|
OSTEOMYELITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$12,792.47
|
|
|
Service Code
|
MSDRG 541
|
| Min. Negotiated Rate |
$9,546.62 |
| Max. Negotiated Rate |
$12,792.47 |
| Rate for Payer: EPIC Health Plan Medicare |
$9,546.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,546.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,978.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,792.47
|
|
|
OSTEOTOMY; CALCANEUS (EG, DWYER OR CHAMBERS TYPE PROCEDURE), WITH OR WITHOUT INTERNAL FIXATION
|
Facility
|
OP
|
$17,732.13
|
|
|
Service Code
|
CPT 28300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,158.00 |
| Max. Negotiated Rate |
$17,732.13 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,332.70
|
| Rate for Payer: Heritage Provider Network Senior |
$11,479.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,732.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,732.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$10,265.97
|
| Rate for Payer: TriValley Medical Group Senior |
$10,265.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
OSTEOTOMY; FIBULA
|
Facility
|
OP
|
$10,001.00
|
|
|
Service Code
|
CPT 27707
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,208.34 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Senior |
$5,176.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,995.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,629.17
|
| Rate for Payer: TriValley Medical Group Senior |
$4,629.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
OSTEOTOMY, SHORTENING, ANGULAR OR ROTATIONAL CORRECTION; PROXIMAL PHALANX, FIRST TOE (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$17,732.13
|
|
|
Service Code
|
CPT 28310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,245.00 |
| Max. Negotiated Rate |
$17,732.13 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,332.70
|
| Rate for Payer: Heritage Provider Network Senior |
$11,479.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,732.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,732.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$10,265.97
|
| Rate for Payer: TriValley Medical Group Senior |
$10,265.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
OSTEOTOMY; TALUS
|
Facility
|
OP
|
$17,732.13
|
|
|
Service Code
|
CPT 28302
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,158.00 |
| Max. Negotiated Rate |
$17,732.13 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,332.70
|
| Rate for Payer: Heritage Provider Network Senior |
$11,479.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,732.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,732.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$10,265.97
|
| Rate for Payer: TriValley Medical Group Senior |
$10,265.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
OSTEOTOMY, TARSAL BONES, OTHER THAN CALCANEUS OR TALUS;
|
Facility
|
OP
|
$17,732.13
|
|
|
Service Code
|
CPT 28304
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,158.00 |
| Max. Negotiated Rate |
$17,732.13 |
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,332.70
|
| Rate for Payer: Heritage Provider Network Senior |
$11,479.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,732.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,732.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$10,265.97
|
| Rate for Payer: TriValley Medical Group Senior |
$10,265.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATARSAL; OTHER THAN FIRST METATARSAL, EACH
|
Facility
|
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 28308
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,208.34 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Senior |
$5,176.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,995.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,629.17
|
| Rate for Payer: TriValley Medical Group Senior |
$4,629.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
OSTOMY ADHESIVE PASTE [115464]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 6845510690
|
| Hospital Charge Code |
901700016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.08
|
| Rate for Payer: Blue Shield of California Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.10
|
| Rate for Payer: Heritage Provider Network Senior |
$0.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Vantage Medical Group Senior |
$0.14
|
|
|
OSTOMY ADHESIVE PASTE [115464]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 6845510690
|
| Hospital Charge Code |
901700016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.10
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.11
|
| Rate for Payer: Heritage Provider Network Senior |
$0.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.12
|
|
|
OSTOMY SUPPLIES POWDER [110541]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 6845510826
|
| Hospital Charge Code |
901700016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.17
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.18
|
| Rate for Payer: Heritage Provider Network Senior |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
|
|
OSTOMY SUPPLIES POWDER [110541]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 6845510826
|
| Hospital Charge Code |
901700016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.13
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.16
|
| Rate for Payer: Heritage Provider Network Senior |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.22
|
| Rate for Payer: Vantage Medical Group Senior |
$0.22
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$18,501.65
|
|
|
Service Code
|
MSDRG 818
|
| Min. Negotiated Rate |
$3,737.00 |
| Max. Negotiated Rate |
$18,501.65 |
| Rate for Payer: EPIC Health Plan Medicare |
$13,807.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,807.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,878.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,501.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,442.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,737.00
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$35,736.62
|
|
|
Service Code
|
MSDRG 817
|
| Min. Negotiated Rate |
$3,737.00 |
| Max. Negotiated Rate |
$35,736.62 |
| Rate for Payer: EPIC Health Plan Medicare |
$26,669.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26,669.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30,669.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35,736.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,442.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,737.00
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$13,905.76
|
|
|
Service Code
|
MSDRG 819
|
| Min. Negotiated Rate |
$3,737.00 |
| Max. Negotiated Rate |
$13,905.76 |
| Rate for Payer: EPIC Health Plan Medicare |
$10,377.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,377.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,934.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13,905.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,442.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,737.00
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$11,782.10
|
|
|
Service Code
|
MSDRG 832
|
| Min. Negotiated Rate |
$3,737.00 |
| Max. Negotiated Rate |
$11,782.10 |
| Rate for Payer: EPIC Health Plan Medicare |
$8,792.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,792.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,111.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,782.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,442.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,737.00
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$19,166.56
|
|
|
Service Code
|
MSDRG 831
|
| Min. Negotiated Rate |
$3,737.00 |
| Max. Negotiated Rate |
$19,166.56 |
| Rate for Payer: EPIC Health Plan Medicare |
$14,303.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,303.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,448.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,166.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,442.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,737.00
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$8,730.98
|
|
|
Service Code
|
MSDRG 833
|
| Min. Negotiated Rate |
$3,737.00 |
| Max. Negotiated Rate |
$8,730.98 |
| Rate for Payer: EPIC Health Plan Medicare |
$6,515.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,515.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,493.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,730.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,442.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,737.00
|
|
|
OTHER CARDIOTHORACIC PROCEDURES WITH MCC
|
Facility
|
IP
|
$76,671.22
|
|
|
Service Code
|
MSDRG 228
|
| Min. Negotiated Rate |
$28,410.00 |
| Max. Negotiated Rate |
$76,671.22 |
| Rate for Payer: EPIC Health Plan Medicare |
$57,217.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57,217.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65,799.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$76,671.22
|
|
|
OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$49,063.63
|
|
|
Service Code
|
MSDRG 229
|
| Min. Negotiated Rate |
$28,410.00 |
| Max. Negotiated Rate |
$49,063.63 |
| Rate for Payer: EPIC Health Plan Medicare |
$36,614.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36,614.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42,106.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49,063.63
|
|
|
OTHER CEREBROVASCULAR DISORDERS WITH CC
|
Facility
|
IP
|
$16,456.30
|
|
|
Service Code
|
MSDRG 071
|
| Min. Negotiated Rate |
$12,280.82 |
| Max. Negotiated Rate |
$16,456.30 |
| Rate for Payer: EPIC Health Plan Medicare |
$12,280.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,280.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,122.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,456.30
|
|
|
OTHER CEREBROVASCULAR DISORDERS WITH MCC
|
Facility
|
IP
|
$26,265.37
|
|
|
Service Code
|
MSDRG 070
|
| Min. Negotiated Rate |
$19,601.02 |
| Max. Negotiated Rate |
$26,265.37 |
| Rate for Payer: EPIC Health Plan Medicare |
$19,601.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19,601.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,541.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26,265.37
|
|
|
OTHER CEREBROVASCULAR DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$12,313.39
|
|
|
Service Code
|
MSDRG 072
|
| Min. Negotiated Rate |
$9,189.10 |
| Max. Negotiated Rate |
$12,313.39 |
| Rate for Payer: EPIC Health Plan Medicare |
$9,189.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,189.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,567.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,313.39
|
|
|
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC
|
Facility
|
IP
|
$15,493.52
|
|
|
Service Code
|
MSDRG 315
|
| Min. Negotiated Rate |
$11,562.33 |
| Max. Negotiated Rate |
$15,493.52 |
| Rate for Payer: EPIC Health Plan Medicare |
$11,562.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,562.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,296.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,493.52
|
|
|
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC
|
Facility
|
IP
|
$32,720.82
|
|
|
Service Code
|
MSDRG 314
|
| Min. Negotiated Rate |
$24,418.52 |
| Max. Negotiated Rate |
$32,720.82 |
| Rate for Payer: EPIC Health Plan Medicare |
$24,418.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24,418.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,081.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32,720.82
|
|
|
OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC
|
Facility
|
IP
|
$11,175.56
|
|
|
Service Code
|
MSDRG 316
|
| Min. Negotiated Rate |
$8,339.97 |
| Max. Negotiated Rate |
$11,175.56 |
| Rate for Payer: EPIC Health Plan Medicare |
$8,339.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,339.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,590.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,175.56
|
|
