|
INPATIENT MS-DRG 147: EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC
|
Facility
IP
|
$32,525.02
|
|
|
Service Code
|
MS-DRG 147
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$32,525.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,525.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20,589.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25,291.40
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$25,515.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,779.75
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17,614.63
|
| Rate for Payer: IEHP Medicare Advantage |
$17,614.63
|
| Rate for Payer: Innovage PACE Commercial |
$26,421.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,614.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23,603.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23,603.60
|
| Rate for Payer: Multiplan WC |
$25,515.52
|
| Rate for Payer: Preferred Health Network WC |
$26,036.24
|
| Rate for Payer: Prime Health Services Medicare |
$18,671.51
|
| Rate for Payer: Prime Health Services WC |
$24,617.93
|
| 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 148: EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC
|
Facility
IP
|
$23,416.01
|
|
|
Service Code
|
MS-DRG 148
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$23,416.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23,416.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,900.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,073.94
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$17,225.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,479.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12,947.72
|
| Rate for Payer: IEHP Medicare Advantage |
$12,947.72
|
| Rate for Payer: Innovage PACE Commercial |
$19,421.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,947.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,349.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,349.94
|
| Rate for Payer: Multiplan WC |
$17,225.23
|
| Rate for Payer: Preferred Health Network WC |
$17,576.77
|
| Rate for Payer: Prime Health Services Medicare |
$13,724.58
|
| Rate for Payer: Prime Health Services WC |
$16,619.29
|
| 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 149: DYSEQUILIBRIUM
|
Facility
IP
|
$19,599.76
|
|
|
Service Code
|
MS-DRG 149
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$19,599.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19,599.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,835.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,766.66
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$15,906.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,839.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$10,992.48
|
| Rate for Payer: IEHP Medicare Advantage |
$10,992.48
|
| Rate for Payer: Innovage PACE Commercial |
$16,488.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,992.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,729.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,729.92
|
| Rate for Payer: Multiplan WC |
$15,906.38
|
| Rate for Payer: Preferred Health Network WC |
$16,231.00
|
| Rate for Payer: Prime Health Services Medicare |
$11,652.03
|
| Rate for Payer: Prime Health Services WC |
$15,346.83
|
| 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 150: EPISTAXIS WITH MCC
|
Facility
IP
|
$34,596.33
|
|
|
Service Code
|
MS-DRG 150
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$34,596.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$34,596.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23,449.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28,803.92
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$29,059.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,212.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18,675.86
|
| Rate for Payer: IEHP Medicare Advantage |
$18,675.86
|
| Rate for Payer: Innovage PACE Commercial |
$28,013.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,675.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,025.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,025.65
|
| Rate for Payer: Multiplan WC |
$29,059.17
|
| Rate for Payer: Preferred Health Network WC |
$29,652.21
|
| Rate for Payer: Prime Health Services Medicare |
$19,796.41
|
| Rate for Payer: Prime Health Services WC |
$28,036.92
|
| 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 151: EPISTAXIS WITHOUT MCC
|
Facility
IP
|
$20,284.05
|
|
|
Service Code
|
MS-DRG 151
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$20,284.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20,284.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,107.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,100.79
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$16,243.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,313.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11,343.08
|
| Rate for Payer: IEHP Medicare Advantage |
$11,343.08
|
| Rate for Payer: Innovage PACE Commercial |
$17,014.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,343.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,199.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,199.73
|
| Rate for Payer: Multiplan WC |
$16,243.47
|
| Rate for Payer: Preferred Health Network WC |
$16,574.97
|
| Rate for Payer: Prime Health Services Medicare |
$12,023.66
|
| Rate for Payer: Prime Health Services WC |
$15,672.06
|
| 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 152: OTITIS MEDIA AND URI WITH MCC
|
Facility
IP
|
$31,272.24
|
|
|
Service Code
|
MS-DRG 152
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$31,272.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,272.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20,362.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25,011.57
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$25,233.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,913.25
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16,972.78
|
| Rate for Payer: IEHP Medicare Advantage |
$16,972.78
|
| Rate for Payer: Innovage PACE Commercial |
$25,459.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,972.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,743.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,743.53
|
| Rate for Payer: Multiplan WC |
$25,233.21
|
| Rate for Payer: Preferred Health Network WC |
$25,748.17
|
| Rate for Payer: Prime Health Services Medicare |
$17,991.15
|
| Rate for Payer: Prime Health Services WC |
$24,345.55
|
| 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 153: OTITIS MEDIA AND URI WITHOUT MCC
|
Facility
IP
|
$19,339.20
|
|
|
Service Code
|
MS-DRG 153
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$19,339.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19,339.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,739.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,419.71
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,547.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,659.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$10,858.99
|
| Rate for Payer: IEHP Medicare Advantage |
$10,858.99
|
| Rate for Payer: Innovage PACE Commercial |
$16,288.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,858.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,551.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,551.05
|
| Rate for Payer: Multiplan WC |
$14,547.49
|
| Rate for Payer: Preferred Health Network WC |
$14,844.38
|
| Rate for Payer: Prime Health Services Medicare |
$11,510.53
|
| Rate for Payer: Prime Health Services WC |
$14,035.74
|
| 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 154: OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC
|
Facility
IP
|
$40,483.89
|
|
|
Service Code
|
MS-DRG 154
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$40,483.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40,483.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25,550.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,385.06
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$31,663.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,284.60
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,692.30
|
| Rate for Payer: IEHP Medicare Advantage |
$21,692.30
|
| Rate for Payer: Innovage PACE Commercial |
$32,538.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,692.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,067.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,067.68
|
| Rate for Payer: Multiplan WC |
$31,663.17
|
| Rate for Payer: Preferred Health Network WC |
$32,309.36
|
| Rate for Payer: Prime Health Services Medicare |
$22,993.84
|
| Rate for Payer: Prime Health Services WC |
$30,549.33
|
| 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 155: OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC
|
Facility
IP
|
$24,913.57
|
|
|
Service Code
|
MS-DRG 155
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$24,913.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,913.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15,629.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19,197.74
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$19,367.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,515.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,714.97
|
| Rate for Payer: IEHP Medicare Advantage |
$13,714.97
|
| Rate for Payer: Innovage PACE Commercial |
$20,572.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,714.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,378.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,378.06
|
| Rate for Payer: Multiplan WC |
$19,367.86
|
| Rate for Payer: Preferred Health Network WC |
$19,763.12
|
| Rate for Payer: Prime Health Services Medicare |
$14,537.87
|
| Rate for Payer: Prime Health Services WC |
$18,686.54
|
| 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 156: OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC
|
Facility
IP
|
$17,252.10
|
|
|
Service Code
|
MS-DRG 156
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$17,252.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17,252.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,589.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,235.94
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,362.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,216.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$9,789.69
|
| Rate for Payer: IEHP Medicare Advantage |
$9,789.69
|
| Rate for Payer: Innovage PACE Commercial |
$14,684.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,789.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,118.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,118.18
|
| Rate for Payer: Multiplan WC |
$14,362.09
|
| Rate for Payer: Preferred Health Network WC |
$14,655.19
|
| Rate for Payer: Prime Health Services Medicare |
$10,377.07
|
| Rate for Payer: Prime Health Services WC |
$13,856.86
|
| 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 157: DENTAL AND ORAL DISEASES WITH MCC
|
Facility
IP
|
$44,926.53
|
|
|
Service Code
|
MS-DRG 157
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$44,926.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$44,926.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28,422.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,912.20
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$35,221.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,357.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,968.48
|
| Rate for Payer: IEHP Medicare Advantage |
$23,968.48
|
| Rate for Payer: Innovage PACE Commercial |
$35,952.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,968.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,117.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,117.76
|
| Rate for Payer: Multiplan WC |
$35,221.57
|
| Rate for Payer: Preferred Health Network WC |
$35,940.38
|
| Rate for Payer: Prime Health Services Medicare |
$25,406.59
|
| Rate for Payer: Prime Health Services WC |
$33,982.54
|
| 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 158: DENTAL AND ORAL DISEASES WITH CC
|
Facility
IP
|
$24,700.38
|
|
|
Service Code
|
MS-DRG 158
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$24,700.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,700.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15,795.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19,402.40
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$19,574.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,367.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,605.76
|
| Rate for Payer: IEHP Medicare Advantage |
$13,605.76
|
| Rate for Payer: Innovage PACE Commercial |
$20,408.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,605.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,231.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,231.72
|
| Rate for Payer: Multiplan WC |
$19,574.32
|
| Rate for Payer: Preferred Health Network WC |
$19,973.80
|
| Rate for Payer: Prime Health Services Medicare |
$14,422.11
|
| Rate for Payer: Prime Health Services WC |
$18,885.74
|
| 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 159: DENTAL AND ORAL DISEASES WITHOUT CC/MCC
|
Facility
IP
|
$17,770.59
|
|
|
Service Code
|
MS-DRG 159
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$17,770.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17,770.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,749.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,660.16
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$15,798.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,574.66
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$10,055.30
|
| Rate for Payer: IEHP Medicare Advantage |
$10,055.30
|
| Rate for Payer: Innovage PACE Commercial |
$15,082.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,055.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,474.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,474.10
|
| Rate for Payer: Multiplan WC |
$15,798.93
|
| Rate for Payer: Preferred Health Network WC |
$16,121.36
|
| Rate for Payer: Prime Health Services Medicare |
$10,658.62
|
| Rate for Payer: Prime Health Services WC |
$15,243.16
|
| 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 163: MAJOR CHEST PROCEDURES WITH MCC
|
Facility
IP
|
$124,057.24
|
|
|
Service Code
|
MS-DRG 163
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$124,057.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124,057.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82,347.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101,150.99
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$102,047.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$87,089.13
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$64,510.47
|
| Rate for Payer: IEHP Medicare Advantage |
$64,510.47
|
| Rate for Payer: Innovage PACE Commercial |
$96,765.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64,510.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$86,444.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86,444.03
|
| Rate for Payer: Multiplan WC |
$102,047.32
|
| Rate for Payer: Preferred Health Network WC |
$104,129.92
|
| Rate for Payer: Prime Health Services Medicare |
$68,381.10
|
| Rate for Payer: Prime Health Services WC |
$98,457.50
|
| 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 164: MAJOR CHEST PROCEDURES WITH CC
|
Facility
IP
|
$67,123.98
|
|
|
Service Code
|
MS-DRG 164
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$67,123.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$67,123.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43,908.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53,934.52
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$54,412.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$47,710.59
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35,341.18
|
| Rate for Payer: IEHP Medicare Advantage |
$35,341.18
|
| Rate for Payer: Innovage PACE Commercial |
$53,011.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35,341.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47,357.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47,357.18
|
| Rate for Payer: Multiplan WC |
$54,412.46
|
| Rate for Payer: Preferred Health Network WC |
$55,522.92
|
| Rate for Payer: Prime Health Services Medicare |
$37,461.65
|
| Rate for Payer: Prime Health Services WC |
$52,498.34
|
| 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 165: MAJOR CHEST PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$49,384.97
|
|
|
Service Code
|
MS-DRG 165
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$49,384.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49,384.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32,759.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40,239.45
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$40,596.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$35,441.14
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$26,252.70
|
| Rate for Payer: IEHP Medicare Advantage |
$26,252.70
|
| Rate for Payer: Innovage PACE Commercial |
$39,379.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,252.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,178.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35,178.62
|
| Rate for Payer: Multiplan WC |
$40,596.03
|
| Rate for Payer: Preferred Health Network WC |
$41,424.52
|
| Rate for Payer: Prime Health Services Medicare |
$27,827.86
|
| Rate for Payer: Prime Health Services WC |
$39,167.94
|
| 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 166: OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC
|
Facility
IP
|
$106,797.24
|
|
|
Service Code
|
MS-DRG 166
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$106,797.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$106,797.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62,322.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76,552.90
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$77,231.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$75,151.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$55,667.44
|
| Rate for Payer: IEHP Medicare Advantage |
$55,667.44
|
| Rate for Payer: Innovage PACE Commercial |
$83,501.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55,667.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74,594.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74,594.37
|
| Rate for Payer: Multiplan WC |
$77,231.26
|
| Rate for Payer: Preferred Health Network WC |
$78,807.41
|
| Rate for Payer: Prime Health Services Medicare |
$59,007.49
|
| Rate for Payer: Prime Health Services WC |
$74,514.42
|
| 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 167: OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC
|
Facility
IP
|
$47,895.32
|
|
|
Service Code
|
MS-DRG 167
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$47,895.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47,895.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32,320.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39,700.67
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$40,052.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,410.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,489.48
|
| Rate for Payer: IEHP Medicare Advantage |
$25,489.48
|
| Rate for Payer: Innovage PACE Commercial |
$38,234.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,489.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,155.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,155.90
|
| Rate for Payer: Multiplan WC |
$40,052.47
|
| Rate for Payer: Preferred Health Network WC |
$40,869.87
|
| Rate for Payer: Prime Health Services Medicare |
$27,018.85
|
| Rate for Payer: Prime Health Services WC |
$38,643.51
|
| 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 168: OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$35,680.67
|
|
|
Service Code
|
MS-DRG 168
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$35,680.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35,680.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24,100.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,603.74
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$29,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,962.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$19,231.40
|
| Rate for Payer: IEHP Medicare Advantage |
$19,231.40
|
| Rate for Payer: Innovage PACE Commercial |
$28,847.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,231.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,770.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,770.08
|
| Rate for Payer: Multiplan WC |
$29,866.07
|
| Rate for Payer: Preferred Health Network WC |
$30,475.58
|
| Rate for Payer: Prime Health Services Medicare |
$20,385.28
|
| Rate for Payer: Prime Health Services WC |
$28,815.44
|
| 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 173: ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM
|
Facility
IP
|
$80,930.92
|
|
|
Service Code
|
MS-DRG 173
|
| Min. Negotiated Rate |
$42,415.04 |
| Max. Negotiated Rate |
$80,930.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$80,930.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$57,260.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$42,415.04
|
| Rate for Payer: IEHP Medicare Advantage |
$42,415.04
|
| Rate for Payer: Innovage PACE Commercial |
$63,622.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42,415.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56,836.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56,836.15
|
| Rate for Payer: Prime Health Services Medicare |
$44,959.94
|
|
|
INPATIENT MS-DRG 175: PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE
|
Facility
IP
|
$36,925.56
|
|
|
Service Code
|
MS-DRG 175
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$36,925.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36,925.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23,747.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,169.37
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$29,427.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,823.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$19,869.22
|
| Rate for Payer: IEHP Medicare Advantage |
$19,869.22
|
| Rate for Payer: Innovage PACE Commercial |
$29,803.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,869.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,624.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26,624.75
|
| Rate for Payer: Multiplan WC |
$29,427.85
|
| Rate for Payer: Preferred Health Network WC |
$30,028.42
|
| Rate for Payer: Prime Health Services Medicare |
$21,061.37
|
| Rate for Payer: Prime Health Services WC |
$28,392.65
|
| 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 176: PULMONARY EMBOLISM WITHOUT MCC
|
Facility
IP
|
$21,465.78
|
|
|
Service Code
|
MS-DRG 176
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$21,465.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21,465.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,900.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,073.94
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$17,225.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,130.50
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11,948.52
|
| Rate for Payer: IEHP Medicare Advantage |
$11,948.52
|
| Rate for Payer: Innovage PACE Commercial |
$17,922.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,948.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,011.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,011.02
|
| Rate for Payer: Multiplan WC |
$17,225.23
|
| Rate for Payer: Preferred Health Network WC |
$17,576.77
|
| Rate for Payer: Prime Health Services Medicare |
$12,665.43
|
| Rate for Payer: Prime Health Services WC |
$16,619.29
|
| 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 177: RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC
|
Facility
IP
|
$44,647.55
|
|
|
Service Code
|
MS-DRG 177
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$44,647.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$44,647.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30,260.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37,169.65
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$37,499.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,164.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23,825.53
|
| Rate for Payer: IEHP Medicare Advantage |
$23,825.53
|
| Rate for Payer: Innovage PACE Commercial |
$35,738.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,825.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,926.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,926.21
|
| Rate for Payer: Multiplan WC |
$37,499.02
|
| Rate for Payer: Preferred Health Network WC |
$38,264.31
|
| Rate for Payer: Prime Health Services Medicare |
$25,255.06
|
| Rate for Payer: Prime Health Services WC |
$36,179.88
|
| 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 178: RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC
|
Facility
IP
|
$25,968.96
|
|
|
Service Code
|
MS-DRG 178
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$25,968.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,968.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18,480.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,699.82
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,900.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,245.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14,255.69
|
| Rate for Payer: IEHP Medicare Advantage |
$14,255.69
|
| Rate for Payer: Innovage PACE Commercial |
$21,383.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,255.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,102.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,102.62
|
| Rate for Payer: Multiplan WC |
$22,900.97
|
| Rate for Payer: Preferred Health Network WC |
$23,368.34
|
| Rate for Payer: Prime Health Services Medicare |
$15,111.03
|
| Rate for Payer: Prime Health Services WC |
$22,095.36
|
| 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 179: RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC
|
Facility
IP
|
$20,089.29
|
|
|
Service Code
|
MS-DRG 179
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$20,089.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20,089.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,352.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,401.51
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$16,546.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,178.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11,243.29
|
| Rate for Payer: IEHP Medicare Advantage |
$11,243.29
|
| Rate for Payer: Innovage PACE Commercial |
$16,864.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,243.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,066.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,066.01
|
| Rate for Payer: Multiplan WC |
$16,546.85
|
| Rate for Payer: Preferred Health Network WC |
$16,884.54
|
| Rate for Payer: Prime Health Services Medicare |
$11,917.89
|
| Rate for Payer: Prime Health Services WC |
$15,964.76
|
| 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
|
|
