|
OTHER MALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES
|
Facility
|
IP
|
$33,600.72
|
|
|
Service Code
|
APR-DRG 4843
|
| Min. Negotiated Rate |
$21,221.51 |
| Max. Negotiated Rate |
$33,600.72 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,221.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25,288.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33,600.72
|
|
|
OTHER MALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES
|
Facility
|
IP
|
$21,771.38
|
|
|
Service Code
|
APR-DRG 4842
|
| Min. Negotiated Rate |
$13,750.34 |
| Max. Negotiated Rate |
$21,771.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,750.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16,385.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21,771.38
|
|
|
OTHER MALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES
|
Facility
|
IP
|
$17,809.46
|
|
|
Service Code
|
APR-DRG 4841
|
| Min. Negotiated Rate |
$11,248.08 |
| Max. Negotiated Rate |
$17,809.46 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,248.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,403.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,809.46
|
|
|
OTHER MALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES
|
Facility
|
IP
|
$58,238.29
|
|
|
Service Code
|
APR-DRG 4844
|
| Min. Negotiated Rate |
$36,782.08 |
| Max. Negotiated Rate |
$58,238.29 |
| Rate for Payer: Adventist Health Medi-Cal |
$36,782.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43,831.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58,238.29
|
|
|
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC
|
Facility
|
IP
|
$27,863.93
|
|
|
Service Code
|
MSDRG 729
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$27,863.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27,863.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17,998.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25,199.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,580.36
|
| Rate for Payer: EPIC Health Plan Senior |
$17,053.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15,503.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,704.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,774.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15,503.25
|
| Rate for Payer: Prime Health Services Medicare |
$16,433.44
|
| 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
|
|
|
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC
|
Facility
|
IP
|
$17,686.37
|
|
|
Service Code
|
MSDRG 730
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$17,686.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17,686.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,424.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,994.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,780.27
|
| Rate for Payer: EPIC Health Plan Senior |
$11,186.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,169.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,237.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13,627.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10,169.86
|
| Rate for Payer: Prime Health Services Medicare |
$10,780.05
|
| 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
|
|
|
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC
|
Facility
|
IP
|
$49,756.07
|
|
|
Service Code
|
MSDRG 717
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$49,756.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49,756.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32,140.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44,997.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$44,509.53
|
| Rate for Payer: EPIC Health Plan Senior |
$29,673.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26,975.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37,765.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36,147.13
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$26,975.47
|
| Rate for Payer: Prime Health Services Medicare |
$28,594.00
|
| 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
|
|
|
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$35,349.05
|
|
|
Service Code
|
MSDRG 718
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$35,349.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35,349.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22,834.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,968.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,052.40
|
| Rate for Payer: EPIC Health Plan Senior |
$21,368.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19,425.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,195.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26,030.44
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19,425.70
|
| Rate for Payer: Prime Health Services Medicare |
$20,591.24
|
| 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
|
|
|
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC
|
Facility
|
IP
|
$58,883.50
|
|
|
Service Code
|
MSDRG 715
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$58,883.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$58,883.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38,036.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53,252.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$52,401.59
|
| Rate for Payer: EPIC Health Plan Senior |
$34,934.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31,758.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44,461.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42,556.44
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$31,758.54
|
| Rate for Payer: Prime Health Services Medicare |
$33,664.05
|
| 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
|
|
|
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$38,715.25
|
|
|
Service Code
|
MSDRG 716
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$38,715.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$38,715.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25,008.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35,012.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,963.00
|
| Rate for Payer: EPIC Health Plan Senior |
$23,308.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,189.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29,665.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28,394.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21,189.70
|
| Rate for Payer: Prime Health Services Medicare |
$22,461.08
|
| 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
|
|
|
OTHER MENTAL DISORDER DIAGNOSES
|
Facility
|
IP
|
$28,185.02
|
|
|
Service Code
|
MSDRG 887
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$28,185.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$28,185.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18,206.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25,489.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,857.97
|
| Rate for Payer: EPIC Health Plan Senior |
$17,238.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15,671.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,940.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,999.81
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15,671.50
|
| Rate for Payer: Prime Health Services Medicare |
$16,611.79
|
| 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
|
|
|
OTHER MENTAL HEALTH CONDITIONS AND DISORDERS
|
Facility
|
IP
|
$22,677.77
|
|
|
Service Code
|
APR-DRG 7604
|
| Min. Negotiated Rate |
$14,322.80 |
| Max. Negotiated Rate |
$22,677.77 |
| Rate for Payer: Adventist Health Medi-Cal |
$14,322.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17,068.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22,677.77
|
|
|
OTHER MENTAL HEALTH CONDITIONS AND DISORDERS
|
Facility
|
IP
|
$6,090.91
|
|
|
Service Code
|
APR-DRG 7601
|
| Min. Negotiated Rate |
$3,846.89 |
| Max. Negotiated Rate |
$6,090.91 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,846.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,584.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,090.91
|
|
|
OTHER MENTAL HEALTH CONDITIONS AND DISORDERS
|
Facility
|
IP
|
$11,265.37
|
|
|
Service Code
|
APR-DRG 7603
|
| Min. Negotiated Rate |
$7,114.97 |
| Max. Negotiated Rate |
$11,265.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,114.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,478.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,265.37
|
|
|
OTHER MENTAL HEALTH CONDITIONS AND DISORDERS
|
Facility
|
IP
|
$8,284.36
|
|
|
Service Code
|
APR-DRG 7602
|
| Min. Negotiated Rate |
$5,232.23 |
| Max. Negotiated Rate |
$8,284.36 |
| Rate for Payer: Adventist Health Medi-Cal |
$5,232.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,235.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,284.36
|
|
|
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC
|
Facility
|
IP
|
$40,336.50
|
|
|
Service Code
|
MSDRG 964
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$40,336.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40,336.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26,055.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36,478.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,364.81
|
| Rate for Payer: EPIC Health Plan Senior |
$24,243.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,039.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,854.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29,532.64
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,039.28
|
| Rate for Payer: Prime Health Services Medicare |
$23,361.64
|
| 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
|
|
|
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC
|
Facility
|
IP
|
$71,950.88
|
|
|
Service Code
|
MSDRG 963
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$71,950.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$71,950.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46,477.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65,069.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$63,700.39
|
| Rate for Payer: EPIC Health Plan Senior |
$42,466.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38,606.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54,048.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51,732.44
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$38,606.30
|
| Rate for Payer: Prime Health Services Medicare |
$40,922.68
|
| 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
|
|
|
OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC
|
Facility
|
IP
|
$24,753.02
|
|
|
Service Code
|
MSDRG 965
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$24,753.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24,753.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15,989.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,385.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,890.48
|
| Rate for Payer: EPIC Health Plan Senior |
$15,260.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,873.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,422.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,589.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,873.02
|
| Rate for Payer: Prime Health Services Medicare |
$14,705.40
|
| 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
|
|
|
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES
|
Facility
|
IP
|
$15,348.12
|
|
|
Service Code
|
APR-DRG 3513
|
| Min. Negotiated Rate |
$9,693.55 |
| Max. Negotiated Rate |
$15,348.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$9,693.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,551.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,348.12
|
|
|
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES
|
Facility
|
IP
|
$7,913.75
|
|
|
Service Code
|
APR-DRG 3511
|
| Min. Negotiated Rate |
$4,998.16 |
| Max. Negotiated Rate |
$7,913.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,998.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,956.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,913.75
|
|
|
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES
|
Facility
|
IP
|
$27,149.27
|
|
|
Service Code
|
APR-DRG 3514
|
| Min. Negotiated Rate |
$17,146.91 |
| Max. Negotiated Rate |
$27,149.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,146.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20,433.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27,149.27
|
|
|
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES
|
Facility
|
IP
|
$10,469.76
|
|
|
Service Code
|
APR-DRG 3512
|
| Min. Negotiated Rate |
$6,612.48 |
| Max. Negotiated Rate |
$10,469.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,612.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,879.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,469.76
|
|
|
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC
|
Facility
|
IP
|
$25,645.23
|
|
|
Service Code
|
MSDRG 565
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$25,645.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25,645.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16,565.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23,192.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,661.92
|
| Rate for Payer: EPIC Health Plan Senior |
$15,774.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,340.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,076.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,216.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,340.56
|
| Rate for Payer: Prime Health Services Medicare |
$15,200.99
|
| 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
|
|
|
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC
|
Facility
|
IP
|
$40,626.01
|
|
|
Service Code
|
MSDRG 564
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$40,626.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40,626.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26,242.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36,740.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,615.17
|
| Rate for Payer: EPIC Health Plan Senior |
$24,410.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,191.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,067.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29,735.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,191.01
|
| Rate for Payer: Prime Health Services Medicare |
$23,522.47
|
| 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
|
|
|
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC
|
Facility
|
IP
|
$19,720.83
|
|
|
Service Code
|
MSDRG 566
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$19,720.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19,720.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,738.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,834.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,539.38
|
| Rate for Payer: EPIC Health Plan Senior |
$12,359.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,235.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,730.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,056.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11,235.99
|
| Rate for Payer: Prime Health Services Medicare |
$11,910.15
|
| 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
|
|
