Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$180,358.98

Service Code	MSDRG 218
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$180,358.98
Rate for Payer: Aetna of CA HMO/PPO	$180,358.98
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$109,337.09
Rate for Payer: EPIC Health Plan Senior	$80,990.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$80,990.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$80,990.44
Rate for Payer: Molina Healthcare of CA Medicare	$108,527.19
Rate for Payer: Multiplan WC	$111,141.57
Rate for Payer: Prime Health Services WC	$110,007.48
Rate for Payer: United Healthcare All Other Commercial	$164,634.00
Rate for Payer: United Healthcare All Other HMO	$116,390.00
Rate for Payer: United Healthcare HMO Rider	$88,410.00
Rate for Payer: United Healthcare Select/Navigate/Core	$80,997.00

MS-DRG 42.00: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC

Facility

$160,574.76

Service Code	MSDRG 220
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$160,574.76
Rate for Payer: Aetna of CA HMO/PPO	$160,574.76
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$100,070.37
Rate for Payer: EPIC Health Plan Senior	$74,126.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$74,126.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$74,126.20
Rate for Payer: Molina Healthcare of CA Medicare	$99,329.11
Rate for Payer: Multiplan WC	$98,950.06
Rate for Payer: Prime Health Services WC	$97,940.37
Rate for Payer: United Healthcare All Other Commercial	$117,371.00
Rate for Payer: United Healthcare All Other HMO	$146,353.00
Rate for Payer: United Healthcare HMO Rider	$111,169.00
Rate for Payer: United Healthcare Select/Navigate/Core	$101,848.00

MS-DRG 42.00: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$234,570.05

Service Code	MSDRG 219
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$234,570.05
Rate for Payer: Aetna of CA HMO/PPO	$234,570.05
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$134,729.03
Rate for Payer: EPIC Health Plan Senior	$99,799.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$99,799.28
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$99,799.28
Rate for Payer: Molina Healthcare of CA Medicare	$133,731.04
Rate for Payer: Multiplan WC	$144,547.75
Rate for Payer: Prime Health Services WC	$143,072.77
Rate for Payer: United Healthcare All Other Commercial	$147,690.00
Rate for Payer: United Healthcare All Other HMO	$146,353.00
Rate for Payer: United Healthcare HMO Rider	$111,169.00
Rate for Payer: United Healthcare Select/Navigate/Core	$101,848.00

MS-DRG 42.00: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$171,252.00

Service Code	MSDRG 221
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$171,252.00
Rate for Payer: Aetna of CA HMO/PPO	$139,229.26
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$90,072.34
Rate for Payer: EPIC Health Plan Senior	$66,720.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$66,720.25
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$66,720.25
Rate for Payer: Molina Healthcare of CA Medicare	$89,405.13
Rate for Payer: Multiplan WC	$85,796.44
Rate for Payer: Prime Health Services WC	$84,920.97
Rate for Payer: United Healthcare All Other Commercial	$171,252.00
Rate for Payer: United Healthcare All Other HMO	$146,353.00
Rate for Payer: United Healthcare HMO Rider	$111,169.00
Rate for Payer: United Healthcare Select/Navigate/Core	$101,848.00

MS-DRG 42.00: CAROTID ARTERY STENT PROCEDURES WITH CC

Facility

$68,962.84

Service Code	MSDRG 035
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$68,962.84
Rate for Payer: Aetna of CA HMO/PPO	$68,962.84
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$57,160.24
Rate for Payer: EPIC Health Plan Senior	$42,340.92
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$42,340.92
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,340.92
Rate for Payer: Molina Healthcare of CA Medicare	$56,736.83
Rate for Payer: Multiplan WC	$42,496.57
Rate for Payer: Prime Health Services WC	$42,062.93
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: CAROTID ARTERY STENT PROCEDURES WITH MCC

Facility

$117,889.83

Service Code	MSDRG 034
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$117,889.83
Rate for Payer: Aetna of CA HMO/PPO	$117,889.83
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$80,077.18
Rate for Payer: EPIC Health Plan Senior	$59,316.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$59,316.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$59,316.43
Rate for Payer: Molina Healthcare of CA Medicare	$79,484.02
Rate for Payer: Multiplan WC	$72,646.57
Rate for Payer: Prime Health Services WC	$71,905.28
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: CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC

Facility

$55,572.26

Service Code	MSDRG 036
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$55,572.26
Rate for Payer: Aetna of CA HMO/PPO	$55,572.26
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$50,888.24
Rate for Payer: EPIC Health Plan Senior	$37,694.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,694.99
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,694.99
Rate for Payer: Molina Healthcare of CA Medicare	$50,511.29
Rate for Payer: Multiplan WC	$34,244.97
Rate for Payer: Prime Health Services WC	$33,895.53
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: CELLULITIS WITH MCC

Facility

$45,720.95

Service Code	MSDRG 602
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$45,720.95
Rate for Payer: Aetna of CA HMO/PPO	$44,540.27
Rate for Payer: EPIC Health Plan Commercial	$45,720.95
Rate for Payer: EPIC Health Plan Senior	$33,867.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,867.37
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,867.37
Rate for Payer: Molina Healthcare of CA Medicare	$45,382.28
Rate for Payer: Multiplan WC	$27,446.79
Rate for Payer: Prime Health Services WC	$27,166.72
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: CELLULITIS WITHOUT MCC

Facility

$37,365.83

Service Code	MSDRG 603
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,365.83
Rate for Payer: Aetna of CA HMO/PPO	$26,702.33
Rate for Payer: EPIC Health Plan Commercial	$37,365.83
Rate for Payer: EPIC Health Plan Senior	$27,678.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,678.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,678.39
Rate for Payer: Molina Healthcare of CA Medicare	$37,089.04
Rate for Payer: Multiplan WC	$16,454.62
Rate for Payer: Prime Health Services WC	$16,286.72
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: CERVICAL SPINAL FUSION WITH CC

Facility

$87,831.52

Service Code	MSDRG 472
Min. Negotiated Rate	$22,650.00
Max. Negotiated Rate	$87,831.52
Rate for Payer: Aetna of CA HMO/PPO	$87,831.52
Rate for Payer: EPIC Health Plan Commercial	$65,998.14
Rate for Payer: EPIC Health Plan Senior	$48,887.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$48,887.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$48,887.51
Rate for Payer: Molina Healthcare of CA Medicare	$65,509.26
Rate for Payer: Multiplan WC	$54,123.91
Rate for Payer: Prime Health Services WC	$53,571.63
Rate for Payer: United Healthcare All Other Commercial	$30,096.00
Rate for Payer: United Healthcare All Other HMO	$42,113.00
Rate for Payer: United Healthcare HMO Rider	$24,721.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,650.00

MS-DRG 42.00: CERVICAL SPINAL FUSION WITH MCC

Facility

$147,253.91

Service Code	MSDRG 471
Min. Negotiated Rate	$24,564.00
Max. Negotiated Rate	$147,253.91
Rate for Payer: Aetna of CA HMO/PPO	$147,253.91
Rate for Payer: EPIC Health Plan Commercial	$93,830.99
Rate for Payer: EPIC Health Plan Senior	$69,504.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$69,504.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$69,504.44
Rate for Payer: Molina Healthcare of CA Medicare	$93,135.95
Rate for Payer: Multiplan WC	$90,741.42
Rate for Payer: Prime Health Services WC	$89,815.49
Rate for Payer: United Healthcare All Other Commercial	$42,108.00
Rate for Payer: United Healthcare All Other HMO	$38,993.00
Rate for Payer: United Healthcare HMO Rider	$34,591.00
Rate for Payer: United Healthcare Select/Navigate/Core	$31,692.00

MS-DRG 42.00: CERVICAL SPINAL FUSION WITHOUT CC/MCC

Facility

$71,770.10

Service Code	MSDRG 473
Min. Negotiated Rate	$22,963.00
Max. Negotiated Rate	$71,770.10
Rate for Payer: Aetna of CA HMO/PPO	$71,770.10
Rate for Payer: EPIC Health Plan Commercial	$58,475.13
Rate for Payer: EPIC Health Plan Senior	$43,314.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$43,314.91
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$43,314.91
Rate for Payer: Molina Healthcare of CA Medicare	$58,041.98
Rate for Payer: Multiplan WC	$44,226.47
Rate for Payer: Prime Health Services WC	$43,775.18
Rate for Payer: United Healthcare All Other Commercial	$42,292.00
Rate for Payer: United Healthcare All Other HMO	$32,996.00
Rate for Payer: United Healthcare HMO Rider	$25,065.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,963.00

MS-DRG 42.00: CESAREAN SECTION WITHOUT STERILIZATION WITH CC

Facility

$39,935.97

Service Code	MSDRG 787
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$39,935.97
Rate for Payer: Aetna of CA HMO/PPO	$32,189.53
Rate for Payer: Cigna of CA PPO	$6,000.00
Rate for Payer: EPIC Health Plan Commercial	$39,935.97
Rate for Payer: EPIC Health Plan Senior	$29,582.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,582.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,582.20
Rate for Payer: Molina Healthcare of CA Medicare	$39,640.15
Rate for Payer: Multiplan WC	$19,835.96
Rate for Payer: Prime Health Services WC	$19,633.56
Rate for Payer: United Healthcare All Other Commercial	$17,587.00
Rate for Payer: United Healthcare All Other HMO	$12,305.00
Rate for Payer: United Healthcare HMO Rider	$10,716.00
Rate for Payer: United Healthcare Select/Navigate/Core	$9,817.00

MS-DRG 42.00: CESAREAN SECTION WITHOUT STERILIZATION WITH MCC

Facility

$48,987.62

Service Code	MSDRG 786
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$48,987.62
Rate for Payer: Aetna of CA HMO/PPO	$48,987.62
Rate for Payer: Cigna of CA PPO	$6,000.00
Rate for Payer: EPIC Health Plan Commercial	$47,804.05
Rate for Payer: EPIC Health Plan Senior	$35,410.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,410.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,410.41
Rate for Payer: Molina Healthcare of CA Medicare	$47,449.95
Rate for Payer: Multiplan WC	$30,187.36
Rate for Payer: Prime Health Services WC	$29,879.33
Rate for Payer: United Healthcare All Other Commercial	$17,587.00
Rate for Payer: United Healthcare All Other HMO	$12,305.00
Rate for Payer: United Healthcare HMO Rider	$10,716.00
Rate for Payer: United Healthcare Select/Navigate/Core	$9,817.00

MS-DRG 42.00: CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC

Facility

$37,705.20

Service Code	MSDRG 788
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$37,705.20
Rate for Payer: Aetna of CA HMO/PPO	$27,426.89
Rate for Payer: Cigna of CA PPO	$6,000.00
Rate for Payer: EPIC Health Plan Commercial	$37,705.20
Rate for Payer: EPIC Health Plan Senior	$27,929.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,929.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,929.78
Rate for Payer: Molina Healthcare of CA Medicare	$37,425.91
Rate for Payer: Multiplan WC	$16,901.11
Rate for Payer: Prime Health Services WC	$16,728.65
Rate for Payer: United Healthcare All Other Commercial	$17,587.00
Rate for Payer: United Healthcare All Other HMO	$12,305.00
Rate for Payer: United Healthcare HMO Rider	$10,716.00
Rate for Payer: United Healthcare Select/Navigate/Core	$9,817.00

MS-DRG 42.00: CESAREAN SECTION WITH STERILIZATION WITH CC

Facility

$40,237.01

Service Code	MSDRG 784
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$40,237.01
Rate for Payer: Aetna of CA HMO/PPO	$32,832.23
Rate for Payer: Cigna of CA PPO	$6,000.00
Rate for Payer: EPIC Health Plan Commercial	$40,237.01
Rate for Payer: EPIC Health Plan Senior	$29,805.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,805.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,805.19
Rate for Payer: Molina Healthcare of CA Medicare	$39,938.95
Rate for Payer: Multiplan WC	$20,232.01
Rate for Payer: Prime Health Services WC	$20,025.56
Rate for Payer: United Healthcare All Other Commercial	$17,587.00
Rate for Payer: United Healthcare All Other HMO	$12,305.00
Rate for Payer: United Healthcare HMO Rider	$10,716.00
Rate for Payer: United Healthcare Select/Navigate/Core	$9,817.00

MS-DRG 42.00: CESAREAN SECTION WITH STERILIZATION WITH MCC

Facility

$55,845.10

Service Code	MSDRG 783
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$55,845.10
Rate for Payer: Aetna of CA HMO/PPO	$55,845.10
Rate for Payer: Cigna of CA PPO	$6,000.00
Rate for Payer: EPIC Health Plan Commercial	$51,016.03
Rate for Payer: EPIC Health Plan Senior	$37,789.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,789.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,789.65
Rate for Payer: Molina Healthcare of CA Medicare	$50,638.13
Rate for Payer: Multiplan WC	$34,413.10
Rate for Payer: Prime Health Services WC	$34,061.95
Rate for Payer: United Healthcare All Other Commercial	$17,587.00
Rate for Payer: United Healthcare All Other HMO	$12,305.00
Rate for Payer: United Healthcare HMO Rider	$10,716.00
Rate for Payer: United Healthcare Select/Navigate/Core	$9,817.00

MS-DRG 42.00: CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC

Facility

$37,262.17

Service Code	MSDRG 785
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$37,262.17
Rate for Payer: Aetna of CA HMO/PPO	$26,481.03
Rate for Payer: Cigna of CA PPO	$6,000.00
Rate for Payer: EPIC Health Plan Commercial	$37,262.17
Rate for Payer: EPIC Health Plan Senior	$27,601.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,601.61
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,601.61
Rate for Payer: Molina Healthcare of CA Medicare	$36,986.16
Rate for Payer: Multiplan WC	$16,318.25
Rate for Payer: Prime Health Services WC	$16,151.74
Rate for Payer: United Healthcare All Other Commercial	$17,587.00
Rate for Payer: United Healthcare All Other HMO	$12,305.00
Rate for Payer: United Healthcare HMO Rider	$10,716.00
Rate for Payer: United Healthcare Select/Navigate/Core	$9,817.00

MS-DRG 42.00: CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC

Facility

$151,798.28

Service Code	MSDRG 837
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$151,798.28
Rate for Payer: Aetna of CA HMO/PPO	$151,798.28
Rate for Payer: EPIC Health Plan Commercial	$95,959.54
Rate for Payer: EPIC Health Plan Senior	$71,081.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$71,081.14
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$71,081.14
Rate for Payer: Molina Healthcare of CA Medicare	$95,248.73
Rate for Payer: Multiplan WC	$93,541.77
Rate for Payer: Prime Health Services WC	$92,587.27
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: CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT

Facility

$61,486.91

Service Code	MSDRG 838
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$61,486.91
Rate for Payer: Aetna of CA HMO/PPO	$61,486.91
Rate for Payer: EPIC Health Plan Commercial	$53,658.60
Rate for Payer: EPIC Health Plan Senior	$39,747.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,747.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,747.11
Rate for Payer: Molina Healthcare of CA Medicare	$53,261.13
Rate for Payer: Multiplan WC	$37,889.72
Rate for Payer: Prime Health Services WC	$37,503.09
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: CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC

Facility

$44,318.02

Service Code	MSDRG 839
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$44,318.02
Rate for Payer: Aetna of CA HMO/PPO	$41,545.05
Rate for Payer: EPIC Health Plan Commercial	$44,318.02
Rate for Payer: EPIC Health Plan Senior	$32,828.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,828.16
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,828.16
Rate for Payer: Molina Healthcare of CA Medicare	$43,989.73
Rate for Payer: Multiplan WC	$25,601.07
Rate for Payer: Prime Health Services WC	$25,339.83
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: CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC

Facility

$42,902.31

Service Code	MSDRG 847
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$42,902.31
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: 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: CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC

Facility

$77,421.00

Service Code	MSDRG 846
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$77,421.00
Rate for Payer: Aetna of CA HMO/PPO	$77,421.00
Rate for Payer: EPIC Health Plan Commercial	$61,121.97
Rate for Payer: EPIC Health Plan Senior	$45,275.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$45,275.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$45,275.53
Rate for Payer: Molina Healthcare of CA Medicare	$60,669.21
Rate for Payer: Multiplan WC	$47,708.69
Rate for Payer: Prime Health Services WC	$47,221.87
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: CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC

Facility

$36,486.88

Service Code	MSDRG 848
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$36,486.88
Rate for Payer: Aetna of CA HMO/PPO	$24,825.77
Rate for Payer: EPIC Health Plan Commercial	$36,486.88
Rate for Payer: EPIC Health Plan Senior	$27,027.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,027.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,027.32
Rate for Payer: Molina Healthcare of CA Medicare	$36,216.61
Rate for Payer: Multiplan WC	$15,298.24
Rate for Payer: Prime Health Services WC	$15,142.14
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: CHEST PAIN

Facility

$34,988.80

Service Code	MSDRG 313
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,988.80
Rate for Payer: Aetna of CA HMO/PPO	$21,627.43
Rate for Payer: EPIC Health Plan Commercial	$34,988.80
Rate for Payer: EPIC Health Plan Senior	$25,917.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,917.63
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,917.63
Rate for Payer: Molina Healthcare of CA Medicare	$34,729.62
Rate for Payer: Multiplan WC	$13,327.35
Rate for Payer: Prime Health Services WC	$13,191.36
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