
Service Code
|
MS-DRG 565
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$33,738.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,297.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,738.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24,991.72
|
| Rate for Payer: IEHP Medicare Advantage |
$24,991.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,991.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,489.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,488.90
|
| Rate for Payer: Multiplan WC |
$20,277.72
|
| Rate for Payer: Prime Health Services WC |
$20,070.80
|
| 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 566: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC
|
Facility
IP
|
$30,013.09
|
|
|
Service Code
|
MS-DRG 566
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$30,013.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,752.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,013.09
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,231.92
|
| Rate for Payer: IEHP Medicare Advantage |
$22,231.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,231.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,012.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,790.77
|
| Rate for Payer: Multiplan WC |
$15,252.45
|
| Rate for Payer: Prime Health Services WC |
$15,096.81
|
| 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 570: SKIN DEBRIDEMENT WITH MCC
|
Facility
IP
|
$88,589.42
|
|
|
Service Code
|
MS-DRG 570
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$88,589.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$88,589.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$62,520.88
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$46,311.76
|
| Rate for Payer: IEHP Medicare Advantage |
$46,311.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46,311.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58,352.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62,057.76
|
| Rate for Payer: Multiplan WC |
$59,906.96
|
| Rate for Payer: Prime Health Services WC |
$59,295.66
|
| 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 571: SKIN DEBRIDEMENT WITH CC
|
Facility
IP
|
$51,291.64
|
|
|
Service Code
|
MS-DRG 571
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$51,291.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$51,291.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$44,104.73
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$32,670.17
|
| Rate for Payer: IEHP Medicare Advantage |
$32,670.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,670.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41,164.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43,778.03
|
| Rate for Payer: Multiplan WC |
$33,856.43
|
| Rate for Payer: Prime Health Services WC |
$33,510.96
|
| 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 572: SKIN DEBRIDEMENT WITHOUT CC/MCC
|
Facility
IP
|
$35,837.44
|
|
|
Service Code
|
MS-DRG 572
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$35,837.44 |
| Rate for Payer: IEHP Medicare Advantage |
$26,546.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34,548.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,837.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$26,546.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,546.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,448.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35,571.98
|
| Rate for Payer: Multiplan WC |
$24,717.71
|
| Rate for Payer: Prime Health Services WC |
$24,465.49
|
| 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 573: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC
|
Facility
IP
|
$188,507.92
|
|
|
Service Code
|
MS-DRG 573
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$188,507.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$188,507.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$111,856.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$82,856.79
|
| Rate for Payer: IEHP Medicare Advantage |
$82,856.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82,856.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$104,399.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$111,028.10
|
| Rate for Payer: Multiplan WC |
$120,559.38
|
| Rate for Payer: Prime Health Services WC |
$119,329.19
|
| 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 574: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC
|
Facility
IP
|
$103,250.23
|
|
|
Service Code
|
MS-DRG 574
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$103,250.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$103,250.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$69,759.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$51,673.94
|
| Rate for Payer: IEHP Medicare Advantage |
$51,673.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51,673.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$65,109.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69,243.08
|
| Rate for Payer: Multiplan WC |
$74,025.78
|
| Rate for Payer: Prime Health Services WC |
$73,270.41
|
| 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 575: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC
|
Facility
IP
|
$62,026.54
|
|
|
Service Code
|
MS-DRG 575
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$62,026.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62,026.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$49,405.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$36,596.44
|
| Rate for Payer: IEHP Medicare Advantage |
$36,596.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36,596.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46,111.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49,039.23
|
| Rate for Payer: Multiplan WC |
$42,091.56
|
| Rate for Payer: Prime Health Services WC |
$41,662.05
|
| 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 576: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC
|
Facility
IP
|
$172,288.86
|
|
|
Service Code
|
MS-DRG 576
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$172,288.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$172,288.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$103,848.33
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76,924.69
|
| Rate for Payer: IEHP Medicare Advantage |
$76,924.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76,924.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96,925.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$103,079.08
|
| Rate for Payer: Multiplan WC |
$116,010.56
|
| Rate for Payer: Prime Health Services WC |
$114,826.78
|
| 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 577: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC
|
Facility
IP
|
$80,310.12
|
|
|
Service Code
|
MS-DRG 577
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$80,310.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$80,310.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$58,432.90
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$43,283.63
|
| Rate for Payer: IEHP Medicare Advantage |
$43,283.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43,283.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54,537.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58,000.06
|
| Rate for Payer: Multiplan WC |
$53,778.87
|
| Rate for Payer: Prime Health Services WC |
$53,230.11
|
| 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 578: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC
|
Facility
IP
|
$48,823.92
|
|
|
Service Code
|
MS-DRG 578
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$48,823.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48,823.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,886.26
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31,767.60
|
| Rate for Payer: IEHP Medicare Advantage |
$31,767.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,767.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40,027.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42,568.58
|
| Rate for Payer: Multiplan WC |
$35,168.71
|
| Rate for Payer: Prime Health Services WC |
$34,809.85
|
| 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 579: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC
|
Facility
IP
|
$101,322.14
|
|
|
Service Code
|
MS-DRG 579
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$101,322.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$101,322.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$68,807.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50,968.74
|
| Rate for Payer: IEHP Medicare Advantage |
$50,968.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50,968.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64,220.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68,298.11
|
| Rate for Payer: Multiplan WC |
$64,724.82
|
| Rate for Payer: Prime Health Services WC |
$64,064.36
|
| 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 580: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC
|
Facility
IP
|
$52,949.93
|
|
|
Service Code
|
MS-DRG 580
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$52,949.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52,949.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$44,923.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33,276.69
|
| Rate for Payer: IEHP Medicare Advantage |
$33,276.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,276.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41,928.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44,590.76
|
| Rate for Payer: Multiplan WC |
$35,655.43
|
| Rate for Payer: Prime Health Services WC |
$35,291.60
|
| 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 581: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$40,826.56
|
|
|
Service Code
|
MS-DRG 581
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$40,826.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40,826.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,937.50
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$28,842.59
|
| Rate for Payer: IEHP Medicare Advantage |
$28,842.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,842.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,341.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,649.07
|
| Rate for Payer: Multiplan WC |
$28,987.23
|
| Rate for Payer: Prime Health Services WC |
$28,691.45
|
| 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
|
|
