|
INPATIENT MS-DRG 881: DEPRESSIVE NEUROSES
|
Facility
IP
|
$32,348.21
|
|
|
Service Code
|
MS-DRG 881
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$32,348.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,481.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,348.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,961.64
|
| Rate for Payer: IEHP Medicare Advantage |
$23,961.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,961.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,191.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,108.60
|
| Rate for Payer: Multiplan WC |
$17,568.96
|
| Rate for Payer: Prime Health Services WC |
$17,389.68
|
| 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 882: NEUROSES EXCEPT DEPRESSIVE
|
Facility
IP
|
$32,839.17
|
|
|
Service Code
|
MS-DRG 882
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$32,839.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28,475.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,839.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24,325.31
|
| Rate for Payer: IEHP Medicare Advantage |
$24,325.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,325.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,649.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,595.92
|
| Rate for Payer: Multiplan WC |
$17,938.62
|
| Rate for Payer: Prime Health Services WC |
$17,755.57
|
| 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 883: DISORDERS OF PERSONALITY AND IMPULSE CONTROL
|
Facility
IP
|
$56,854.63
|
|
|
Service Code
|
MS-DRG 883
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$56,854.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$56,854.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,851.51
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$34,704.82
|
| Rate for Payer: IEHP Medicare Advantage |
$34,704.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,704.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43,728.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46,504.46
|
| Rate for Payer: Multiplan WC |
$33,156.14
|
| Rate for Payer: Prime Health Services WC |
$32,817.82
|
| 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 884: ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY
|
Facility
IP
|
$53,262.18
|
|
|
Service Code
|
MS-DRG 884
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$53,262.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53,262.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,077.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33,390.89
|
| Rate for Payer: IEHP Medicare Advantage |
$33,390.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,390.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42,072.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44,743.79
|
| Rate for Payer: Multiplan WC |
$32,242.26
|
| Rate for Payer: Prime Health Services WC |
$31,913.26
|
| 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 885: PSYCHOSES
|
Facility
IP
|
$41,423.78
|
|
|
Service Code
|
MS-DRG 885
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$41,423.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41,423.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$39,232.38
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29,061.02
|
| Rate for Payer: IEHP Medicare Advantage |
$29,061.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,061.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,616.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,941.77
|
| Rate for Payer: Multiplan WC |
$26,605.00
|
| Rate for Payer: Prime Health Services WC |
$26,333.52
|
| 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 886: BEHAVIORAL AND DEVELOPMENTAL DISORDERS
|
Facility
IP
|
$50,982.42
|
|
|
Service Code
|
MS-DRG 886
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$50,982.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$50,982.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$43,952.03
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$32,557.06
|
| Rate for Payer: IEHP Medicare Advantage |
$32,557.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,557.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41,021.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43,626.46
|
| Rate for Payer: Multiplan WC |
$28,032.29
|
| Rate for Payer: Prime Health Services WC |
$27,746.25
|
| 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 887: OTHER MENTAL DISORDER DIAGNOSES
|
Facility
IP
|
$39,277.41
|
|
|
Service Code
|
MS-DRG 887
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$39,277.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,277.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,172.59
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$28,275.99
|
| Rate for Payer: IEHP Medicare Advantage |
$28,275.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,275.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,627.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,889.83
|
| Rate for Payer: Multiplan WC |
$26,625.54
|
| Rate for Payer: Prime Health Services WC |
$26,353.85
|
| 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 894: ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA
|
Facility
IP
|
$27,378.55
|
|
|
Service Code
|
MS-DRG 894
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$27,378.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17,416.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,378.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20,280.41
|
| Rate for Payer: IEHP Medicare Advantage |
$20,280.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,280.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,553.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,175.75
|
| Rate for Payer: Multiplan WC |
$11,742.76
|
| Rate for Payer: Prime Health Services WC |
$11,622.94
|
| 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 895: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY
|
Facility
IP
|
$48,772.38
|
|
|
Service Code
|
MS-DRG 895
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$48,772.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48,772.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,860.81
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31,748.75
|
| Rate for Payer: IEHP Medicare Advantage |
$31,748.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,748.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40,003.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42,543.32
|
| Rate for Payer: Multiplan WC |
$32,010.21
|
| Rate for Payer: Prime Health Services WC |
$31,683.58
|
| 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 896: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC
|
Facility
IP
|
$53,904.88
|
|
|
Service Code
|
MS-DRG 896
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$53,904.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53,904.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,395.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33,625.96
|
| Rate for Payer: IEHP Medicare Advantage |
$33,625.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,625.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42,368.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45,058.79
|
| Rate for Payer: Multiplan WC |
$36,053.84
|
| Rate for Payer: Prime Health Services WC |
$35,685.94
|
| 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 897: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC
|
Facility
IP
|
$31,586.30
|
|
|
Service Code
|
MS-DRG 897
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$31,586.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,938.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,586.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,397.26
|
| Rate for Payer: IEHP Medicare Advantage |
$23,397.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,397.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,480.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,352.33
|
| Rate for Payer: Multiplan WC |
$17,482.70
|
| Rate for Payer: Prime Health Services WC |
$17,304.31
|
| 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 901: WOUND DEBRIDEMENTS FOR INJURIES WITH MCC
|
Facility
IP
|
$131,201.58
|
|
|
Service Code
|
MS-DRG 901
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$131,201.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$131,201.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$83,561.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$61,897.10
|
| Rate for Payer: IEHP Medicare Advantage |
$61,897.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61,897.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77,990.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$82,942.11
|
| Rate for Payer: Multiplan WC |
$90,331.74
|
| Rate for Payer: Prime Health Services WC |
$89,409.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 902: WOUND DEBRIDEMENTS FOR INJURIES WITH CC
|
Facility
IP
|
$57,136.57
|
|
|
Service Code
|
MS-DRG 902
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$57,136.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$57,136.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,990.73
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$34,807.95
|
| Rate for Payer: IEHP Medicare Advantage |
$34,807.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,807.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43,858.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46,642.65
|
| Rate for Payer: Multiplan WC |
$40,699.18
|
| Rate for Payer: Prime Health Services WC |
$40,283.89
|
| 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 903: WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC
|
Facility
IP
|
$37,637.31
|
|
|
Service Code
|
MS-DRG 903
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$37,637.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37,637.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,362.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,676.13
|
| Rate for Payer: IEHP Medicare Advantage |
$27,676.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,676.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,871.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,086.01
|
| Rate for Payer: Multiplan WC |
$24,964.14
|
| Rate for Payer: Prime Health Services WC |
$24,709.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 904: SKIN GRAFTS FOR INJURIES WITH CC/MCC
|
Facility
IP
|
$98,714.96
|
|
|
Service Code
|
MS-DRG 904
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$98,714.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$98,714.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$67,520.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50,015.17
|
| Rate for Payer: IEHP Medicare Advantage |
$50,015.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50,015.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63,019.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67,020.33
|
| Rate for Payer: Multiplan WC |
$72,943.51
|
| Rate for Payer: Prime Health Services WC |
$72,199.19
|
| 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 905: SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC
|
Facility
IP
|
$48,011.45
|
|
|
Service Code
|
MS-DRG 905
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$48,011.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48,011.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,485.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31,470.45
|
| Rate for Payer: IEHP Medicare Advantage |
$31,470.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,470.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,652.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42,170.40
|
| Rate for Payer: Multiplan WC |
$32,034.85
|
| Rate for Payer: Prime Health Services WC |
$31,707.96
|
| 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 906: HAND PROCEDURES FOR INJURIES
|
Facility
IP
|
$57,042.59
|
|
|
Service Code
|
MS-DRG 906
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$57,042.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$57,042.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,944.33
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$34,773.58
|
| Rate for Payer: IEHP Medicare Advantage |
$34,773.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,773.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43,814.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46,596.60
|
| Rate for Payer: Multiplan WC |
$36,715.11
|
| Rate for Payer: Prime Health Services WC |
$36,340.47
|
| 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 907: OTHER O.R. PROCEDURES FOR INJURIES WITH MCC
|
Facility
IP
|
$112,760.36
|
|
|
Service Code
|
MS-DRG 907
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$112,760.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$112,760.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$74,455.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$55,152.25
|
| Rate for Payer: IEHP Medicare Advantage |
$55,152.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55,152.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69,491.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73,904.02
|
| Rate for Payer: Multiplan WC |
$79,387.86
|
| Rate for Payer: Prime Health Services WC |
$78,577.78
|
| 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 908: OTHER O.R. PROCEDURES FOR INJURIES WITH CC
|
Facility
IP
|
$60,756.30
|
|
|
Service Code
|
MS-DRG 908
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$60,756.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$60,756.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$48,778.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$36,131.85
|
| Rate for Payer: IEHP Medicare Advantage |
$36,131.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36,131.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45,526.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48,416.68
|
| Rate for Payer: Multiplan WC |
$42,233.27
|
| Rate for Payer: Prime Health Services WC |
$41,802.31
|
| 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 909: OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC
|
Facility
IP
|
$41,117.59
|
|
|
Service Code
|
MS-DRG 909
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$41,117.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41,117.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$39,081.20
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$28,949.04
|
| Rate for Payer: IEHP Medicare Advantage |
$28,949.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,949.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36,475.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,791.71
|
| Rate for Payer: Multiplan WC |
$28,026.13
|
| Rate for Payer: Prime Health Services WC |
$27,740.15
|
| 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 913: TRAUMATIC INJURY WITH MCC
|
Facility
IP
|
$45,307.26
|
|
|
Service Code
|
MS-DRG 913
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$45,307.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45,307.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,149.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30,481.40
|
| Rate for Payer: IEHP Medicare Advantage |
$30,481.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,481.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38,406.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40,845.08
|
| Rate for Payer: Multiplan WC |
$31,094.28
|
| Rate for Payer: Prime Health Services WC |
$30,776.99
|
| 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 914: TRAUMATIC INJURY WITHOUT MCC
|
Facility
IP
|
$32,366.18
|
|
|
Service Code
|
MS-DRG 914
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$32,366.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,517.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,366.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,974.95
|
| Rate for Payer: IEHP Medicare Advantage |
$23,974.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,974.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30,208.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,126.43
|
| Rate for Payer: Multiplan WC |
$18,258.98
|
| Rate for Payer: Prime Health Services WC |
$18,072.66
|
| 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 915: ALLERGIC REACTIONS WITH MCC
|
Facility
IP
|
$53,780.58
|
|
|
Service Code
|
MS-DRG 915
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$53,780.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53,780.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,333.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33,580.50
|
| Rate for Payer: IEHP Medicare Advantage |
$33,580.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,580.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42,311.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44,997.87
|
| Rate for Payer: Multiplan WC |
$37,378.44
|
| Rate for Payer: Prime Health Services WC |
$36,997.03
|
| 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 916: ALLERGIC REACTIONS WITHOUT MCC
|
Facility
IP
|
$28,640.41
|
|
|
Service Code
|
MS-DRG 916
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$28,640.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19,972.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,640.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,215.12
|
| Rate for Payer: IEHP Medicare Advantage |
$21,215.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,215.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,731.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,428.26
|
| Rate for Payer: Multiplan WC |
$13,640.33
|
| Rate for Payer: Prime Health Services WC |
$13,501.14
|
| 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 917: POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC
|
Facility
IP
|
$48,381.30
|
|
|
Service Code
|
MS-DRG 917
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$48,381.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48,381.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$42,667.72
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31,605.72
|
| Rate for Payer: IEHP Medicare Advantage |
$31,605.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,605.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,823.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42,351.66
|
| Rate for Payer: Multiplan WC |
$31,266.78
|
| Rate for Payer: Prime Health Services WC |
$30,947.73
|
| 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
|
|
