Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA

Facility

$33,719.11

Service Code	MSDRG 894
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$33,719.11
Rate for Payer: Aetna of CA HMO/PPO	$18,920.22
Rate for Payer: EPIC Health Plan Commercial	$33,719.11
Rate for Payer: EPIC Health Plan Senior	$24,977.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,977.12
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,977.12
Rate for Payer: Molina Healthcare of CA Medicare	$33,469.34
Rate for Payer: Multiplan WC	$11,659.10
Rate for Payer: Prime Health Services WC	$11,540.13
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: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC

Facility

$53,986.73

Service Code	MSDRG 896
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$53,986.73
Rate for Payer: Aetna of CA HMO/PPO	$53,986.73
Rate for Payer: EPIC Health Plan Commercial	$50,143.93
Rate for Payer: EPIC Health Plan Senior	$37,143.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,143.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,143.65
Rate for Payer: Molina Healthcare of CA Medicare	$49,772.49
Rate for Payer: Multiplan WC	$33,267.93
Rate for Payer: Prime Health Services WC	$32,928.46
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: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC

Facility

$37,384.07

Service Code	MSDRG 897
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,384.07
Rate for Payer: Aetna of CA HMO/PPO	$26,744.78
Rate for Payer: EPIC Health Plan Commercial	$37,384.07
Rate for Payer: EPIC Health Plan Senior	$27,691.90
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,691.90
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,691.90
Rate for Payer: Molina Healthcare of CA Medicare	$37,107.15
Rate for Payer: Multiplan WC	$16,480.78
Rate for Payer: Prime Health Services WC	$16,312.61
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: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY

Facility

$45,416.83

Service Code	MSDRG 895
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$45,416.83
Rate for Payer: Aetna of CA HMO/PPO	$43,894.54
Rate for Payer: EPIC Health Plan Commercial	$45,416.83
Rate for Payer: EPIC Health Plan Senior	$33,642.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,642.10
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,642.10
Rate for Payer: Molina Healthcare of CA Medicare	$45,080.41
Rate for Payer: Multiplan WC	$27,048.87
Rate for Payer: Prime Health Services WC	$26,772.86
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: ALLERGIC REACTIONS WITH MCC

Facility

$52,686.18

Service Code	MSDRG 915
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$52,686.18
Rate for Payer: Aetna of CA HMO/PPO	$52,686.18
Rate for Payer: EPIC Health Plan Commercial	$49,534.75
Rate for Payer: EPIC Health Plan Senior	$36,692.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,692.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,692.41
Rate for Payer: Molina Healthcare of CA Medicare	$49,167.83
Rate for Payer: Multiplan WC	$32,466.50
Rate for Payer: Prime Health Services WC	$32,135.21
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: ALLERGIC REACTIONS WITHOUT MCC

Facility

$34,287.10

Service Code	MSDRG 916
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,287.10
Rate for Payer: Aetna of CA HMO/PPO	$20,132.86
Rate for Payer: EPIC Health Plan Commercial	$34,287.10
Rate for Payer: EPIC Health Plan Senior	$25,397.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,397.85
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,397.85
Rate for Payer: Molina Healthcare of CA Medicare	$34,033.12
Rate for Payer: Multiplan WC	$12,406.35
Rate for Payer: Prime Health Services WC	$12,279.75
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: ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$397,194.17

Service Code	MSDRG 014
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$397,194.17
Rate for Payer: Aetna of CA HMO/PPO	$397,194.17
Rate for Payer: EPIC Health Plan Commercial	$210,898.92
Rate for Payer: EPIC Health Plan Senior	$156,221.42
Rate for Payer: Health Plan of Nevada (Sierra) Transplant	$165,000.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$156,221.42
Rate for Payer: Molina Healthcare of CA Medicare	$209,336.70
Rate for Payer: Multiplan WC	$244,760.67
Rate for Payer: Prime Health Services WC	$242,263.12
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: AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC

Facility

$88,286.26

Service Code	MSDRG 240
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$88,286.26
Rate for Payer: Aetna of CA HMO/PPO	$88,286.26
Rate for Payer: EPIC Health Plan Commercial	$66,209.49
Rate for Payer: EPIC Health Plan Senior	$49,044.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$49,044.07
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$49,044.07
Rate for Payer: Molina Healthcare of CA Medicare	$65,719.05
Rate for Payer: Multiplan WC	$54,404.13
Rate for Payer: Prime Health Services WC	$53,848.99
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: AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC

Facility

$152,698.66

Service Code	MSDRG 239
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$152,698.66
Rate for Payer: Aetna of CA HMO/PPO	$152,698.66
Rate for Payer: EPIC Health Plan Commercial	$96,379.63
Rate for Payer: EPIC Health Plan Senior	$71,392.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$71,392.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$71,392.32
Rate for Payer: Molina Healthcare of CA Medicare	$95,665.71
Rate for Payer: Multiplan WC	$94,096.61
Rate for Payer: Prime Health Services WC	$93,136.44
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: AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC

Facility

$46,297.22

Service Code	MSDRG 241
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$46,297.22
Rate for Payer: Aetna of CA HMO/PPO	$45,774.13
Rate for Payer: EPIC Health Plan Commercial	$46,297.22
Rate for Payer: EPIC Health Plan Senior	$34,294.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,294.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,294.24
Rate for Payer: Molina Healthcare of CA Medicare	$45,954.28
Rate for Payer: Multiplan WC	$28,207.12
Rate for Payer: Prime Health Services WC	$27,919.30
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: AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$65,400.71

Service Code	MSDRG 475
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$65,400.71
Rate for Payer: Aetna of CA HMO/PPO	$65,400.71
Rate for Payer: EPIC Health Plan Commercial	$55,490.10
Rate for Payer: EPIC Health Plan Senior	$41,103.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$41,103.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$41,103.78
Rate for Payer: Molina Healthcare of CA Medicare	$55,079.07
Rate for Payer: Multiplan WC	$40,301.50
Rate for Payer: Prime Health Services WC	$39,890.26
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: AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$135,958.17

Service Code	MSDRG 474
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$135,958.17
Rate for Payer: Aetna of CA HMO/PPO	$135,958.17
Rate for Payer: EPIC Health Plan Commercial	$88,538.54
Rate for Payer: EPIC Health Plan Senior	$65,584.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$65,584.10
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$65,584.10
Rate for Payer: Molina Healthcare of CA Medicare	$87,882.69
Rate for Payer: Multiplan WC	$83,780.72
Rate for Payer: Prime Health Services WC	$82,925.81
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: AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$41,372.75

Service Code	MSDRG 476
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$41,372.75
Rate for Payer: Aetna of CA HMO/PPO	$35,260.54
Rate for Payer: EPIC Health Plan Commercial	$41,372.75
Rate for Payer: EPIC Health Plan Senior	$30,646.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,646.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,646.48
Rate for Payer: Molina Healthcare of CA Medicare	$41,066.28
Rate for Payer: Multiplan WC	$21,728.40
Rate for Payer: Prime Health Services WC	$21,506.68
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: AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC

Facility

$58,558.39

Service Code	MSDRG 617
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$58,558.39
Rate for Payer: Aetna of CA HMO/PPO	$58,558.39
Rate for Payer: EPIC Health Plan Commercial	$52,285.23
Rate for Payer: EPIC Health Plan Senior	$38,729.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$38,729.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$38,729.80
Rate for Payer: Molina Healthcare of CA Medicare	$51,897.93
Rate for Payer: Multiplan WC	$36,085.10
Rate for Payer: Prime Health Services WC	$35,716.88
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: AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC

Facility

$117,171.34

Service Code	MSDRG 616
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$117,171.34
Rate for Payer: Aetna of CA HMO/PPO	$117,171.34
Rate for Payer: EPIC Health Plan Commercial	$79,738.96
Rate for Payer: EPIC Health Plan Senior	$59,065.90
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$59,065.90
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$59,065.90
Rate for Payer: Molina Healthcare of CA Medicare	$79,148.31
Rate for Payer: Multiplan WC	$72,203.82
Rate for Payer: Prime Health Services WC	$71,467.05
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: AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC

Facility

$42,537.15

Service Code	MSDRG 618
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$42,537.15
Rate for Payer: Aetna of CA HMO/PPO	$37,746.45
Rate for Payer: EPIC Health Plan Commercial	$42,537.15
Rate for Payer: EPIC Health Plan Senior	$31,509.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,509.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,509.00
Rate for Payer: Molina Healthcare of CA Medicare	$42,222.06
Rate for Payer: Multiplan WC	$23,260.28
Rate for Payer: Prime Health Services WC	$23,022.93
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: ANAL AND STOMAL PROCEDURES WITH CC

Facility

$42,733.09

Service Code	MSDRG 348
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$42,733.09
Rate for Payer: Aetna of CA HMO/PPO	$38,164.81
Rate for Payer: EPIC Health Plan Commercial	$42,733.09
Rate for Payer: EPIC Health Plan Senior	$31,654.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,654.14
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,654.14
Rate for Payer: Molina Healthcare of CA Medicare	$42,416.55
Rate for Payer: Multiplan WC	$23,518.08
Rate for Payer: Prime Health Services WC	$23,278.10
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: ANAL AND STOMAL PROCEDURES WITH MCC

Facility

$71,751.91

Service Code	MSDRG 347
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$71,751.91
Rate for Payer: Aetna of CA HMO/PPO	$71,751.91
Rate for Payer: EPIC Health Plan Commercial	$58,464.95
Rate for Payer: EPIC Health Plan Senior	$43,307.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$43,307.37
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$43,307.37
Rate for Payer: Molina Healthcare of CA Medicare	$58,031.88
Rate for Payer: Multiplan WC	$44,215.27
Rate for Payer: Prime Health Services WC	$43,764.09
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: ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC

Facility

$37,365.60

Service Code	MSDRG 349
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$37,365.60
Rate for Payer: Aetna of CA HMO/PPO	$26,705.36
Rate for Payer: EPIC Health Plan Commercial	$37,365.60
Rate for Payer: EPIC Health Plan Senior	$27,678.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,678.22
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,678.22
Rate for Payer: Molina Healthcare of CA Medicare	$37,088.81
Rate for Payer: Multiplan WC	$16,456.49
Rate for Payer: Prime Health Services WC	$16,288.57
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: ANGINA PECTORIS

Facility

$34,772.73

Service Code	MSDRG 311
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,772.73
Rate for Payer: Aetna of CA HMO/PPO	$21,169.66
Rate for Payer: EPIC Health Plan Commercial	$34,772.73
Rate for Payer: EPIC Health Plan Senior	$25,757.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,757.58
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,757.58
Rate for Payer: Molina Healthcare of CA Medicare	$34,515.16
Rate for Payer: Multiplan WC	$13,045.26
Rate for Payer: Prime Health Services WC	$12,912.15
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: AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC

Facility

$202,134.96

Service Code	MSDRG 268
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$202,134.96
Rate for Payer: Aetna of CA HMO/PPO	$202,134.96
Rate for Payer: EPIC Health Plan Commercial	$119,535.10
Rate for Payer: EPIC Health Plan Senior	$88,544.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$88,544.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$88,544.52
Rate for Payer: Molina Healthcare of CA Medicare	$118,649.66
Rate for Payer: Multiplan WC	$124,560.46
Rate for Payer: Prime Health Services WC	$123,289.43
Rate for Payer: United Healthcare All Other Commercial	$127,168.00
Rate for Payer: United Healthcare All Other HMO	$111,805.00
Rate for Payer: United Healthcare HMO Rider	$84,927.00
Rate for Payer: United Healthcare Select/Navigate/Core	$77,806.00

MS-DRG 42.00: AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC

Facility

$126,135.78

Service Code	MSDRG 269
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$126,135.78
Rate for Payer: Aetna of CA HMO/PPO	$126,135.78
Rate for Payer: EPIC Health Plan Commercial	$83,937.82
Rate for Payer: EPIC Health Plan Senior	$62,176.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$62,176.16
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$62,176.16
Rate for Payer: Molina Healthcare of CA Medicare	$83,316.05
Rate for Payer: Multiplan WC	$77,727.93
Rate for Payer: Prime Health Services WC	$76,934.78
Rate for Payer: United Healthcare All Other Commercial	$79,046.00
Rate for Payer: United Healthcare All Other HMO	$69,501.00
Rate for Payer: United Healthcare HMO Rider	$52,792.00
Rate for Payer: United Healthcare Select/Navigate/Core	$48,365.00

MS-DRG 42.00: APPENDIX PROCEDURES WITH CC

Facility

$46,344.10

Service Code	MSDRG 398
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$46,344.10
Rate for Payer: Aetna of CA HMO/PPO	$45,874.17
Rate for Payer: EPIC Health Plan Commercial	$46,344.10
Rate for Payer: EPIC Health Plan Senior	$34,328.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,328.96
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,328.96
Rate for Payer: Molina Healthcare of CA Medicare	$46,000.81
Rate for Payer: Multiplan WC	$28,268.78
Rate for Payer: Prime Health Services WC	$27,980.32
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: APPENDIX PROCEDURES WITH MCC

Facility

$75,116.98

Service Code	MSDRG 397
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$75,116.98
Rate for Payer: Aetna of CA HMO/PPO	$75,116.98
Rate for Payer: EPIC Health Plan Commercial	$60,041.11
Rate for Payer: EPIC Health Plan Senior	$44,474.90
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$44,474.90
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$44,474.90
Rate for Payer: Molina Healthcare of CA Medicare	$59,596.37
Rate for Payer: Multiplan WC	$46,288.91
Rate for Payer: Prime Health Services WC	$45,816.57
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: APPENDIX PROCEDURES WITHOUT CC/MCC

Facility

$40,814.71

Service Code	MSDRG 399
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$40,814.71
Rate for Payer: Aetna of CA HMO/PPO	$34,069.12
Rate for Payer: EPIC Health Plan Commercial	$40,814.71
Rate for Payer: EPIC Health Plan Senior	$30,233.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,233.12
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,233.12
Rate for Payer: Molina Healthcare of CA Medicare	$40,512.38
Rate for Payer: Multiplan WC	$20,994.22
Rate for Payer: Prime Health Services WC	$20,779.99
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.

All Charges