Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 40.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$163,736.72

Service Code	MSDRG 463
Min. Negotiated Rate	$46,778.00
Max. Negotiated Rate	$163,736.72
Rate for Payer: United Healthcare All Other Commercial	$112,353.00
Rate for Payer: United Healthcare All Other HMO	$67,223.00
Rate for Payer: United Healthcare HMO Rider	$51,058.00
Rate for Payer: United Healthcare Select/Navigate/Core	$46,778.00

MS-DRG 40.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$112,353.00

Service Code	MSDRG 465
Min. Negotiated Rate	$27,650.00
Max. Negotiated Rate	$112,353.00
Rate for Payer: United Healthcare All Other Commercial	$112,353.00
Rate for Payer: United Healthcare All Other HMO	$39,735.00
Rate for Payer: United Healthcare HMO Rider	$30,180.00
Rate for Payer: United Healthcare Select/Navigate/Core	$27,650.00

MS-DRG 42.00: ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$40,137.63

Service Code	MSDRG 770
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$40,137.63
Rate for Payer: Aetna of CA HMO/PPO	$32,620.02
Rate for Payer: EPIC Health Plan Commercial	$40,137.63
Rate for Payer: EPIC Health Plan Senior	$29,731.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,731.58
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,731.58
Rate for Payer: Molina Healthcare of CA Medicare	$39,840.32
Rate for Payer: Multiplan WC	$20,101.24
Rate for Payer: Prime Health Services WC	$19,896.13
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

MS-DRG 42.00: ABORTION WITHOUT D&C

Facility

$38,132.63

Service Code	MSDRG 779
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$38,132.63
Rate for Payer: Aetna of CA HMO/PPO	$28,339.40
Rate for Payer: EPIC Health Plan Commercial	$38,132.63
Rate for Payer: EPIC Health Plan Senior	$28,246.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,246.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,246.39
Rate for Payer: Molina Healthcare of CA Medicare	$37,850.16
Rate for Payer: Multiplan WC	$17,463.42
Rate for Payer: Prime Health Services WC	$17,285.23
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

MS-DRG 42.00: ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION

Facility

$38,470.57

Service Code	MSDRG 880
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$38,470.57
Rate for Payer: Aetna of CA HMO/PPO	$29,060.92
Rate for Payer: EPIC Health Plan Commercial	$38,470.57
Rate for Payer: EPIC Health Plan Senior	$28,496.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,496.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,496.72
Rate for Payer: Molina Healthcare of CA Medicare	$38,185.60
Rate for Payer: Multiplan WC	$17,908.04
Rate for Payer: Prime Health Services WC	$17,725.30
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

MS-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS WITH CC

Facility

$47,799.24

Service Code	MSDRG 289
Min. Negotiated Rate	$27,248.00
Max. Negotiated Rate	$47,799.24
Rate for Payer: Aetna of CA HMO/PPO	$47,799.24
Rate for Payer: EPIC Health Plan Commercial	$47,247.41
Rate for Payer: EPIC Health Plan Senior	$34,998.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,998.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,998.08
Rate for Payer: Molina Healthcare of CA Medicare	$46,897.43
Rate for Payer: Multiplan WC	$29,455.05
Rate for Payer: Prime Health Services WC	$29,154.48
Rate for Payer: United Healthcare All Other Commercial	$33,040.00
Rate for Payer: United Healthcare All Other HMO	$39,155.00
Rate for Payer: United Healthcare HMO Rider	$29,741.00
Rate for Payer: United Healthcare Select/Navigate/Core	$27,248.00

MS-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC

Facility

$82,808.15

Service Code	MSDRG 288
Min. Negotiated Rate	$34,413.00
Max. Negotiated Rate	$82,808.15
Rate for Payer: Aetna of CA HMO/PPO	$82,808.15
Rate for Payer: EPIC Health Plan Commercial	$63,645.26
Rate for Payer: EPIC Health Plan Senior	$47,144.64
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$47,144.64
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$47,144.64
Rate for Payer: Molina Healthcare of CA Medicare	$63,173.82
Rate for Payer: Multiplan WC	$51,028.39
Rate for Payer: Prime Health Services WC	$50,507.70
Rate for Payer: United Healthcare All Other Commercial	$37,549.00
Rate for Payer: United Healthcare All Other HMO	$49,452.00
Rate for Payer: United Healthcare HMO Rider	$37,563.00
Rate for Payer: United Healthcare Select/Navigate/Core	$34,413.00

MS-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC

Facility

$38,760.24

Service Code	MSDRG 290
Min. Negotiated Rate	$18,102.52
Max. Negotiated Rate	$38,760.24
Rate for Payer: Aetna of CA HMO/PPO	$29,679.36
Rate for Payer: EPIC Health Plan Commercial	$38,760.24
Rate for Payer: EPIC Health Plan Senior	$28,711.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,711.29
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,711.29
Rate for Payer: Molina Healthcare of CA Medicare	$38,473.13
Rate for Payer: Multiplan WC	$18,289.14
Rate for Payer: Prime Health Services WC	$18,102.52
Rate for Payer: United Healthcare All Other Commercial	$33,040.00
Rate for Payer: United Healthcare All Other HMO	$33,480.00
Rate for Payer: United Healthcare HMO Rider	$25,436.00
Rate for Payer: United Healthcare Select/Navigate/Core	$23,302.00

MS-DRG 42.00: ACUTE LEUKEMIA WITH CC

Facility

$64,751.94

Service Code	MSDRG 835
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$64,751.94
Rate for Payer: Aetna of CA HMO/PPO	$64,751.94
Rate for Payer: EPIC Health Plan Commercial	$55,187.89
Rate for Payer: EPIC Health Plan Senior	$40,879.92
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$40,879.92
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,879.92
Rate for Payer: Molina Healthcare of CA Medicare	$54,779.09
Rate for Payer: Multiplan WC	$39,901.72
Rate for Payer: Prime Health Services WC	$39,494.56
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

MS-DRG 42.00: ACUTE LEUKEMIA WITH MCC

Facility

$167,565.63

Service Code	MSDRG 834
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$167,565.63
Rate for Payer: Aetna of CA HMO/PPO	$167,565.63
Rate for Payer: EPIC Health Plan Commercial	$103,344.82
Rate for Payer: EPIC Health Plan Senior	$76,551.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$76,551.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$76,551.72
Rate for Payer: Molina Healthcare of CA Medicare	$102,579.30
Rate for Payer: Multiplan WC	$103,258.00
Rate for Payer: Prime Health Services WC	$102,204.35
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

MS-DRG 42.00: ACUTE LEUKEMIA WITH OTHER PROCEDURES

Facility

$279,267.96

Service Code	MSDRG 850
Min. Negotiated Rate	$115,307.48
Max. Negotiated Rate	$279,267.96
Rate for Payer: Aetna of CA HMO/PPO	$279,267.96
Rate for Payer: EPIC Health Plan Commercial	$155,665.10
Rate for Payer: EPIC Health Plan Senior	$115,307.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$115,307.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$115,307.48
Rate for Payer: Molina Healthcare of CA Medicare	$154,512.02
Rate for Payer: Multiplan WC	$172,091.68
Rate for Payer: Prime Health Services WC	$170,335.65

MS-DRG 42.00: ACUTE LEUKEMIA WITHOUT CC/MCC

Facility

$42,902.31

Service Code	MSDRG 836
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$42,902.31
Rate for Payer: Prime Health Services WC	$23,496.29
Rate for Payer: Aetna of CA HMO/PPO	$38,522.54
Rate for Payer: EPIC Health Plan Commercial	$42,902.31
Rate for Payer: EPIC Health Plan Senior	$31,779.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,779.49
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,779.49
Rate for Payer: Molina Healthcare of CA Medicare	$42,584.52
Rate for Payer: Multiplan WC	$23,738.52
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

MS-DRG 42.00: ACUTE MAJOR EYE INFECTIONS WITH CC/MCC

Facility

$41,375.81

Service Code	MSDRG 121
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$41,375.81
Rate for Payer: Aetna of CA HMO/PPO	$35,263.57
Rate for Payer: EPIC Health Plan Commercial	$41,375.81
Rate for Payer: EPIC Health Plan Senior	$30,648.75
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,648.75
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,648.75
Rate for Payer: Molina Healthcare of CA Medicare	$41,069.32
Rate for Payer: Multiplan WC	$21,730.27
Rate for Payer: Prime Health Services WC	$21,508.53
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

MS-DRG 42.00: ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC

Facility

$34,490.38

Service Code	MSDRG 122
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,490.38
Rate for Payer: Aetna of CA HMO/PPO	$20,563.34
Rate for Payer: EPIC Health Plan Commercial	$34,490.38
Rate for Payer: EPIC Health Plan Senior	$25,548.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,548.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,548.43
Rate for Payer: Molina Healthcare of CA Medicare	$34,234.90
Rate for Payer: Multiplan WC	$12,671.63
Rate for Payer: Prime Health Services WC	$12,542.32
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

MS-DRG 42.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC

Facility

$37,948.03

Service Code	MSDRG 281
Min. Negotiated Rate	$15,502.00
Max. Negotiated Rate	$37,948.03
Rate for Payer: Aetna of CA HMO/PPO	$27,945.29
Rate for Payer: EPIC Health Plan Commercial	$37,948.03
Rate for Payer: EPIC Health Plan Senior	$28,109.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,109.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,109.65
Rate for Payer: Molina Healthcare of CA Medicare	$37,666.93
Rate for Payer: Multiplan WC	$17,220.56
Rate for Payer: Prime Health Services WC	$17,044.84
Rate for Payer: United Healthcare All Other Commercial	$26,466.00
Rate for Payer: United Healthcare All Other HMO	$22,273.00
Rate for Payer: United Healthcare HMO Rider	$16,920.00
Rate for Payer: United Healthcare Select/Navigate/Core	$15,502.00

MS-DRG 42.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC

Facility

$49,760.68

Service Code	MSDRG 280
Min. Negotiated Rate	$20,535.00
Max. Negotiated Rate	$49,760.68
Rate for Payer: Aetna of CA HMO/PPO	$49,760.68
Rate for Payer: EPIC Health Plan Commercial	$48,166.14
Rate for Payer: EPIC Health Plan Senior	$35,678.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,678.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,678.62
Rate for Payer: Molina Healthcare of CA Medicare	$47,809.35
Rate for Payer: Multiplan WC	$30,663.74
Rate for Payer: Prime Health Services WC	$30,350.84
Rate for Payer: United Healthcare All Other Commercial	$27,038.00
Rate for Payer: United Healthcare All Other HMO	$29,511.00
Rate for Payer: United Healthcare HMO Rider	$22,413.00
Rate for Payer: United Healthcare Select/Navigate/Core	$20,535.00

MS-DRG 42.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC

Facility

$35,154.94

Service Code	MSDRG 282
Min. Negotiated Rate	$12,537.00
Max. Negotiated Rate	$35,154.94
Rate for Payer: Aetna of CA HMO/PPO	$21,982.13
Rate for Payer: EPIC Health Plan Commercial	$35,154.94
Rate for Payer: EPIC Health Plan Senior	$26,040.70
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,040.70
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,040.70
Rate for Payer: Molina Healthcare of CA Medicare	$34,894.54
Rate for Payer: Multiplan WC	$13,545.92
Rate for Payer: Prime Health Services WC	$13,407.70
Rate for Payer: United Healthcare All Other Commercial	$28,087.00
Rate for Payer: United Healthcare All Other HMO	$18,018.00
Rate for Payer: United Healthcare HMO Rider	$13,685.00
Rate for Payer: United Healthcare Select/Navigate/Core	$12,537.00

MS-DRG 42.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC

Facility

$35,380.71

Service Code	MSDRG 284
Min. Negotiated Rate	$13,701.71
Max. Negotiated Rate	$35,380.71
Rate for Payer: Aetna of CA HMO/PPO	$22,464.16
Rate for Payer: EPIC Health Plan Commercial	$35,380.71
Rate for Payer: EPIC Health Plan Senior	$26,207.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,207.93
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,207.93
Rate for Payer: Molina Healthcare of CA Medicare	$35,118.63
Rate for Payer: Multiplan WC	$13,842.96
Rate for Payer: Prime Health Services WC	$13,701.71
Rate for Payer: United Healthcare All Other Commercial	$28,275.00
Rate for Payer: United Healthcare All Other HMO	$20,489.00
Rate for Payer: United Healthcare HMO Rider	$15,558.00
Rate for Payer: United Healthcare Select/Navigate/Core	$14,254.00

MS-DRG 42.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC

Facility

$59,279.91

Service Code	MSDRG 283
Min. Negotiated Rate	$18,641.00
Max. Negotiated Rate	$59,279.91
Rate for Payer: Aetna of CA HMO/PPO	$59,279.91
Rate for Payer: EPIC Health Plan Commercial	$52,624.86
Rate for Payer: EPIC Health Plan Senior	$38,981.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$38,981.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$38,981.38
Rate for Payer: Molina Healthcare of CA Medicare	$52,235.05
Rate for Payer: Multiplan WC	$36,529.72
Rate for Payer: Prime Health Services WC	$36,156.96
Rate for Payer: United Healthcare All Other Commercial	$29,007.00
Rate for Payer: United Healthcare All Other HMO	$26,787.00
Rate for Payer: United Healthcare HMO Rider	$20,346.00
Rate for Payer: United Healthcare Select/Navigate/Core	$18,641.00

MS-DRG 42.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC

Facility

$32,830.45

Service Code	MSDRG 285
Min. Negotiated Rate	$10,380.75
Max. Negotiated Rate	$32,830.45
Rate for Payer: Aetna of CA HMO/PPO	$17,019.40
Rate for Payer: EPIC Health Plan Commercial	$32,830.45
Rate for Payer: EPIC Health Plan Senior	$24,318.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,318.85
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,318.85
Rate for Payer: Molina Healthcare of CA Medicare	$32,587.26
Rate for Payer: Multiplan WC	$10,487.76
Rate for Payer: Prime Health Services WC	$10,380.75
Rate for Payer: United Healthcare All Other Commercial	$27,865.00
Rate for Payer: United Healthcare All Other HMO	$17,683.00
Rate for Payer: United Healthcare HMO Rider	$13,432.00
Rate for Payer: United Healthcare Select/Navigate/Core	$12,305.00

MS-DRG 42.00: ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC

Facility

$69,090.16

Service Code	MSDRG 614
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$69,090.16
Rate for Payer: Aetna of CA HMO/PPO	$69,090.16
Rate for Payer: EPIC Health Plan Commercial	$57,219.89
Rate for Payer: EPIC Health Plan Senior	$42,385.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$42,385.10
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,385.10
Rate for Payer: Molina Healthcare of CA Medicare	$56,796.03
Rate for Payer: Multiplan WC	$42,575.03
Rate for Payer: Prime Health Services WC	$42,140.59
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

MS-DRG 42.00: ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC

Facility

$45,206.92

Service Code	MSDRG 615
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$45,206.92
Rate for Payer: Aetna of CA HMO/PPO	$43,442.83
Rate for Payer: EPIC Health Plan Commercial	$45,206.92
Rate for Payer: EPIC Health Plan Senior	$33,486.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,486.61
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,486.61
Rate for Payer: Molina Healthcare of CA Medicare	$44,872.06
Rate for Payer: Multiplan WC	$26,770.52
Rate for Payer: Prime Health Services WC	$26,497.35
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

MS-DRG 42.00: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC

Facility

$41,027.93

Service Code	MSDRG 560
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$41,027.93
Rate for Payer: Aetna of CA HMO/PPO	$34,520.83
Rate for Payer: EPIC Health Plan Commercial	$41,027.93
Rate for Payer: EPIC Health Plan Senior	$30,391.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,391.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,391.06
Rate for Payer: Molina Healthcare of CA Medicare	$40,724.02
Rate for Payer: Multiplan WC	$21,272.58
Rate for Payer: Prime Health Services WC	$21,055.51
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

MS-DRG 42.00: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$56,275.59

Service Code	MSDRG 559
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$56,275.59
Rate for Payer: Aetna of CA HMO/PPO	$56,275.59
Rate for Payer: EPIC Health Plan Commercial	$51,217.65
Rate for Payer: EPIC Health Plan Senior	$37,939.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,939.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,939.00
Rate for Payer: Molina Healthcare of CA Medicare	$50,838.26
Rate for Payer: Multiplan WC	$34,678.38
Rate for Payer: Prime Health Services WC	$34,324.52
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

MS-DRG 42.00: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC

Facility

$36,468.43

Service Code	MSDRG 561
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$36,468.43
Rate for Payer: Aetna of CA HMO/PPO	$24,786.36
Rate for Payer: EPIC Health Plan Commercial	$36,468.43
Rate for Payer: EPIC Health Plan Senior	$27,013.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,013.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,013.65
Rate for Payer: Molina Healthcare of CA Medicare	$36,198.29
Rate for Payer: Multiplan WC	$15,273.96
Rate for Payer: Prime Health Services WC	$15,118.10
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

Know your out-of-pocket cost for care.

All Charges