Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION

Facility

$38,468.91

Service Code	MSDRG 880
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$38,468.91
Rate for Payer: Aetna of CA HMO/PPO	$29,060.92
Rate for Payer: EPIC Health Plan Commercial	$38,468.91
Rate for Payer: EPIC Health Plan Senior	$28,495.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,495.49
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,495.49
Rate for Payer: Molina Healthcare of CA Medicare	$38,183.96
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	$47,245.75
Rate for Payer: EPIC Health Plan Senior	$34,996.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,996.85
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,996.85
Rate for Payer: Molina Healthcare of CA Medicare	$46,895.78
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	$63,643.60
Rate for Payer: EPIC Health Plan Senior	$47,143.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$47,143.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$47,143.41
Rate for Payer: Molina Healthcare of CA Medicare	$63,172.17
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

$38,758.58

Service Code	MSDRG 290
Min. Negotiated Rate	$18,102.52
Max. Negotiated Rate	$38,758.58
Rate for Payer: Aetna of CA HMO/PPO	$29,679.36
Rate for Payer: EPIC Health Plan Commercial	$38,758.58
Rate for Payer: EPIC Health Plan Senior	$28,710.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,710.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,710.06
Rate for Payer: Molina Healthcare of CA Medicare	$38,471.48
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	$55,186.23
Rate for Payer: EPIC Health Plan Senior	$40,878.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$40,878.69
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,878.69
Rate for Payer: Molina Healthcare of CA Medicare	$54,777.44
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	$103,343.16
Rate for Payer: EPIC Health Plan Senior	$76,550.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$76,550.49
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$76,550.49
Rate for Payer: Molina Healthcare of CA Medicare	$102,577.66
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	$115,306.25
Max. Negotiated Rate	$279,267.96
Rate for Payer: Aetna of CA HMO/PPO	$279,267.96
Rate for Payer: EPIC Health Plan Commercial	$155,663.44
Rate for Payer: EPIC Health Plan Senior	$115,306.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$115,306.25
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$115,306.25
Rate for Payer: Molina Healthcare of CA Medicare	$154,510.38
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

$42,900.65

Service Code	MSDRG 836
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$42,900.65
Rate for Payer: Aetna of CA HMO/PPO	$38,522.54
Rate for Payer: EPIC Health Plan Commercial	$42,900.65
Rate for Payer: EPIC Health Plan Senior	$31,778.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,778.26
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,778.26
Rate for Payer: Molina Healthcare of CA Medicare	$42,582.87
Rate for Payer: Multiplan WC	$23,738.52
Rate for Payer: Prime Health Services WC	$23,496.29
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

$41,374.15

Service Code	MSDRG 121
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$41,374.15
Rate for Payer: Aetna of CA HMO/PPO	$35,263.57
Rate for Payer: EPIC Health Plan Commercial	$41,374.15
Rate for Payer: EPIC Health Plan Senior	$30,647.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,647.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,647.52
Rate for Payer: Molina Healthcare of CA Medicare	$41,067.68
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

$34,488.72

Service Code	MSDRG 122
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,488.72
Rate for Payer: Aetna of CA HMO/PPO	$20,563.34
Rate for Payer: EPIC Health Plan Commercial	$34,488.72
Rate for Payer: EPIC Health Plan Senior	$25,547.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,547.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,547.20
Rate for Payer: Molina Healthcare of CA Medicare	$34,233.25
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

$37,946.37

Service Code	MSDRG 281
Min. Negotiated Rate	$15,502.00
Max. Negotiated Rate	$37,946.37
Rate for Payer: Aetna of CA HMO/PPO	$27,945.29
Rate for Payer: EPIC Health Plan Commercial	$37,946.37
Rate for Payer: EPIC Health Plan Senior	$28,108.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,108.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,108.42
Rate for Payer: Molina Healthcare of CA Medicare	$37,665.28
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	$48,164.48
Rate for Payer: EPIC Health Plan Senior	$35,677.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,677.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,677.39
Rate for Payer: Molina Healthcare of CA Medicare	$47,807.70
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

$35,153.28

Service Code	MSDRG 282
Min. Negotiated Rate	$12,537.00
Max. Negotiated Rate	$35,153.28
Rate for Payer: Aetna of CA HMO/PPO	$21,982.13
Rate for Payer: EPIC Health Plan Commercial	$35,153.28
Rate for Payer: EPIC Health Plan Senior	$26,039.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,039.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,039.47
Rate for Payer: Molina Healthcare of CA Medicare	$34,892.89
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

$35,379.04

Service Code	MSDRG 284
Min. Negotiated Rate	$13,701.71
Max. Negotiated Rate	$35,379.04
Rate for Payer: Aetna of CA HMO/PPO	$22,464.16
Rate for Payer: EPIC Health Plan Commercial	$35,379.04
Rate for Payer: EPIC Health Plan Senior	$26,206.70
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,206.70
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,206.70
Rate for Payer: Molina Healthcare of CA Medicare	$35,116.98
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	$52,623.20
Rate for Payer: EPIC Health Plan Senior	$38,980.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$38,980.15
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$38,980.15
Rate for Payer: Molina Healthcare of CA Medicare	$52,233.40
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

$32,828.79

Service Code	MSDRG 285
Min. Negotiated Rate	$10,380.75
Max. Negotiated Rate	$32,828.79
Rate for Payer: Aetna of CA HMO/PPO	$17,019.40
Rate for Payer: EPIC Health Plan Commercial	$32,828.79
Rate for Payer: EPIC Health Plan Senior	$24,317.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,317.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,317.62
Rate for Payer: Molina Healthcare of CA Medicare	$32,585.61
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	$57,218.22
Rate for Payer: EPIC Health Plan Senior	$42,383.87
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$42,383.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,383.87
Rate for Payer: Molina Healthcare of CA Medicare	$56,794.39
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

$45,205.26

Service Code	MSDRG 615
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$45,205.26
Rate for Payer: Aetna of CA HMO/PPO	$43,442.83
Rate for Payer: EPIC Health Plan Commercial	$45,205.26
Rate for Payer: EPIC Health Plan Senior	$33,485.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,485.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,485.38
Rate for Payer: Molina Healthcare of CA Medicare	$44,870.41
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

$41,026.27

Service Code	MSDRG 560
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$41,026.27
Rate for Payer: Aetna of CA HMO/PPO	$34,520.83
Rate for Payer: EPIC Health Plan Commercial	$41,026.27
Rate for Payer: EPIC Health Plan Senior	$30,389.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,389.83
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,389.83
Rate for Payer: Molina Healthcare of CA Medicare	$40,722.37
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	$51,215.99
Rate for Payer: EPIC Health Plan Senior	$37,937.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,937.77
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,937.77
Rate for Payer: Molina Healthcare of CA Medicare	$50,836.61
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

$36,466.77

Service Code	MSDRG 561
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$36,466.77
Rate for Payer: Aetna of CA HMO/PPO	$24,786.36
Rate for Payer: EPIC Health Plan Commercial	$36,466.77
Rate for Payer: EPIC Health Plan Senior	$27,012.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,012.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,012.42
Rate for Payer: Molina Healthcare of CA Medicare	$36,196.64
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

MS-DRG 42.00: AFTERCARE WITH CC/MCC

Facility

$40,178.58

Service Code	MSDRG 949
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$40,178.58
Rate for Payer: Aetna of CA HMO/PPO	$32,710.96
Rate for Payer: EPIC Health Plan Commercial	$40,178.58
Rate for Payer: EPIC Health Plan Senior	$29,761.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,761.91
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,761.91
Rate for Payer: Molina Healthcare of CA Medicare	$39,880.96
Rate for Payer: Multiplan WC	$20,157.29
Rate for Payer: Prime Health Services WC	$19,951.60
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 WITHOUT CC/MCC

Facility

$33,179.53

Service Code	MSDRG 950
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$33,179.53
Rate for Payer: Aetna of CA HMO/PPO	$17,768.21
Rate for Payer: EPIC Health Plan Commercial	$33,179.53
Rate for Payer: EPIC Health Plan Senior	$24,577.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,577.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,577.43
Rate for Payer: Molina Healthcare of CA Medicare	$32,933.76
Rate for Payer: Multiplan WC	$10,949.20
Rate for Payer: Prime Health Services WC	$10,837.47
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

MS-DRG 42.00: AICD GENERATOR PROCEDURES

Facility

$148,148.23

Service Code	MSDRG 245
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$148,148.23
Rate for Payer: Aetna of CA HMO/PPO	$148,148.23
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$94,248.24
Rate for Payer: EPIC Health Plan Senior	$69,813.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$69,813.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$69,813.51
Rate for Payer: Molina Healthcare of CA Medicare	$93,550.10
Rate for Payer: Multiplan WC	$91,292.53
Rate for Payer: Prime Health Services WC	$90,360.97
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: AICD LEAD PROCEDURES

Facility

$108,143.24

Service Code	MSDRG 265
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$108,143.24
Rate for Payer: Aetna of CA HMO/PPO	$108,143.24
Rate for Payer: EPIC Health Plan Commercial	$75,510.31
Rate for Payer: EPIC Health Plan Senior	$55,933.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$55,933.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$55,933.56
Rate for Payer: Molina Healthcare of CA Medicare	$74,950.97
Rate for Payer: Multiplan WC	$66,640.48
Rate for Payer: Prime Health Services WC	$65,960.48
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

Know your out-of-pocket cost for care.

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