|
INPATIENT MS-DRG 101: SEIZURES WITHOUT MCC
|
Facility
IP
|
$23,939.76
|
|
|
Service Code
|
MS-DRG 101
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$23,939.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23,939.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15,326.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18,826.02
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$18,992.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,841.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,216.04
|
| Rate for Payer: IEHP Medicare Advantage |
$13,216.04
|
| Rate for Payer: Innovage PACE Commercial |
$19,824.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,216.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,709.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,709.49
|
| Rate for Payer: Multiplan WC |
$18,992.85
|
| Rate for Payer: Preferred Health Network WC |
$19,380.46
|
| Rate for Payer: Prime Health Services Medicare |
$14,009.00
|
| Rate for Payer: Prime Health Services WC |
$18,324.72
|
| 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 102: HEADACHES WITH MCC
|
Facility
IP
|
$31,756.51
|
|
|
Service Code
|
MS-DRG 102
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$31,756.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,756.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19,549.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24,013.36
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$24,226.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,248.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17,220.90
|
| Rate for Payer: IEHP Medicare Advantage |
$17,220.90
|
| Rate for Payer: Innovage PACE Commercial |
$25,831.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,220.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23,076.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23,076.01
|
| Rate for Payer: Multiplan WC |
$24,226.15
|
| Rate for Payer: Preferred Health Network WC |
$24,720.56
|
| Rate for Payer: Prime Health Services Medicare |
$18,254.15
|
| Rate for Payer: Prime Health Services WC |
$23,373.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 103: HEADACHES WITHOUT MCC
|
Facility
IP
|
$22,171.13
|
|
|
Service Code
|
MS-DRG 103
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$22,171.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,171.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14,153.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,385.10
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$17,539.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,618.38
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12,309.91
|
| Rate for Payer: IEHP Medicare Advantage |
$12,309.91
|
| Rate for Payer: Innovage PACE Commercial |
$18,464.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,309.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,495.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,495.28
|
| Rate for Payer: Multiplan WC |
$17,539.15
|
| Rate for Payer: Preferred Health Network WC |
$17,897.09
|
| Rate for Payer: Prime Health Services Medicare |
$13,048.50
|
| Rate for Payer: Prime Health Services WC |
$16,922.16
|
| 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 113: ORBITAL PROCEDURES WITH CC/MCC
|
Facility
IP
|
$65,989.63
|
|
|
Service Code
|
MS-DRG 113
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$65,989.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$65,989.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38,172.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46,888.60
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$47,304.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,925.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$34,759.97
|
| Rate for Payer: IEHP Medicare Advantage |
$34,759.97
|
| Rate for Payer: Innovage PACE Commercial |
$52,139.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34,759.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46,578.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46,578.36
|
| Rate for Payer: Multiplan WC |
$47,304.10
|
| Rate for Payer: Preferred Health Network WC |
$48,269.49
|
| Rate for Payer: Prime Health Services Medicare |
$36,845.57
|
| Rate for Payer: Prime Health Services WC |
$45,640.03
|
| 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 114: ORBITAL PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$32,419.74
|
|
|
Service Code
|
MS-DRG 114
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$32,419.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,419.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22,148.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,206.37
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$27,447.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,706.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17,560.70
|
| Rate for Payer: IEHP Medicare Advantage |
$17,560.70
|
| Rate for Payer: Innovage PACE Commercial |
$26,341.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,560.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23,531.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23,531.34
|
| Rate for Payer: Multiplan WC |
$27,447.46
|
| Rate for Payer: Preferred Health Network WC |
$28,007.61
|
| Rate for Payer: Prime Health Services Medicare |
$18,614.34
|
| Rate for Payer: Prime Health Services WC |
$26,481.91
|
| 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 115: EXTRAOCULAR PROCEDURES EXCEPT ORBIT
|
Facility
IP
|
$41,173.44
|
|
|
Service Code
|
MS-DRG 115
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$41,173.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41,173.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25,826.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,723.37
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$32,004.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,761.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,045.60
|
| Rate for Payer: IEHP Medicare Advantage |
$22,045.60
|
| Rate for Payer: Innovage PACE Commercial |
$33,068.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,045.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,541.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,541.10
|
| Rate for Payer: Multiplan WC |
$32,004.48
|
| Rate for Payer: Preferred Health Network WC |
$32,657.63
|
| Rate for Payer: Prime Health Services Medicare |
$23,368.34
|
| Rate for Payer: Prime Health Services WC |
$30,878.62
|
| 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 116: INTRAOCULAR PROCEDURES WITH CC/MCC
|
Facility
IP
|
$48,184.83
|
|
|
Service Code
|
MS-DRG 116
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$48,184.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48,184.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32,072.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39,395.78
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$39,744.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,611.03
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,637.80
|
| Rate for Payer: IEHP Medicare Advantage |
$25,637.80
|
| Rate for Payer: Innovage PACE Commercial |
$38,456.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,637.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,354.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,354.65
|
| Rate for Payer: Multiplan WC |
$39,744.88
|
| Rate for Payer: Preferred Health Network WC |
$40,556.00
|
| Rate for Payer: Prime Health Services Medicare |
$27,176.07
|
| Rate for Payer: Prime Health Services WC |
$38,346.74
|
| 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 117: INTRAOCULAR PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$31,540.69
|
|
|
Service Code
|
MS-DRG 117
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$31,540.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,540.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16,878.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20,732.64
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$20,916.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,098.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17,110.34
|
| Rate for Payer: IEHP Medicare Advantage |
$17,110.34
|
| Rate for Payer: Innovage PACE Commercial |
$25,665.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,110.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,927.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,927.86
|
| Rate for Payer: Multiplan WC |
$20,916.37
|
| Rate for Payer: Preferred Health Network WC |
$21,343.23
|
| Rate for Payer: Prime Health Services Medicare |
$18,136.96
|
| Rate for Payer: Prime Health Services WC |
$20,180.57
|
| 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 121: ACUTE MAJOR EYE INFECTIONS WITH CC/MCC
|
Facility
IP
|
$33,719.90
|
|
|
Service Code
|
MS-DRG 121
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$33,719.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$33,719.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20,831.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25,587.94
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$25,814.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,606.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18,226.83
|
| Rate for Payer: IEHP Medicare Advantage |
$18,226.83
|
| Rate for Payer: Innovage PACE Commercial |
$27,340.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,226.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24,423.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24,423.95
|
| Rate for Payer: Multiplan WC |
$25,814.68
|
| Rate for Payer: Preferred Health Network WC |
$26,341.51
|
| Rate for Payer: Prime Health Services Medicare |
$19,320.44
|
| Rate for Payer: Prime Health Services WC |
$24,906.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 122: ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC
|
Facility
IP
|
$19,594.50
|
|
|
Service Code
|
MS-DRG 122
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$19,594.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19,594.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,744.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,425.98
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,553.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,836.20
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$10,989.78
|
| Rate for Payer: IEHP Medicare Advantage |
$10,989.78
|
| Rate for Payer: Innovage PACE Commercial |
$16,484.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,989.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,726.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,726.31
|
| Rate for Payer: Multiplan WC |
$14,553.81
|
| Rate for Payer: Preferred Health Network WC |
$14,850.83
|
| Rate for Payer: Prime Health Services Medicare |
$11,649.17
|
| Rate for Payer: Prime Health Services WC |
$14,041.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 123: NEUROLOGICAL EYE DISORDERS
|
Facility
IP
|
$21,160.48
|
|
|
Service Code
|
MS-DRG 123
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$21,160.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21,160.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,495.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,576.93
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$16,723.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,919.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11,792.09
|
| Rate for Payer: IEHP Medicare Advantage |
$11,792.09
|
| Rate for Payer: Innovage PACE Commercial |
$17,688.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,792.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,801.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,801.40
|
| Rate for Payer: Multiplan WC |
$16,723.82
|
| Rate for Payer: Preferred Health Network WC |
$17,065.12
|
| Rate for Payer: Prime Health Services Medicare |
$12,499.62
|
| Rate for Payer: Prime Health Services WC |
$16,135.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 124: OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT
|
Facility
IP
|
$34,791.09
|
|
|
Service Code
|
MS-DRG 124
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$34,791.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$34,791.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23,813.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,250.82
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$29,510.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,347.13
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18,775.65
|
| Rate for Payer: IEHP Medicare Advantage |
$18,775.65
|
| Rate for Payer: Innovage PACE Commercial |
$28,163.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,775.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,159.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,159.37
|
| Rate for Payer: Multiplan WC |
$29,510.02
|
| Rate for Payer: Preferred Health Network WC |
$30,112.27
|
| Rate for Payer: Prime Health Services Medicare |
$19,902.19
|
| Rate for Payer: Prime Health Services WC |
$28,471.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 125: OTHER DISORDERS OF THE EYE WITHOUT MCC
|
Facility
IP
|
$20,989.40
|
|
|
Service Code
|
MS-DRG 125
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$20,989.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20,989.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14,656.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18,003.23
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$18,162.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,801.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11,704.45
|
| Rate for Payer: IEHP Medicare Advantage |
$11,704.45
|
| Rate for Payer: Innovage PACE Commercial |
$17,556.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,704.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,683.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,683.96
|
| Rate for Payer: Multiplan WC |
$18,162.77
|
| Rate for Payer: Preferred Health Network WC |
$18,533.44
|
| Rate for Payer: Prime Health Services Medicare |
$12,406.72
|
| Rate for Payer: Prime Health Services WC |
$17,523.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 135: SINUS AND MASTOID PROCEDURES WITH CC/MCC
|
Facility
IP
|
$69,800.62
|
|
|
Service Code
|
MS-DRG 135
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$69,800.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$69,800.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41,664.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51,177.97
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$51,631.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$49,561.90
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$36,712.52
|
| Rate for Payer: IEHP Medicare Advantage |
$36,712.52
|
| Rate for Payer: Innovage PACE Commercial |
$55,068.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36,712.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49,194.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49,194.78
|
| Rate for Payer: Multiplan WC |
$51,631.48
|
| Rate for Payer: Preferred Health Network WC |
$52,685.18
|
| Rate for Payer: Prime Health Services Medicare |
$38,915.27
|
| Rate for Payer: Prime Health Services WC |
$49,815.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 136: SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$24,944.14
|
|
|
Service Code
|
MS-DRG 136
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$24,944.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,716.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19,726.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24,230.54
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$24,445.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,293.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15,032.40
|
| Rate for Payer: IEHP Medicare Advantage |
$15,032.40
|
| Rate for Payer: Innovage PACE Commercial |
$22,548.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,032.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,143.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,143.42
|
| Rate for Payer: Multiplan WC |
$24,445.26
|
| Rate for Payer: Preferred Health Network WC |
$24,944.14
|
| Rate for Payer: Prime Health Services Medicare |
$15,934.34
|
| Rate for Payer: Prime Health Services WC |
$23,585.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 137: MOUTH PROCEDURES WITH CC/MCC
|
Facility
IP
|
$39,602.20
|
|
|
Service Code
|
MS-DRG 137
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$39,602.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39,602.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25,494.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,316.15
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$31,593.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,674.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,240.58
|
| Rate for Payer: IEHP Medicare Advantage |
$21,240.58
|
| Rate for Payer: Innovage PACE Commercial |
$31,860.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,240.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,462.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,462.38
|
| Rate for Payer: Multiplan WC |
$31,593.65
|
| Rate for Payer: Preferred Health Network WC |
$32,238.42
|
| Rate for Payer: Prime Health Services Medicare |
$22,515.01
|
| Rate for Payer: Prime Health Services WC |
$30,482.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 138: MOUTH PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$22,784.36
|
|
|
Service Code
|
MS-DRG 138
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$22,784.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,784.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15,033.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18,466.84
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$18,630.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,042.51
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12,624.08
|
| Rate for Payer: IEHP Medicare Advantage |
$12,624.08
|
| Rate for Payer: Innovage PACE Commercial |
$18,936.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,624.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,916.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,916.27
|
| Rate for Payer: Multiplan WC |
$18,630.48
|
| Rate for Payer: Preferred Health Network WC |
$19,010.69
|
| Rate for Payer: Prime Health Services Medicare |
$13,381.52
|
| Rate for Payer: Prime Health Services WC |
$17,975.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 139: SALIVARY GLAND PROCEDURES
|
Facility
IP
|
$31,259.08
|
|
|
Service Code
|
MS-DRG 139
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$31,259.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,259.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21,378.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26,260.37
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$26,493.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,904.14
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16,966.03
|
| Rate for Payer: IEHP Medicare Advantage |
$16,966.03
|
| Rate for Payer: Innovage PACE Commercial |
$25,449.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,966.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,734.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,734.48
|
| Rate for Payer: Multiplan WC |
$26,493.08
|
| Rate for Payer: Preferred Health Network WC |
$27,033.75
|
| Rate for Payer: Prime Health Services Medicare |
$17,983.99
|
| Rate for Payer: Prime Health Services WC |
$25,561.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 140: MAJOR HEAD AND NECK PROCEDURES WITH MCC
|
Facility
IP
|
$99,435.81
|
|
|
Service Code
|
MS-DRG 140
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$99,435.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$99,435.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$70,661.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86,796.01
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$87,565.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$70,059.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$51,895.89
|
| Rate for Payer: IEHP Medicare Advantage |
$51,895.89
|
| Rate for Payer: Innovage PACE Commercial |
$77,843.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51,895.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69,540.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69,540.49
|
| Rate for Payer: Multiplan WC |
$87,565.15
|
| Rate for Payer: Preferred Health Network WC |
$89,352.19
|
| Rate for Payer: Prime Health Services Medicare |
$55,009.64
|
| Rate for Payer: Prime Health Services WC |
$84,484.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 141: MAJOR HEAD AND NECK PROCEDURES WITH CC
|
Facility
IP
|
$54,525.07
|
|
|
Service Code
|
MS-DRG 141
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$54,525.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$54,525.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37,956.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46,623.39
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$47,036.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,996.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$28,886.20
|
| Rate for Payer: IEHP Medicare Advantage |
$28,886.20
|
| Rate for Payer: Innovage PACE Commercial |
$43,329.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,886.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38,707.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38,707.51
|
| Rate for Payer: Multiplan WC |
$47,036.53
|
| Rate for Payer: Preferred Health Network WC |
$47,996.46
|
| Rate for Payer: Prime Health Services Medicare |
$30,619.37
|
| Rate for Payer: Prime Health Services WC |
$45,381.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 142: MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$40,662.86
|
|
|
Service Code
|
MS-DRG 142
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$40,662.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40,662.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28,930.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35,536.60
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$35,851.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,408.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,784.00
|
| Rate for Payer: IEHP Medicare Advantage |
$21,784.00
|
| Rate for Payer: Innovage PACE Commercial |
$32,676.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,784.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,190.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,190.56
|
| Rate for Payer: Multiplan WC |
$35,851.51
|
| Rate for Payer: Preferred Health Network WC |
$36,583.17
|
| Rate for Payer: Prime Health Services Medicare |
$23,091.04
|
| Rate for Payer: Prime Health Services WC |
$34,590.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 143: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC
|
Facility
IP
|
$87,526.47
|
|
|
Service Code
|
MS-DRG 143
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$87,526.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$87,526.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53,937.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66,253.41
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$66,840.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$61,822.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$45,794.21
|
| Rate for Payer: IEHP Medicare Advantage |
$45,794.21
|
| Rate for Payer: Innovage PACE Commercial |
$68,691.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45,794.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61,364.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61,364.24
|
| Rate for Payer: Multiplan WC |
$66,840.50
|
| Rate for Payer: Preferred Health Network WC |
$68,204.59
|
| Rate for Payer: Prime Health Services Medicare |
$48,541.86
|
| Rate for Payer: Prime Health Services WC |
$64,489.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 144: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC
|
Facility
IP
|
$45,545.03
|
|
|
Service Code
|
MS-DRG 144
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$45,545.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45,545.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30,759.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37,783.61
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$38,118.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,785.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24,285.35
|
| Rate for Payer: IEHP Medicare Advantage |
$24,285.35
|
| Rate for Payer: Innovage PACE Commercial |
$36,428.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24,285.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,542.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,542.37
|
| Rate for Payer: Multiplan WC |
$38,118.42
|
| Rate for Payer: Preferred Health Network WC |
$38,896.35
|
| Rate for Payer: Prime Health Services Medicare |
$25,742.47
|
| Rate for Payer: Prime Health Services WC |
$36,777.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 145: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$32,138.13
|
|
|
Service Code
|
MS-DRG 145
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$32,138.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,138.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20,533.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25,222.49
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$25,445.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,512.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17,416.42
|
| Rate for Payer: IEHP Medicare Advantage |
$17,416.42
|
| Rate for Payer: Innovage PACE Commercial |
$26,124.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,416.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23,338.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23,338.00
|
| Rate for Payer: Multiplan WC |
$25,445.99
|
| Rate for Payer: Preferred Health Network WC |
$25,965.30
|
| Rate for Payer: Prime Health Services Medicare |
$18,461.41
|
| Rate for Payer: Prime Health Services WC |
$24,550.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 146: EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC
|
Facility
IP
|
$55,559.41
|
|
|
Service Code
|
MS-DRG 146
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$55,559.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55,559.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34,243.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42,062.54
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$42,435.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$39,711.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29,416.15
|
| Rate for Payer: IEHP Medicare Advantage |
$29,416.15
|
| Rate for Payer: Innovage PACE Commercial |
$44,124.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,416.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,417.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39,417.64
|
| Rate for Payer: Multiplan WC |
$42,435.27
|
| Rate for Payer: Preferred Health Network WC |
$43,301.30
|
| Rate for Payer: Prime Health Services Medicare |
$31,181.12
|
| Rate for Payer: Prime Health Services WC |
$40,942.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
