|
INPATIENT MS-DRG 298: CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC
|
Facility
IP
|
$11,551.41
|
|
|
Service Code
|
MS-DRG 298
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$11,551.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,551.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,304.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,201.35
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,291.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,287.66
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,879.75
|
| Rate for Payer: IEHP Medicare Advantage |
$6,879.75
|
| Rate for Payer: Innovage PACE Commercial |
$10,319.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,879.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,218.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,218.86
|
| Rate for Payer: Multiplan WC |
$10,291.74
|
| Rate for Payer: Preferred Health Network WC |
$10,501.78
|
| Rate for Payer: Prime Health Services Medicare |
$7,292.54
|
| Rate for Payer: Prime Health Services WC |
$9,929.70
|
| 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 299: PERIPHERAL VASCULAR DISORDERS WITH MCC
|
Facility
IP
|
$41,484.01
|
|
|
Service Code
|
MS-DRG 299
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$41,484.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41,484.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26,147.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32,118.05
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$32,402.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,976.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22,204.71
|
| Rate for Payer: IEHP Medicare Advantage |
$22,204.71
|
| Rate for Payer: Innovage PACE Commercial |
$33,307.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,204.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,754.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,754.31
|
| Rate for Payer: Multiplan WC |
$32,402.66
|
| Rate for Payer: Preferred Health Network WC |
$33,063.94
|
| Rate for Payer: Prime Health Services Medicare |
$23,536.99
|
| Rate for Payer: Prime Health Services WC |
$31,262.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 300: PERIPHERAL VASCULAR DISORDERS WITH CC
|
Facility
IP
|
$28,082.37
|
|
|
Service Code
|
MS-DRG 300
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$28,082.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28,082.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17,529.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,532.46
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$21,723.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,706.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15,338.47
|
| Rate for Payer: IEHP Medicare Advantage |
$15,338.47
|
| Rate for Payer: Innovage PACE Commercial |
$23,007.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,338.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,553.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,553.55
|
| Rate for Payer: Multiplan WC |
$21,723.27
|
| Rate for Payer: Preferred Health Network WC |
$22,166.60
|
| Rate for Payer: Prime Health Services Medicare |
$16,258.78
|
| Rate for Payer: Prime Health Services WC |
$20,959.09
|
| 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 301: PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC
|
Facility
IP
|
$18,681.23
|
|
|
Service Code
|
MS-DRG 301
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$18,681.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18,681.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,176.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,956.40
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$15,088.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,204.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$10,521.87
|
| Rate for Payer: IEHP Medicare Advantage |
$10,521.87
|
| Rate for Payer: Innovage PACE Commercial |
$15,782.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,521.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,099.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,099.31
|
| Rate for Payer: Multiplan WC |
$15,088.94
|
| Rate for Payer: Preferred Health Network WC |
$15,396.88
|
| Rate for Payer: Prime Health Services Medicare |
$11,153.18
|
| Rate for Payer: Prime Health Services WC |
$14,558.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 302: ATHEROSCLEROSIS WITH MCC
|
Facility
IP
|
$29,506.23
|
|
|
Service Code
|
MS-DRG 302
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$29,506.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29,506.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20,499.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25,180.72
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$25,403.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,691.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16,067.98
|
| Rate for Payer: IEHP Medicare Advantage |
$16,067.98
|
| Rate for Payer: Innovage PACE Commercial |
$24,101.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,067.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,531.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,531.09
|
| Rate for Payer: Multiplan WC |
$25,403.85
|
| Rate for Payer: Preferred Health Network WC |
$25,922.30
|
| Rate for Payer: Prime Health Services Medicare |
$17,032.06
|
| Rate for Payer: Prime Health Services WC |
$24,510.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 303: ATHEROSCLEROSIS WITHOUT MCC
|
Facility
IP
|
$17,320.53
|
|
|
Service Code
|
MS-DRG 303
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$17,320.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17,320.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,494.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,119.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,244.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,263.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$9,824.74
|
| Rate for Payer: IEHP Medicare Advantage |
$9,824.74
|
| Rate for Payer: Innovage PACE Commercial |
$14,737.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,824.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,165.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,165.15
|
| Rate for Payer: Multiplan WC |
$14,244.11
|
| Rate for Payer: Preferred Health Network WC |
$14,534.81
|
| Rate for Payer: Prime Health Services Medicare |
$10,414.22
|
| Rate for Payer: Prime Health Services WC |
$13,743.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 304: HYPERTENSION WITH MCC
|
Facility
IP
|
$30,240.53
|
|
|
Service Code
|
MS-DRG 304
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$30,240.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,240.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18,677.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,942.06
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$23,145.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,199.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16,444.20
|
| Rate for Payer: IEHP Medicare Advantage |
$16,444.20
|
| Rate for Payer: Innovage PACE Commercial |
$24,666.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,444.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,035.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,035.23
|
| Rate for Payer: Multiplan WC |
$23,145.37
|
| Rate for Payer: Preferred Health Network WC |
$23,617.72
|
| Rate for Payer: Prime Health Services Medicare |
$17,430.85
|
| Rate for Payer: Prime Health Services WC |
$22,331.16
|
| 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 305: HYPERTENSION WITHOUT MCC
|
Facility
IP
|
$19,831.37
|
|
|
Service Code
|
MS-DRG 305
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$19,831.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19,831.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,675.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,570.36
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$15,708.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,000.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11,111.14
|
| Rate for Payer: IEHP Medicare Advantage |
$11,111.14
|
| Rate for Payer: Innovage PACE Commercial |
$16,666.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,111.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,888.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,888.93
|
| Rate for Payer: Multiplan WC |
$15,708.34
|
| Rate for Payer: Preferred Health Network WC |
$16,028.92
|
| Rate for Payer: Prime Health Services Medicare |
$11,777.81
|
| Rate for Payer: Prime Health Services WC |
$15,155.76
|
| 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
|
|
|
INPATIENT MS-DRG 306: CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC
|
Facility
IP
|
$40,447.04
|
|
|
Service Code
|
MS-DRG 306
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$40,447.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40,447.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25,090.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,819.13
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$31,092.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$29,259.13
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21,673.43
|
| Rate for Payer: IEHP Medicare Advantage |
$21,673.43
|
| Rate for Payer: Innovage PACE Commercial |
$32,510.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,673.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,042.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,042.40
|
| Rate for Payer: Multiplan WC |
$31,092.23
|
| Rate for Payer: Preferred Health Network WC |
$31,726.77
|
| Rate for Payer: Prime Health Services Medicare |
$22,973.84
|
| Rate for Payer: Prime Health Services WC |
$29,998.47
|
| 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 307: CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC
|
Facility
IP
|
$24,808.29
|
|
|
Service Code
|
MS-DRG 307
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$24,808.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,808.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15,494.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19,032.77
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$19,201.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,442.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,661.04
|
| Rate for Payer: IEHP Medicare Advantage |
$13,661.04
|
| Rate for Payer: Innovage PACE Commercial |
$20,491.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,661.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,305.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,305.79
|
| Rate for Payer: Multiplan WC |
$19,201.42
|
| Rate for Payer: Preferred Health Network WC |
$19,593.29
|
| Rate for Payer: Prime Health Services Medicare |
$14,480.70
|
| Rate for Payer: Prime Health Services WC |
$18,525.95
|
| 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 308: CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC
|
Facility
IP
|
$31,640.70
|
|
|
Service Code
|
MS-DRG 308
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$31,640.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31,640.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19,935.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24,487.41
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$24,704.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,168.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17,161.57
|
| Rate for Payer: IEHP Medicare Advantage |
$17,161.57
|
| Rate for Payer: Innovage PACE Commercial |
$25,742.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,161.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,996.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,996.50
|
| Rate for Payer: Multiplan WC |
$24,704.40
|
| Rate for Payer: Preferred Health Network WC |
$25,208.57
|
| Rate for Payer: Prime Health Services Medicare |
$18,191.26
|
| Rate for Payer: Prime Health Services WC |
$23,835.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 309: CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC
|
Facility
IP
|
$19,599.76
|
|
|
Service Code
|
MS-DRG 309
|
| 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 |
$12,539.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,403.30
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$15,539.79
|
| 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 |
$15,539.79
|
| Rate for Payer: Preferred Health Network WC |
$15,856.93
|
| Rate for Payer: Prime Health Services Medicare |
$11,652.03
|
| Rate for Payer: Prime Health Services WC |
$14,993.13
|
| 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 310: CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC
|
Facility
IP
|
$14,554.41
|
|
|
Service Code
|
MS-DRG 310
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$14,554.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14,554.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9,370.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,510.71
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,612.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,350.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,407.53
|
| Rate for Payer: IEHP Medicare Advantage |
$8,407.53
|
| Rate for Payer: Innovage PACE Commercial |
$12,611.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,407.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,266.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,266.09
|
| Rate for Payer: Multiplan WC |
$11,612.71
|
| Rate for Payer: Preferred Health Network WC |
$11,849.70
|
| Rate for Payer: Prime Health Services Medicare |
$8,911.98
|
| Rate for Payer: Prime Health Services WC |
$11,204.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 311: ANGINA PECTORIS
|
Facility
IP
|
$18,373.29
|
|
|
Service Code
|
MS-DRG 311
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$18,373.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18,373.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,358.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,951.93
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,075.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,991.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$10,364.12
|
| Rate for Payer: IEHP Medicare Advantage |
$10,364.12
|
| Rate for Payer: Innovage PACE Commercial |
$15,546.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,364.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,887.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,887.92
|
| Rate for Payer: Multiplan WC |
$14,075.56
|
| Rate for Payer: Preferred Health Network WC |
$14,362.82
|
| Rate for Payer: Prime Health Services Medicare |
$10,985.97
|
| Rate for Payer: Prime Health Services WC |
$13,580.42
|
| 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 312: SYNCOPE AND COLLAPSE
|
Facility
IP
|
$22,726.46
|
|
|
Service Code
|
MS-DRG 312
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$22,726.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,726.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14,496.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,806.93
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$17,964.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,002.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12,594.43
|
| Rate for Payer: IEHP Medicare Advantage |
$12,594.43
|
| Rate for Payer: Innovage PACE Commercial |
$18,891.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,594.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,876.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,876.54
|
| Rate for Payer: Multiplan WC |
$17,964.72
|
| Rate for Payer: Preferred Health Network WC |
$18,331.35
|
| Rate for Payer: Prime Health Services Medicare |
$13,350.10
|
| Rate for Payer: Prime Health Services WC |
$17,332.77
|
| 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 313: CHEST PAIN
|
Facility
IP
|
$19,044.43
|
|
|
Service Code
|
MS-DRG 313
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$19,044.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19,044.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,298.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,106.76
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$15,240.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,455.75
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$10,707.96
|
| Rate for Payer: IEHP Medicare Advantage |
$10,707.96
|
| Rate for Payer: Innovage PACE Commercial |
$16,061.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,707.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,348.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,348.67
|
| Rate for Payer: Multiplan WC |
$15,240.63
|
| Rate for Payer: Preferred Health Network WC |
$15,551.66
|
| Rate for Payer: Prime Health Services Medicare |
$11,350.44
|
| Rate for Payer: Prime Health Services WC |
$14,704.49
|
| 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
|
|
|
INPATIENT MS-DRG 314: OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC
|
Facility
IP
|
$55,098.83
|
|
|
Service Code
|
MS-DRG 314
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$55,098.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55,098.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35,406.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43,490.94
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$43,876.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$39,393.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29,180.16
|
| Rate for Payer: IEHP Medicare Advantage |
$29,180.16
|
| Rate for Payer: Innovage PACE Commercial |
$43,770.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,180.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,101.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39,101.41
|
| Rate for Payer: Multiplan WC |
$43,876.32
|
| Rate for Payer: Preferred Health Network WC |
$44,771.76
|
| Rate for Payer: Prime Health Services Medicare |
$30,930.97
|
| Rate for Payer: Prime Health Services WC |
$42,332.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,486.00
|
|
|
INPATIENT MS-DRG 315: OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC
|
Facility
IP
|
$25,458.37
|
|
|
Service Code
|
MS-DRG 315
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$25,458.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,458.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16,465.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20,225.19
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$20,404.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,892.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,994.09
|
| Rate for Payer: IEHP Medicare Advantage |
$13,994.09
|
| Rate for Payer: Innovage PACE Commercial |
$20,991.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,994.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,752.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,752.08
|
| Rate for Payer: Multiplan WC |
$20,404.40
|
| Rate for Payer: Preferred Health Network WC |
$20,820.82
|
| Rate for Payer: Prime Health Services Medicare |
$14,833.74
|
| Rate for Payer: Prime Health Services WC |
$19,686.63
|
| 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 316: OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC
|
Facility
IP
|
$18,231.17
|
|
|
Service Code
|
MS-DRG 316
|
| Min. Negotiated Rate |
$6,486.00 |
| Max. Negotiated Rate |
$18,231.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18,231.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,594.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,242.21
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,368.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,893.26
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$10,291.30
|
| Rate for Payer: IEHP Medicare Advantage |
$10,291.30
|
| Rate for Payer: Innovage PACE Commercial |
$15,436.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,291.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,790.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,790.34
|
| Rate for Payer: Multiplan WC |
$14,368.41
|
| Rate for Payer: Preferred Health Network WC |
$14,661.64
|
| Rate for Payer: Prime Health Services Medicare |
$10,908.78
|
| Rate for Payer: Prime Health Services WC |
$13,862.96
|
| 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 319: OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC
|
Facility
IP
|
$114,800.85
|
|
|
Service Code
|
MS-DRG 319
|
| Min. Negotiated Rate |
$53,798.00 |
| Max. Negotiated Rate |
$114,800.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$114,800.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73,216.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89,934.73
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$90,731.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$80,686.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59,768.03
|
| Rate for Payer: IEHP Medicare Advantage |
$59,768.03
|
| Rate for Payer: Innovage PACE Commercial |
$89,652.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59,768.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80,089.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80,089.16
|
| Rate for Payer: Multiplan WC |
$90,731.67
|
| Rate for Payer: Preferred Health Network WC |
$92,583.34
|
| Rate for Payer: Prime Health Services Medicare |
$63,354.11
|
| Rate for Payer: Prime Health Services WC |
$87,539.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$81,709.00
|
| Rate for Payer: United Healthcare All Other HMO |
$73,964.00
|
| Rate for Payer: United Healthcare HMO Rider |
$58,833.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53,798.00
|
|
|
INPATIENT MS-DRG 320: OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC
|
Facility
IP
|
$58,586.09
|
|
|
Service Code
|
MS-DRG 320
|
| Min. Negotiated Rate |
$30,800.00 |
| Max. Negotiated Rate |
$58,586.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$58,586.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42,016.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51,610.25
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$52,067.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$41,805.23
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30,966.84
|
| Rate for Payer: IEHP Medicare Advantage |
$30,966.84
|
| Rate for Payer: Innovage PACE Commercial |
$46,450.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,966.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41,495.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,495.57
|
| Rate for Payer: Multiplan WC |
$52,067.59
|
| Rate for Payer: Preferred Health Network WC |
$53,130.19
|
| Rate for Payer: Prime Health Services Medicare |
$32,824.85
|
| Rate for Payer: Prime Health Services WC |
$50,235.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$46,777.00
|
| Rate for Payer: United Healthcare All Other HMO |
$42,347.00
|
| Rate for Payer: United Healthcare HMO Rider |
$33,682.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,800.00
|
|
|
INPATIENT MS-DRG 321: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES
|
Facility
IP
|
$75,659.23
|
|
|
Service Code
|
MS-DRG 321
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$75,659.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$75,659.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$53,614.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$39,714.13
|
| Rate for Payer: IEHP Medicare Advantage |
$39,714.13
|
| Rate for Payer: Innovage PACE Commercial |
$59,571.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39,714.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53,216.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53,216.93
|
| Rate for Payer: Prime Health Services Medicare |
$42,096.98
|
| 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 322: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
IP
|
$47,990.06
|
|
|
Service Code
|
MS-DRG 322
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$47,990.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47,990.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,476.38
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25,538.06
|
| Rate for Payer: IEHP Medicare Advantage |
$25,538.06
|
| Rate for Payer: Innovage PACE Commercial |
$38,307.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,538.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34,221.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34,221.00
|
| Rate for Payer: Prime Health Services Medicare |
$27,070.34
|
| 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 323: CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC
|
Facility
IP
|
$108,960.66
|
|
|
Service Code
|
MS-DRG 323
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$108,960.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$108,960.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$76,647.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$56,775.86
|
| Rate for Payer: IEHP Medicare Advantage |
$56,775.86
|
| Rate for Payer: Innovage PACE Commercial |
$85,163.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56,775.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76,079.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76,079.65
|
| Rate for Payer: Prime Health Services Medicare |
$60,182.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,192.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,235.00
|
|
|
INPATIENT MS-DRG 324: CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
IP
|
$78,130.58
|
|
|
Service Code
|
MS-DRG 324
|
| Min. Negotiated Rate |
$7,235.00 |
| Max. Negotiated Rate |
$78,130.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$78,130.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$55,323.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$40,980.32
|
| Rate for Payer: IEHP Medicare Advantage |
$40,980.32
|
| Rate for Payer: Innovage PACE Commercial |
$61,470.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40,980.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54,913.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54,913.63
|
| Rate for Payer: Prime Health Services Medicare |
$43,439.14
|
| 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
|
|
