|
INPATIENT MS-DRG 964: OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC
|
Facility
IP
|
$23,901.42
|
|
|
Service Code
|
MS-DRG 964
|
| Min. Negotiated Rate |
$17,106.31 |
| Max. Negotiated Rate |
$23,901.42 |
| Rate for Payer: EPIC Health Plan Medicare |
$17,106.31
|
| Rate for Payer: Humana Medicare |
$17,106.31
|
| Rate for Payer: IEHP Medicare Advantage |
$17,106.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,185.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,553.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,553.95
|
| Rate for Payer: Multiplan WC |
$23,901.42
|
|
|
INPATIENT MS-DRG 965: OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC
|
Facility
IP
|
$14,850.05
|
|
|
Service Code
|
MS-DRG 965
|
| Min. Negotiated Rate |
$10,968.26 |
| Max. Negotiated Rate |
$14,850.05 |
| Rate for Payer: EPIC Health Plan Medicare |
$10,968.26
|
| Rate for Payer: Humana Medicare |
$10,968.26
|
| Rate for Payer: IEHP Medicare Advantage |
$10,968.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,942.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,820.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,820.01
|
| Rate for Payer: Multiplan WC |
$14,850.05
|
|
|
INPATIENT MS-DRG 969: HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC
|
Facility
IP
|
$118,284.66
|
|
|
Service Code
|
MS-DRG 969
|
| Min. Negotiated Rate |
$77,592.95 |
| Max. Negotiated Rate |
$118,284.66 |
| Rate for Payer: EPIC Health Plan Medicare |
$77,592.95
|
| Rate for Payer: Humana Medicare |
$77,592.95
|
| Rate for Payer: IEHP Medicare Advantage |
$77,592.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91,559.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$97,767.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$97,767.12
|
| Rate for Payer: Multiplan WC |
$118,284.66
|
|
|
INPATIENT MS-DRG 970: HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC
|
Facility
IP
|
$50,404.32
|
|
|
Service Code
|
MS-DRG 970
|
| Min. Negotiated Rate |
$31,503.93 |
| Max. Negotiated Rate |
$50,404.32 |
| Rate for Payer: EPIC Health Plan Medicare |
$31,503.93
|
| Rate for Payer: Humana Medicare |
$31,503.93
|
| Rate for Payer: IEHP Medicare Advantage |
$31,503.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37,174.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,694.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39,694.95
|
| Rate for Payer: Multiplan WC |
$50,404.32
|
|
|
INPATIENT MS-DRG 974: HIV WITH MAJOR RELATED CONDITION WITH MCC
|
Facility
IP
|
$46,888.87
|
|
|
Service Code
|
MS-DRG 974
|
| Min. Negotiated Rate |
$33,045.48 |
| Max. Negotiated Rate |
$46,888.87 |
| Rate for Payer: EPIC Health Plan Medicare |
$33,045.48
|
| Rate for Payer: Humana Medicare |
$33,045.48
|
| Rate for Payer: IEHP Medicare Advantage |
$33,045.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38,993.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41,637.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,637.30
|
| Rate for Payer: Multiplan WC |
$46,888.87
|
|
|
INPATIENT MS-DRG 975: HIV WITH MAJOR RELATED CONDITION WITH CC
|
Facility
IP
|
$22,452.15
|
|
|
Service Code
|
MS-DRG 975
|
| Min. Negotiated Rate |
$15,555.76 |
| Max. Negotiated Rate |
$22,452.15 |
| Rate for Payer: EPIC Health Plan Medicare |
$15,555.76
|
| Rate for Payer: Humana Medicare |
$15,555.76
|
| Rate for Payer: IEHP Medicare Advantage |
$15,555.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,355.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,600.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,600.26
|
| Rate for Payer: Multiplan WC |
$22,452.15
|
|
|
INPATIENT MS-DRG 976: HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC
|
Facility
IP
|
$15,060.58
|
|
|
Service Code
|
MS-DRG 976
|
| Min. Negotiated Rate |
$9,722.85 |
| Max. Negotiated Rate |
$15,060.58 |
| Rate for Payer: EPIC Health Plan Medicare |
$9,722.85
|
| Rate for Payer: Humana Medicare |
$9,722.85
|
| Rate for Payer: IEHP Medicare Advantage |
$9,722.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,472.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,250.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,250.79
|
| Rate for Payer: Multiplan WC |
$15,060.58
|
|
|
INPATIENT MS-DRG 977: HIV WITH OR WITHOUT OTHER RELATED CONDITION
|
Facility
IP
|
$21,215.05
|
|
|
Service Code
|
MS-DRG 977
|
| Min. Negotiated Rate |
$16,150.31 |
| Max. Negotiated Rate |
$21,215.05 |
| Rate for Payer: EPIC Health Plan Medicare |
$16,150.31
|
| Rate for Payer: Humana Medicare |
$16,150.31
|
| Rate for Payer: IEHP Medicare Advantage |
$16,150.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,057.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,349.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,349.39
|
| Rate for Payer: Multiplan WC |
$21,215.05
|
|
|
INPATIENT MS-DRG 981: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC
|
Facility
IP
|
$74,754.55
|
|
|
Service Code
|
MS-DRG 981
|
| Min. Negotiated Rate |
$53,583.41 |
| Max. Negotiated Rate |
$74,754.55 |
| Rate for Payer: EPIC Health Plan Medicare |
$53,583.41
|
| Rate for Payer: Humana Medicare |
$53,583.41
|
| Rate for Payer: IEHP Medicare Advantage |
$53,583.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63,228.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67,515.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67,515.10
|
| Rate for Payer: Multiplan WC |
$74,754.55
|
|
|
INPATIENT MS-DRG 982: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC
|
Facility
IP
|
$40,935.15
|
|
|
Service Code
|
MS-DRG 982
|
| Min. Negotiated Rate |
$28,197.85 |
| Max. Negotiated Rate |
$40,935.15 |
| Rate for Payer: EPIC Health Plan Medicare |
$28,197.85
|
| Rate for Payer: Humana Medicare |
$28,197.85
|
| Rate for Payer: IEHP Medicare Advantage |
$28,197.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33,273.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,529.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35,529.29
|
| Rate for Payer: Multiplan WC |
$40,935.15
|
|
|
INPATIENT MS-DRG 983: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC
|
Facility
IP
|
$27,258.54
|
|
|
Service Code
|
MS-DRG 983
|
| Min. Negotiated Rate |
$18,617.47 |
| Max. Negotiated Rate |
$27,258.54 |
| Rate for Payer: EPIC Health Plan Medicare |
$18,617.47
|
| Rate for Payer: Humana Medicare |
$18,617.47
|
| Rate for Payer: IEHP Medicare Advantage |
$18,617.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,968.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23,458.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23,458.01
|
| Rate for Payer: Multiplan WC |
$27,258.54
|
|
|
INPATIENT MS-DRG 987: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC
|
Facility
IP
|
$54,158.04
|
|
|
Service Code
|
MS-DRG 987
|
| Min. Negotiated Rate |
$38,227.55 |
| Max. Negotiated Rate |
$54,158.04 |
| Rate for Payer: EPIC Health Plan Medicare |
$38,227.55
|
| Rate for Payer: Humana Medicare |
$38,227.55
|
| Rate for Payer: IEHP Medicare Advantage |
$38,227.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45,108.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48,166.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48,166.71
|
| Rate for Payer: Multiplan WC |
$54,158.04
|
|
|
INPATIENT MS-DRG 988: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC
|
Facility
IP
|
$27,686.15
|
|
|
Service Code
|
MS-DRG 988
|
| Min. Negotiated Rate |
$19,313.37 |
| Max. Negotiated Rate |
$27,686.15 |
| Rate for Payer: EPIC Health Plan Medicare |
$19,313.37
|
| Rate for Payer: Humana Medicare |
$19,313.37
|
| Rate for Payer: IEHP Medicare Advantage |
$19,313.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,789.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24,334.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24,334.85
|
| Rate for Payer: Multiplan WC |
$27,686.15
|
|
|
INPATIENT MS-DRG 989: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC
|
Facility
IP
|
$17,991.75
|
|
|
Service Code
|
MS-DRG 989
|
| Min. Negotiated Rate |
$12,369.06 |
| Max. Negotiated Rate |
$17,991.75 |
| Rate for Payer: EPIC Health Plan Medicare |
$12,369.06
|
| Rate for Payer: Humana Medicare |
$12,369.06
|
| Rate for Payer: IEHP Medicare Advantage |
$12,369.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,595.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,585.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,585.02
|
| Rate for Payer: Multiplan WC |
$17,991.75
|
|
|
Inpatient Vaginal Delivery
|
Facility
IP
|
$9,404.00
|
|
|
Service Code
|
ICD 10E0XZZ
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$9,404.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,404.00
|
| Rate for Payer: Blue Shield of California EPN |
$8,059.00
|
|
|
Inpatient Vaginal Delivery
|
Facility
IP
|
$9,404.00
|
|
|
Service Code
|
ICD 10D07Z7
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$9,404.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,404.00
|
| Rate for Payer: Blue Shield of California EPN |
$8,059.00
|
|
|
Inpatient Vaginal Delivery
|
Facility
IP
|
$9,404.00
|
|
|
Service Code
|
ICD 10D07Z4
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$9,404.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,404.00
|
| Rate for Payer: Blue Shield of California EPN |
$8,059.00
|
|
|
Inpatient Vaginal Delivery
|
Facility
IP
|
$9,404.00
|
|
|
Service Code
|
ICD 10D07Z6
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$9,404.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,404.00
|
| Rate for Payer: Blue Shield of California EPN |
$8,059.00
|
|
|
Inpatient Vaginal Delivery
|
Facility
IP
|
$9,404.00
|
|
|
Service Code
|
ICD 10D07Z8
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$9,404.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,404.00
|
| Rate for Payer: Blue Shield of California EPN |
$8,059.00
|
|
|
Inpatient Vaginal Delivery
|
Facility
IP
|
$9,404.00
|
|
|
Service Code
|
ICD 10D07Z3
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$9,404.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,404.00
|
| Rate for Payer: Blue Shield of California EPN |
$8,059.00
|
|
|
Inpatient Vaginal Delivery
|
Facility
IP
|
$9,404.00
|
|
|
Service Code
|
ICD 10D07Z5
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$9,404.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,404.00
|
| Rate for Payer: Blue Shield of California EPN |
$8,059.00
|
|
|
Insertion, drug-delivery implant (ie, bioresorbable, biodegradable, non-biodegradable)
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 11981
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: IEHP Medi-Cal |
$65.05
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.56
|
| Rate for Payer: TriValley Medical Group Senior |
$159.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach
|
Facility
OP
|
$9,652.00
|
|
|
Service Code
|
CPT 66183
|
| Min. Negotiated Rate |
$3,728.00 |
| Max. Negotiated Rate |
$9,652.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,620.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,588.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,080.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,620.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,588.00
|
| Rate for Payer: Dignity Health Senior |
$5,080.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$5,080.00
|
| Rate for Payer: Humana Medicare |
$5,080.00
|
| Rate for Payer: IEHP Medicare Advantage |
$5,080.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,652.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,994.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,400.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,400.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,588.00
|
| Rate for Payer: TriValley Medical Group Senior |
$5,080.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,620.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,588.00
|
| Rate for Payer: Vantage Medical Group Senior |
$5,080.00
|
|
|
Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space; initial device
|
Facility
OP
|
$12,407.40
|
|
|
Service Code
|
CPT 0449T
|
| Min. Negotiated Rate |
$3,728.00 |
| Max. Negotiated Rate |
$12,407.40 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,795.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,183.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,530.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,795.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,183.23
|
| Rate for Payer: Dignity Health Senior |
$6,530.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,530.21
|
| Rate for Payer: Humana Medicare |
$6,530.21
|
| Rate for Payer: IEHP Medicare Advantage |
$6,530.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,407.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,705.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,228.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,228.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,183.23
|
| Rate for Payer: TriValley Medical Group Senior |
$6,530.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,795.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,183.23
|
| Rate for Payer: Vantage Medical Group Senior |
$6,530.21
|
|
|
Insertion of breast implant on same day of mastectomy (ie, immediate)
|
Facility
OP
|
$15,480.57
|
|
|
Service Code
|
CPT 19340
|
| Min. Negotiated Rate |
$813.10 |
| Max. Negotiated Rate |
$15,480.57 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,221.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,962.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,147.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,221.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,962.44
|
| Rate for Payer: Dignity Health Senior |
$8,147.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,147.67
|
| Rate for Payer: Humana Medicare |
$8,147.67
|
| Rate for Payer: IEHP Medi-Cal |
$813.10
|
| Rate for Payer: IEHP Medicare Advantage |
$8,147.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15,480.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,614.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,266.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,266.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,962.44
|
| Rate for Payer: TriValley Medical Group Senior |
$8,147.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,221.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,962.44
|
| Rate for Payer: Vantage Medical Group Senior |
$8,147.67
|
|
