Mission Viejo, CA, 92691
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vs nat'l shows this hospital's negotiated median against the national median for that code (green = at/below market, amber = 1–1.5×, red = >1.5× the national median).
| Procedure | Type | Code | Payers | Gross | Cash | Neg min | Neg median | vs nat'l | Neg max |
|---|---|---|---|---|---|---|---|---|---|
| behavioral | |||||||||
| Psychoses | MS-DRG | 885 | 20 | — | — | $13,856 | $13,856 | 1.1× | $33,783 |
| inpatient | |||||||||
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 20 | — | — | $19,705 | $19,705 | 0.98× | $47,675 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 20 | — | — | $10,176 | $10,176 | 0.95× | $24,375 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 20 | — | — | $7,072.52 | $7,072.52 | 0.93× | $16,497 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 20 | — | — | $15,436 | $15,436 | 1.0× | $38,744 |
| COPD w MCC | MS-DRG | 190 | 20 | — | — | $11,103 | $11,103 | 0.99× | $26,923 |
| COPD w CC | MS-DRG | 191 | 20 | — | — | $8,582.74 | $8,582.74 | 0.97× | $20,591 |
| COPD w/o CC/MCC | MS-DRG | 192 | 20 | — | — | $6,668.78 | $6,668.78 | 0.95× | $15,512 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 20 | — | — | $8,229.47 | $8,229.47 | 0.97× | $19,654 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 20 | — | — | $6,540.23 | $6,540.23 | 0.98× | $14,927 |
| AMI discharged alive w MCC | MS-DRG | 280 | 20 | — | — | $15,830 | $15,830 | 1.0× | $39,343 |
| AMI discharged alive w CC | MS-DRG | 281 | 20 | — | — | $9,307.38 | $9,307.38 | 0.96× | $22,094 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 20 | — | — | $7,441.03 | $7,441.03 | 0.95× | $17,379 |
| Heart failure & shock w MCC | MS-DRG | 291 | 20 | — | — | $12,780 | $12,780 | 1.00× | $31,276 |
| Heart failure & shock w CC | MS-DRG | 292 | 20 | — | — | $8,639.88 | $8,639.88 | 0.97× | $20,644 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 20 | — | — | $5,945.09 | $5,945.09 | 0.96× | $13,158 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 20 | — | — | $12,020 | $12,020 | 0.99× | $28,905 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 20 | — | — | $7,561.01 | $7,561.01 | 0.97× | $17,720 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 20 | — | — | $5,946.05 | $5,946.05 | 0.96× | $13,410 |
| GI hemorrhage w CC | MS-DRG | 378 | 20 | — | — | $9,893.95 | $9,893.95 | 0.99× | $23,630 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 20 | — | — | $6,558.32 | $6,558.32 | 0.96× | $15,258 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 20 | — | — | $7,979.03 | $7,979.03 | 0.99× | $18,702 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 20 | — | — | $15,483 | $15,483 | 1.0× | $36,546 |
| Kidney/UTI w MCC | MS-DRG | 689 | 20 | — | — | $11,604 | $11,604 | 1.00× | $28,052 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 20 | — | — | $8,263.75 | $8,263.75 | 0.99× | $19,237 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 20 | — | — | $19,052 | $19,052 | 1.0× | $47,032 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 20 | — | — | $10,300 | $10,300 | 0.99× | $24,711 |
| surgery | |||||||||
| PCI w drug-eluting stent w MCC | MS-DRG | 246 | 4 | — | — | $16,552 | $42,216 | 1.5× | $71,794 |
| PCI w drug-eluting stent w/o MCC | MS-DRG | 247 | 4 | — | — | $16,552 | $26,853 | 1.5× | $45,767 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 20 | — | — | $44,324 | $44,324 | 1.0× | $110,054 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 20 | — | — | $23,382 | $23,382 | 1.0× | $56,653 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 20 | — | — | $16,580 | $16,580 | 1.0× | $39,571 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 20 | — | — | $16,663 | $16,663 | 1.0× | $39,751 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 20 | — | — | $13,561 | $13,561 | 1.0× | $31,580 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 20 | — | — | $32,999 | $32,999 | 1.0× | $84,588 |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 4 | — | — | $10,137 | $90,920 | 1.8× | $158,963 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 4 | — | — | $10,137 | $53,115 | 1.6× | $87,673 |
| Major joint replacement w MCC | MS-DRG | 469 | 20 | — | — | $28,839 | $29,438 | 1.00× | $78,339 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 20 | — | — | $18,923 | $18,923 | 1.0× | $45,192 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 20 | — | — | $10,137 | $28,287 | 1.0× | $70,490 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 20 | — | — | $10,137 | $20,500 | 1.0× | $49,731 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 20 | — | — | $10,137 | $16,086 | 1.0× | $38,023 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 20 | — | — | $28,050 | $28,050 | 1.0× | $65,346 |
| OR procedure for obesity w CC | MS-DRG | 620 | 20 | — | — | $15,794 | $15,794 | 0.97× | $38,275 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 20 | — | — | $14,919 | $14,919 | 0.98× | $35,034 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 20 | — | — | $9,565 | $12,370 | 1.0× | $28,728 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 20 | — | — | $20,067 | $20,067 | 1.0× | $46,831 |
| Payer | Codes covered | Median rate |
|---|---|---|
| Health Net | 47 | $21,468 |
| Blue Cross Blue Shield | 47 | $17,896 |
| UnitedHealthcare | 47 | $23,382 |
| providence | 47 | $15,484 |
| Cigna | 43 | $16,086 |
| Empire BCBS | 43 | $12,780 |
| healthcare partners | 43 | $12,780 |
| heritage provider network | 43 | $12,780 |
| Humana | 43 | $12,780 |
| Kaiser Permanente | 43 | $12,780 |
| Molina | 43 | $12,780 |
| monarch health plan | 43 | $12,780 |
| one care | 43 | $12,780 |
| providence health plan | 43 | $12,780 |
| scan | 43 | $12,780 |
| Aetna | 43 | $12,780 |
| WellCare | 43 | $12,780 |
| brand new day | 43 | $12,780 |
| caremore | 43 | $12,780 |
| central health plan | 43 | $12,780 |
