|
MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$42,015.65
|
|
|
Service Code
|
MSDRG 142
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$42,015.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42,015.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27,140.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37,997.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,816.75
|
| Rate for Payer: EPIC Health Plan Senior |
$25,211.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,919.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32,086.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30,711.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,919.24
|
| Rate for Payer: Prime Health Services Medicare |
$24,294.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC
|
Facility
|
IP
|
$33,317.22
|
|
|
Service Code
|
MSDRG 809
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$33,317.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$33,317.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21,521.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,130.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,295.58
|
| Rate for Payer: EPIC Health Plan Senior |
$20,197.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18,360.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25,705.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24,603.69
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18,360.96
|
| Rate for Payer: Prime Health Services Medicare |
$19,462.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC
|
Facility
|
IP
|
$58,109.72
|
|
|
Service Code
|
MSDRG 808
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$58,109.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$58,109.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37,536.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52,552.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$51,732.55
|
| Rate for Payer: EPIC Health Plan Senior |
$34,488.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,353.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43,894.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42,013.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$31,353.06
|
| Rate for Payer: Prime Health Services Medicare |
$33,234.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$27,545.47
|
|
|
Service Code
|
MSDRG 810
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$27,545.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,545.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17,793.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24,911.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,304.98
|
| Rate for Payer: EPIC Health Plan Senior |
$16,869.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15,336.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,470.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,550.71
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15,336.35
|
| Rate for Payer: Prime Health Services Medicare |
$16,256.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
MAJOR HEMATOLOGIC OR IMMUNOLOGIC DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION
|
Facility
|
IP
|
$34,482.93
|
|
|
Service Code
|
APR-DRG 6604
|
| Min. Negotiated Rate |
$21,778.69 |
| Max. Negotiated Rate |
$34,482.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,778.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25,952.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34,482.93
|
|
|
MAJOR HEMATOLOGIC OR IMMUNOLOGIC DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION
|
Facility
|
IP
|
$9,372.03
|
|
|
Service Code
|
APR-DRG 6601
|
| Min. Negotiated Rate |
$5,919.18 |
| Max. Negotiated Rate |
$9,372.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,919.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,053.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,372.03
|
|
|
MAJOR HEMATOLOGIC OR IMMUNOLOGIC DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION
|
Facility
|
IP
|
$18,844.77
|
|
|
Service Code
|
APR-DRG 6603
|
| Min. Negotiated Rate |
$11,901.96 |
| Max. Negotiated Rate |
$18,844.77 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,901.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,183.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,844.77
|
|
|
MAJOR HEMATOLOGIC OR IMMUNOLOGIC DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION
|
Facility
|
IP
|
$12,141.53
|
|
|
Service Code
|
APR-DRG 6602
|
| Min. Negotiated Rate |
$7,668.34 |
| Max. Negotiated Rate |
$12,141.53 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,668.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9,138.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,141.53
|
|
|
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT
|
Facility
|
IP
|
$79,830.79
|
|
|
Service Code
|
MSDRG 469
|
| Min. Negotiated Rate |
$23,506.00 |
| Max. Negotiated Rate |
$79,830.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$79,830.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51,567.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72,196.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$70,513.82
|
| Rate for Payer: EPIC Health Plan Senior |
$47,009.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42,735.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59,829.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57,265.77
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42,735.65
|
| Rate for Payer: Prime Health Services Medicare |
$45,299.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$41,904.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41,904.00
|
| Rate for Payer: United Healthcare HMO Rider |
$34,363.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31,483.00
|
|
|
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC
|
Facility
|
IP
|
$53,685.00
|
|
|
Service Code
|
MSDRG 470
|
| Min. Negotiated Rate |
$23,467.00 |
| Max. Negotiated Rate |
$53,685.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$50,766.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32,793.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,911.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,383.38
|
| Rate for Payer: EPIC Health Plan Senior |
$30,255.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27,505.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38,507.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36,856.81
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$27,505.08
|
| Rate for Payer: Prime Health Services Medicare |
$29,155.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$53,685.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53,685.00
|
| Rate for Payer: United Healthcare HMO Rider |
$25,615.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23,467.00
|
|
|
MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES
|
Facility
|
IP
|
$72,953.64
|
|
|
Service Code
|
MSDRG 483
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$72,953.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$72,953.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47,125.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65,976.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$64,567.42
|
| Rate for Payer: EPIC Health Plan Senior |
$43,044.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$39,131.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54,784.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$52,436.57
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$39,131.77
|
| Rate for Payer: Prime Health Services Medicare |
$41,479.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
MAJOR LARGE BOWEL PROCEDURES
|
Facility
|
IP
|
$30,283.34
|
|
|
Service Code
|
APR-DRG 2312
|
| Min. Negotiated Rate |
$19,126.32 |
| Max. Negotiated Rate |
$30,283.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,126.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22,792.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30,283.34
|
|
|
MAJOR LARGE BOWEL PROCEDURES
|
Facility
|
IP
|
$24,317.32
|
|
|
Service Code
|
APR-DRG 2311
|
| Min. Negotiated Rate |
$15,358.31 |
| Max. Negotiated Rate |
$24,317.32 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,358.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18,301.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24,317.32
|
|
|
MAJOR LARGE BOWEL PROCEDURES
|
Facility
|
IP
|
$64,911.30
|
|
|
Service Code
|
APR-DRG 2314
|
| Min. Negotiated Rate |
$40,996.61 |
| Max. Negotiated Rate |
$64,911.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$40,996.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$48,854.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64,911.30
|
|
|
MAJOR LARGE BOWEL PROCEDURES
|
Facility
|
IP
|
$42,813.63
|
|
|
Service Code
|
APR-DRG 2313
|
| Min. Negotiated Rate |
$27,040.19 |
| Max. Negotiated Rate |
$42,813.63 |
| Rate for Payer: Adventist Health Medi-Cal |
$27,040.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32,222.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42,813.63
|
|
|
MAJOR MALE PELVIC PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$52,645.90
|
|
|
Service Code
|
MSDRG 707
|
| Min. Negotiated Rate |
$22,398.00 |
| Max. Negotiated Rate |
$52,645.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52,645.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34,007.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,611.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$47,008.24
|
| Rate for Payer: EPIC Health Plan Senior |
$31,338.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,489.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39,885.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$38,176.39
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$28,489.84
|
| Rate for Payer: Prime Health Services Medicare |
$30,199.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$24,996.00
|
| Rate for Payer: United Healthcare All Other HMO |
$24,996.00
|
| Rate for Payer: United Healthcare HMO Rider |
$24,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22,398.00
|
|
|
MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$40,378.61
|
|
|
Service Code
|
MSDRG 708
|
| Min. Negotiated Rate |
$22,061.35 |
| Max. Negotiated Rate |
$40,378.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40,378.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26,082.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36,517.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,401.23
|
| Rate for Payer: EPIC Health Plan Senior |
$24,267.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,061.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,885.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29,562.21
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,061.35
|
| Rate for Payer: Prime Health Services Medicare |
$23,385.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$24,996.00
|
| Rate for Payer: United Healthcare All Other HMO |
$24,996.00
|
| Rate for Payer: United Healthcare HMO Rider |
$24,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22,398.00
|
|
|
MAJOR O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS
|
Facility
|
IP
|
$33,715.52
|
|
|
Service Code
|
APR-DRG 6802
|
| Min. Negotiated Rate |
$21,294.01 |
| Max. Negotiated Rate |
$33,715.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,294.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25,375.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33,715.52
|
|
|
MAJOR O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS
|
Facility
|
IP
|
$100,685.33
|
|
|
Service Code
|
APR-DRG 6804
|
| Min. Negotiated Rate |
$63,590.74 |
| Max. Negotiated Rate |
$100,685.33 |
| Rate for Payer: Adventist Health Medi-Cal |
$63,590.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$75,778.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$100,685.33
|
|
|
MAJOR O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS
|
Facility
|
IP
|
$53,450.55
|
|
|
Service Code
|
APR-DRG 6803
|
| Min. Negotiated Rate |
$33,758.24 |
| Max. Negotiated Rate |
$53,450.55 |
| Rate for Payer: Adventist Health Medi-Cal |
$33,758.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40,228.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53,450.55
|
|
|
MAJOR O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS
|
Facility
|
IP
|
$24,613.40
|
|
|
Service Code
|
APR-DRG 6801
|
| Min. Negotiated Rate |
$15,545.30 |
| Max. Negotiated Rate |
$24,613.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$15,545.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18,524.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24,613.40
|
|
|
MAJOR PANCREAS, LIVER AND SHUNT PROCEDURES
|
Facility
|
IP
|
$89,226.60
|
|
|
Service Code
|
APR-DRG 2604
|
| Min. Negotiated Rate |
$56,353.64 |
| Max. Negotiated Rate |
$89,226.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$56,353.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67,154.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89,226.60
|
|
|
MAJOR PANCREAS, LIVER AND SHUNT PROCEDURES
|
Facility
|
IP
|
$27,409.10
|
|
|
Service Code
|
APR-DRG 2601
|
| Min. Negotiated Rate |
$17,311.01 |
| Max. Negotiated Rate |
$27,409.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,311.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20,628.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27,409.10
|
|
|
MAJOR PANCREAS, LIVER AND SHUNT PROCEDURES
|
Facility
|
IP
|
$38,954.43
|
|
|
Service Code
|
APR-DRG 2602
|
| Min. Negotiated Rate |
$24,602.80 |
| Max. Negotiated Rate |
$38,954.43 |
| Rate for Payer: Adventist Health Medi-Cal |
$24,602.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29,318.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38,954.43
|
|
|
MAJOR PANCREAS, LIVER AND SHUNT PROCEDURES
|
Facility
|
IP
|
$51,249.04
|
|
|
Service Code
|
APR-DRG 2603
|
| Min. Negotiated Rate |
$32,367.82 |
| Max. Negotiated Rate |
$51,249.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$32,367.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38,571.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51,249.04
|
|
