|
INPATIENT MS-DRG 918: POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC
|
Facility
IP
|
$31,665.63
|
|
|
Service Code
|
MS-DRG 918
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$31,665.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26,099.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,665.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,456.02
|
| Rate for Payer: IEHP Medicare Advantage |
$23,456.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,456.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,554.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,431.07
|
| Rate for Payer: Multiplan WC |
$16,792.67
|
| Rate for Payer: Prime Health Services WC |
$16,621.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 919: COMPLICATIONS OF TREATMENT WITH MCC
|
Facility
IP
|
$55,317.61
|
|
|
Service Code
|
MS-DRG 919
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$55,317.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55,317.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,092.59
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$34,142.66
|
| Rate for Payer: IEHP Medicare Advantage |
$34,142.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,142.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43,019.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45,751.16
|
| Rate for Payer: Multiplan WC |
$36,834.22
|
| Rate for Payer: Prime Health Services WC |
$36,458.36
|
| 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 920: COMPLICATIONS OF TREATMENT WITH CC
|
Facility
IP
|
$34,253.74
|
|
|
Service Code
|
MS-DRG 920
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$34,253.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,340.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,253.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,373.14
|
| Rate for Payer: IEHP Medicare Advantage |
$25,373.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,373.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,970.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,000.01
|
| Rate for Payer: Multiplan WC |
$20,984.17
|
| Rate for Payer: Prime Health Services WC |
$20,770.05
|
| 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 921: COMPLICATIONS OF TREATMENT WITHOUT CC/MCC
|
Facility
IP
|
$29,224.21
|
|
|
Service Code
|
MS-DRG 921
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$29,224.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21,154.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,224.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,647.56
|
| Rate for Payer: IEHP Medicare Advantage |
$21,647.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,647.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,275.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,007.73
|
| 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 922: OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC
|
Facility
IP
|
$52,898.39
|
|
|
Service Code
|
MS-DRG 922
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$52,898.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52,898.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$44,898.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33,257.84
|
| Rate for Payer: IEHP Medicare Advantage |
$33,257.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,257.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41,904.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44,565.51
|
| Rate for Payer: Multiplan WC |
$31,950.65
|
| Rate for Payer: Prime Health Services WC |
$31,624.62
|
| 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 923: OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC
|
Facility
IP
|
$33,918.45
|
|
|
Service Code
|
MS-DRG 923
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$33,918.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,661.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,918.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,124.78
|
| Rate for Payer: IEHP Medicare Advantage |
$25,124.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,124.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,657.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,667.21
|
| Rate for Payer: Multiplan WC |
$19,370.00
|
| Rate for Payer: Prime Health Services WC |
$19,172.35
|
| 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 927: EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT
|
Facility
IP
|
$799,090.35
|
|
|
Service Code
|
MS-DRG 927
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$799,090.35 |
| Rate for Payer: IEHP Medicare Advantage |
$306,176.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$799,090.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$413,337.98
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306,176.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306,176.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385,782.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410,276.22
|
| Rate for Payer: Multiplan WC |
$389,827.50
|
| Rate for Payer: Prime Health Services WC |
$385,849.67
|
| 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 928: FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC
|
Facility
IP
|
$209,777.63
|
|
|
Service Code
|
MS-DRG 928
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$209,777.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$209,777.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$122,358.79
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$90,636.14
|
| Rate for Payer: IEHP Medicare Advantage |
$90,636.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90,636.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$114,201.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121,452.43
|
| Rate for Payer: Multiplan WC |
$127,147.48
|
| Rate for Payer: Prime Health Services WC |
$125,850.06
|
| 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 929: FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC
|
Facility
IP
|
$97,481.10
|
|
|
Service Code
|
MS-DRG 929
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$97,481.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$97,481.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$66,911.26
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$49,563.90
|
| Rate for Payer: IEHP Medicare Advantage |
$49,563.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49,563.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62,450.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66,415.63
|
| Rate for Payer: Multiplan WC |
$60,352.59
|
| Rate for Payer: Prime Health Services WC |
$59,736.75
|
| 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 933: EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT
|
Facility
IP
|
$91,918.11
|
|
|
Service Code
|
MS-DRG 933
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$91,918.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$91,918.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$64,164.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$47,529.23
|
| Rate for Payer: IEHP Medicare Advantage |
$47,529.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47,529.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59,886.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63,689.17
|
| Rate for Payer: Multiplan WC |
$62,287.13
|
| Rate for Payer: Prime Health Services WC |
$61,651.55
|
| 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 934: FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY
|
Facility
IP
|
$63,436.23
|
|
|
Service Code
|
MS-DRG 934
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$63,436.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$63,436.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$50,101.25
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37,112.04
|
| Rate for Payer: IEHP Medicare Advantage |
$37,112.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37,112.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46,761.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49,730.13
|
| Rate for Payer: Multiplan WC |
$38,526.43
|
| Rate for Payer: Prime Health Services WC |
$38,133.30
|
| 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 935: NON-EXTENSIVE BURNS
|
Facility
IP
|
$61,877.99
|
|
|
Service Code
|
MS-DRG 935
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$61,877.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$61,877.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$49,331.86
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$36,542.12
|
| Rate for Payer: IEHP Medicare Advantage |
$36,542.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36,542.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46,043.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48,966.44
|
| Rate for Payer: Multiplan WC |
$41,567.89
|
| Rate for Payer: Prime Health Services WC |
$41,143.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 939: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC
|
Facility
IP
|
$97,475.03
|
|
|
Service Code
|
MS-DRG 939
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$97,475.03 |
| Rate for Payer: IEHP Medicare Advantage |
$49,561.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97,475.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$66,908.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$49,561.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49,561.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62,447.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66,412.62
|
| Rate for Payer: Multiplan WC |
$63,603.52
|
| Rate for Payer: Prime Health Services WC |
$62,954.50
|
| 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 940: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC
|
Facility
IP
|
$65,682.65
|
|
|
Service Code
|
MS-DRG 940
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$65,682.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$65,682.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$51,210.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37,933.66
|
| Rate for Payer: IEHP Medicare Advantage |
$37,933.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37,933.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47,796.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50,831.10
|
| Rate for Payer: Multiplan WC |
$45,248.02
|
| Rate for Payer: Prime Health Services WC |
$44,786.31
|
| 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 941: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC
|
Facility
IP
|
$56,266.50
|
|
|
Service Code
|
MS-DRG 941
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$56,266.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$56,266.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,561.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$34,489.72
|
| Rate for Payer: IEHP Medicare Advantage |
$34,489.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,489.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43,457.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46,216.22
|
| Rate for Payer: Multiplan WC |
$38,760.55
|
| Rate for Payer: Prime Health Services WC |
$38,365.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 945: REHABILITATION WITH CC/MCC
|
Facility
IP
|
$45,762.00
|
|
|
Service Code
|
MS-DRG 945
|
| Min. Negotiated Rate |
$2,739.00 |
| Max. Negotiated Rate |
$45,762.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45,762.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,374.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30,647.71
|
| Rate for Payer: IEHP Medicare Advantage |
$30,647.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,647.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38,616.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,067.93
|
| Rate for Payer: Multiplan WC |
$30,911.50
|
| Rate for Payer: Prime Health Services WC |
$30,596.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,770.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,196.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,995.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,739.00
|
|
|
INPATIENT MS-DRG 946: REHABILITATION WITHOUT CC/MCC
|
Facility
IP
|
$33,937.89
|
|
|
Service Code
|
MS-DRG 946
|
| Min. Negotiated Rate |
$2,739.00 |
| Max. Negotiated Rate |
$33,937.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,701.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$33,937.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,139.18
|
| Rate for Payer: IEHP Medicare Advantage |
$25,139.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,139.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,675.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,686.50
|
| Rate for Payer: Multiplan WC |
$23,054.25
|
| Rate for Payer: Prime Health Services WC |
$22,819.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,770.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,196.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,995.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,739.00
|
|
|
INPATIENT MS-DRG 947: SIGNS AND SYMPTOMS WITH MCC
|
Facility
IP
|
$37,943.51
|
|
|
Service Code
|
MS-DRG 947
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$37,943.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37,943.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,513.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27,788.10
|
| Rate for Payer: IEHP Medicare Advantage |
$27,788.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,788.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,013.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37,236.05
|
| 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 |
$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 948: SIGNS AND SYMPTOMS WITHOUT MCC
|
Facility
IP
|
$30,769.00
|
|
|
Service Code
|
MS-DRG 948
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$30,769.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,283.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,769.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,791.85
|
| Rate for Payer: IEHP Medicare Advantage |
$22,791.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,791.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,717.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,541.08
|
| Rate for Payer: Multiplan WC |
$15,969.17
|
| Rate for Payer: Prime Health Services WC |
$15,806.22
|
| 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 949: AFTERCARE WITH CC/MCC
|
Facility
IP
|
$34,837.52
|
|
|
Service Code
|
MS-DRG 949
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$34,837.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,410.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,837.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,805.57
|
| Rate for Payer: IEHP Medicare Advantage |
$25,805.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,805.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,515.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,579.46
|
| Rate for Payer: Multiplan WC |
$24,479.48
|
| Rate for Payer: Prime Health Services WC |
$24,229.69
|
| 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 950: AFTERCARE WITHOUT CC/MCC
|
Facility
IP
|
$28,338.04
|
|
|
Service Code
|
MS-DRG 950
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$28,338.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19,044.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,338.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20,991.14
|
| Rate for Payer: IEHP Medicare Advantage |
$20,991.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,991.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,448.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,128.13
|
| Rate for Payer: Multiplan WC |
$14,570.63
|
| Rate for Payer: Prime Health Services WC |
$14,421.95
|
| 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 951: OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
IP
|
$27,610.56
|
|
|
Service Code
|
MS-DRG 951
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$27,610.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17,886.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,610.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20,452.27
|
| Rate for Payer: IEHP Medicare Advantage |
$20,452.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,452.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,769.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,406.04
|
| Rate for Payer: Multiplan WC |
$11,689.36
|
| Rate for Payer: Prime Health Services WC |
$11,570.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 955: CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
IP
|
$184,630.50
|
|
|
Service Code
|
MS-DRG 955
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$184,630.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$184,630.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$109,942.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$81,438.64
|
| Rate for Payer: IEHP Medicare Advantage |
$81,438.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81,438.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102,612.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109,127.78
|
| Rate for Payer: Multiplan WC |
$138,333.70
|
| Rate for Payer: Prime Health Services WC |
$136,922.13
|
| 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 956: LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
IP
|
$117,571.51
|
|
|
Service Code
|
MS-DRG 956
|
| Min. Negotiated Rate |
$25,608.00 |
| Max. Negotiated Rate |
$117,571.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$117,571.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$76,831.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$56,911.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$25,608.00
|
| Rate for Payer: IEHP Medicare Advantage |
$56,911.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56,911.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71,709.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76,261.99
|
| Rate for Payer: Multiplan WC |
$78,124.86
|
| Rate for Payer: Prime Health Services WC |
$77,327.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$86,845.00
|
| Rate for Payer: United Healthcare All Other HMO |
$56,323.00
|
| Rate for Payer: United Healthcare HMO Rider |
$42,781.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39,121.00
|
|
|
INPATIENT MS-DRG 957: OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC
|
Facility
IP
|
$219,260.47
|
|
|
Service Code
|
MS-DRG 957
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$219,260.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$219,260.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$127,041.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$94,104.49
|
| Rate for Payer: IEHP Medicare Advantage |
$94,104.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94,104.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$118,571.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$126,100.02
|
| Rate for Payer: Multiplan WC |
$152,185.55
|
| Rate for Payer: Prime Health Services WC |
$150,632.64
|
| 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
|
|
