Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: CHOLECYSTECTOMY WITH C.D.E. WITH CC

Facility

$64,621.59

Service Code	MSDRG 412
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$64,621.59
Rate for Payer: Aetna of CA HMO/PPO	$64,621.59
Rate for Payer: EPIC Health Plan Commercial	$55,125.17
Rate for Payer: EPIC Health Plan Senior	$40,833.46
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$40,833.46
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,833.46
Rate for Payer: Molina Healthcare of CA Medicare	$54,716.84
Rate for Payer: Multiplan WC	$39,821.39
Rate for Payer: Prime Health Services WC	$39,415.05
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: CHOLECYSTECTOMY WITH C.D.E. WITH MCC

Facility

$82,956.70

Service Code	MSDRG 411
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$82,956.70
Rate for Payer: Aetna of CA HMO/PPO	$82,956.70
Rate for Payer: EPIC Health Plan Commercial	$63,713.16
Rate for Payer: EPIC Health Plan Senior	$47,194.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$47,194.93
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$47,194.93
Rate for Payer: Molina Healthcare of CA Medicare	$63,241.21
Rate for Payer: Multiplan WC	$51,119.93
Rate for Payer: Prime Health Services WC	$50,598.29
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: CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC

Facility

$50,400.35

Service Code	MSDRG 413
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$50,400.35
Rate for Payer: Aetna of CA HMO/PPO	$50,400.35
Rate for Payer: EPIC Health Plan Commercial	$48,464.10
Rate for Payer: EPIC Health Plan Senior	$35,899.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,899.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,899.33
Rate for Payer: Molina Healthcare of CA Medicare	$48,105.10
Rate for Payer: Multiplan WC	$31,057.92
Rate for Payer: Prime Health Services WC	$30,741.00
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: CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC

Facility

$37,056.03

Service Code	MSDRG 191
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,056.03
Rate for Payer: Aetna of CA HMO/PPO	$26,044.48
Rate for Payer: EPIC Health Plan Commercial	$37,056.03
Rate for Payer: EPIC Health Plan Senior	$27,448.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,448.91
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,448.91
Rate for Payer: Molina Healthcare of CA Medicare	$36,781.54
Rate for Payer: Multiplan WC	$16,049.23
Rate for Payer: Prime Health Services WC	$15,885.47
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: CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC

Facility

$40,803.35

Service Code	MSDRG 190
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$40,803.35
Rate for Payer: Aetna of CA HMO/PPO	$34,044.87
Rate for Payer: EPIC Health Plan Commercial	$40,803.35
Rate for Payer: EPIC Health Plan Senior	$30,224.70
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,224.70
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,224.70
Rate for Payer: Molina Healthcare of CA Medicare	$40,501.10
Rate for Payer: Multiplan WC	$20,979.27
Rate for Payer: Prime Health Services WC	$20,765.20
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: CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC

Facility

$34,047.12

Service Code	MSDRG 192
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,047.12
Rate for Payer: Aetna of CA HMO/PPO	$19,620.52
Rate for Payer: EPIC Health Plan Commercial	$34,047.12
Rate for Payer: EPIC Health Plan Senior	$25,220.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,220.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,220.09
Rate for Payer: Molina Healthcare of CA Medicare	$33,794.92
Rate for Payer: Multiplan WC	$12,090.63
Rate for Payer: Prime Health Services WC	$11,967.26
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: CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC

Facility

$67,098.40

Service Code	MSDRG 286
Min. Negotiated Rate	$4,504.00
Max. Negotiated Rate	$67,098.40
Rate for Payer: Aetna of CA HMO/PPO	$67,098.40
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$56,285.29
Rate for Payer: EPIC Health Plan Senior	$41,692.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$41,692.81
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$41,692.81
Rate for Payer: Molina Healthcare of CA Medicare	$55,868.37
Rate for Payer: Multiplan WC	$41,347.66
Rate for Payer: Prime Health Services WC	$40,925.75
Rate for Payer: United Healthcare All Other Commercial	$20,829.00
Rate for Payer: United Healthcare All Other HMO	$20,011.00
Rate for Payer: United Healthcare HMO Rider	$15,202.00
Rate for Payer: United Healthcare Select/Navigate/Core	$13,927.00

MS-DRG 42.00: CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC

Facility

$40,330.48

Service Code	MSDRG 287
Min. Negotiated Rate	$4,504.00
Max. Negotiated Rate	$40,330.48
Rate for Payer: Aetna of CA HMO/PPO	$33,035.35
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$40,330.48
Rate for Payer: EPIC Health Plan Senior	$29,874.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,874.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,874.43
Rate for Payer: Molina Healthcare of CA Medicare	$40,031.74
Rate for Payer: Multiplan WC	$20,357.18
Rate for Payer: Prime Health Services WC	$20,149.45
Rate for Payer: United Healthcare All Other Commercial	$27,003.00
Rate for Payer: United Healthcare All Other HMO	$19,364.00
Rate for Payer: United Healthcare HMO Rider	$14,707.00
Rate for Payer: United Healthcare Select/Navigate/Core	$13,475.00

MS-DRG 42.00: CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC

Facility

$40,047.91

Service Code	MSDRG 433
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$40,047.91
Rate for Payer: Aetna of CA HMO/PPO	$32,432.06
Rate for Payer: EPIC Health Plan Commercial	$40,047.91
Rate for Payer: EPIC Health Plan Senior	$29,665.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,665.12
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,665.12
Rate for Payer: Molina Healthcare of CA Medicare	$39,751.26
Rate for Payer: Multiplan WC	$19,985.42
Rate for Payer: Prime Health Services WC	$19,781.49
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: CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC

Facility

$59,392.08

Service Code	MSDRG 432
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$59,392.08
Rate for Payer: Aetna of CA HMO/PPO	$59,392.08
Rate for Payer: EPIC Health Plan Commercial	$52,675.72
Rate for Payer: EPIC Health Plan Senior	$39,019.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,019.05
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,019.05
Rate for Payer: Molina Healthcare of CA Medicare	$52,285.53
Rate for Payer: Multiplan WC	$36,598.83
Rate for Payer: Prime Health Services WC	$36,225.38
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: CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC

Facility

$34,747.18

Service Code	MSDRG 434
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,747.18
Rate for Payer: Aetna of CA HMO/PPO	$21,115.09
Rate for Payer: EPIC Health Plan Commercial	$34,747.18
Rate for Payer: EPIC Health Plan Senior	$25,738.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,738.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,738.65
Rate for Payer: Molina Healthcare of CA Medicare	$34,489.79
Rate for Payer: Multiplan WC	$13,011.64
Rate for Payer: Prime Health Services WC	$12,878.86
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: COAGULATION DISORDERS

Facility

$46,929.17

Service Code	MSDRG 813
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$46,929.17
Rate for Payer: Aetna of CA HMO/PPO	$46,929.17
Rate for Payer: EPIC Health Plan Commercial	$46,838.22
Rate for Payer: EPIC Health Plan Senior	$34,694.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,694.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,694.98
Rate for Payer: Molina Healthcare of CA Medicare	$46,491.27
Rate for Payer: Multiplan WC	$28,918.89
Rate for Payer: Prime Health Services WC	$28,623.80
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: COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC

Facility

$252,853.63

Service Code	MSDRG 429
Min. Negotiated Rate	$106,141.64
Max. Negotiated Rate	$252,853.63
Rate for Payer: Aetna of CA HMO/PPO	$252,853.63
Rate for Payer: EPIC Health Plan Commercial	$143,291.21
Rate for Payer: EPIC Health Plan Senior	$106,141.64
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$106,141.64
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$106,141.64
Rate for Payer: Molina Healthcare of CA Medicare	$142,229.80
Rate for Payer: Multiplan WC	$155,814.53
Rate for Payer: Prime Health Services WC	$154,224.59

MS-DRG 42.00: COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC

Facility

$165,843.68

Service Code	MSDRG 430
Min. Negotiated Rate	$75,953.06
Max. Negotiated Rate	$165,843.68
Rate for Payer: Aetna of CA HMO/PPO	$165,843.68
Rate for Payer: EPIC Health Plan Commercial	$102,536.63
Rate for Payer: EPIC Health Plan Senior	$75,953.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$75,953.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$75,953.06
Rate for Payer: Molina Healthcare of CA Medicare	$101,777.10
Rate for Payer: Multiplan WC	$102,196.89
Rate for Payer: Prime Health Services WC	$101,154.06

MS-DRG 42.00: COMPLICATED PEPTIC ULCER WITH CC

Facility

$40,321.98

Service Code	MSDRG 381
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$40,321.98
Rate for Payer: Aetna of CA HMO/PPO	$33,017.16
Rate for Payer: EPIC Health Plan Commercial	$40,321.98
Rate for Payer: EPIC Health Plan Senior	$29,868.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,868.13
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,868.13
Rate for Payer: Molina Healthcare of CA Medicare	$40,023.29
Rate for Payer: Multiplan WC	$20,345.98
Rate for Payer: Prime Health Services WC	$20,138.36
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

MS-DRG 42.00: COMPLICATED PEPTIC ULCER WITH MCC

Facility

$58,337.08

Service Code	MSDRG 380
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$58,337.08
Rate for Payer: Aetna of CA HMO/PPO	$58,337.08
Rate for Payer: EPIC Health Plan Commercial	$52,181.58
Rate for Payer: EPIC Health Plan Senior	$38,653.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$38,653.02
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$38,653.02
Rate for Payer: Molina Healthcare of CA Medicare	$51,795.05
Rate for Payer: Multiplan WC	$35,948.72
Rate for Payer: Prime Health Services WC	$35,581.90
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: COMPLICATED PEPTIC ULCER WITHOUT CC/MCC

Facility

$35,496.90

Service Code	MSDRG 382
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$35,496.90
Rate for Payer: Aetna of CA HMO/PPO	$22,715.78
Rate for Payer: EPIC Health Plan Commercial	$35,496.90
Rate for Payer: EPIC Health Plan Senior	$26,294.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,294.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,294.00
Rate for Payer: Molina Healthcare of CA Medicare	$35,233.96
Rate for Payer: Multiplan WC	$13,998.02
Rate for Payer: Prime Health Services WC	$13,855.18
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: COMPLICATIONS OF TREATMENT WITH CC

Facility

$39,282.56

Service Code	MSDRG 920
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$39,282.56
Rate for Payer: Aetna of CA HMO/PPO	$30,798.02
Rate for Payer: EPIC Health Plan Commercial	$39,282.56
Rate for Payer: EPIC Health Plan Senior	$29,098.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,098.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,098.19
Rate for Payer: Molina Healthcare of CA Medicare	$38,991.57
Rate for Payer: Multiplan WC	$18,978.49
Rate for Payer: Prime Health Services WC	$18,784.84
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: COMPLICATIONS OF TREATMENT WITH MCC

Facility

$55,284.26

Service Code	MSDRG 919
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$55,284.26
Rate for Payer: Aetna of CA HMO/PPO	$55,284.26
Rate for Payer: EPIC Health Plan Commercial	$50,751.67
Rate for Payer: EPIC Health Plan Senior	$37,593.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,593.83
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,593.83
Rate for Payer: Molina Healthcare of CA Medicare	$50,375.73
Rate for Payer: Multiplan WC	$34,067.50
Rate for Payer: Prime Health Services WC	$33,719.87
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: COMPLICATIONS OF TREATMENT WITHOUT CC/MCC

Facility

$34,622.19

Service Code	MSDRG 921
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,622.19
Rate for Payer: Aetna of CA HMO/PPO	$20,848.31
Rate for Payer: EPIC Health Plan Commercial	$34,622.19
Rate for Payer: EPIC Health Plan Senior	$25,646.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,646.07
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,646.07
Rate for Payer: Molina Healthcare of CA Medicare	$34,365.73
Rate for Payer: Multiplan WC	$12,847.23
Rate for Payer: Prime Health Services WC	$12,716.14
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: CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES

Facility

$330,259.47

Service Code	MSDRG 212
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$330,259.47
Rate for Payer: Aetna of CA HMO/PPO	$330,259.47
Rate for Payer: EPIC Health Plan Commercial	$179,547.35
Rate for Payer: EPIC Health Plan Senior	$132,998.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$132,998.04
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$132,998.04
Rate for Payer: Molina Healthcare of CA Medicare	$178,217.37
Rate for Payer: Multiplan WC	$203,513.89
Rate for Payer: Prime Health Services WC	$201,437.21
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: CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION

Facility

$187,546.90

Service Code	MSDRG 317
Min. Negotiated Rate	$83,483.10
Max. Negotiated Rate	$187,546.90
Rate for Payer: Aetna of CA HMO/PPO	$187,546.90
Rate for Payer: EPIC Health Plan Commercial	$112,702.18
Rate for Payer: EPIC Health Plan Senior	$83,483.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$83,483.10
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$83,483.10
Rate for Payer: Molina Healthcare of CA Medicare	$111,867.35
Rate for Payer: Multiplan WC	$115,570.95
Rate for Payer: Prime Health Services WC	$114,391.65

MS-DRG 42.00: CONCUSSION WITH CC

Facility

$40,080.58

Service Code	MSDRG 089
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$40,080.58
Rate for Payer: Aetna of CA HMO/PPO	$32,501.78
Rate for Payer: EPIC Health Plan Commercial	$40,080.58
Rate for Payer: EPIC Health Plan Senior	$29,689.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,689.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,689.32
Rate for Payer: Molina Healthcare of CA Medicare	$39,783.69
Rate for Payer: Multiplan WC	$20,028.39
Rate for Payer: Prime Health Services WC	$19,824.02
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: CONCUSSION WITH MCC

Facility

$44,888.59

Service Code	MSDRG 088
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$44,888.59
Rate for Payer: Aetna of CA HMO/PPO	$42,766.78
Rate for Payer: EPIC Health Plan Commercial	$44,888.59
Rate for Payer: EPIC Health Plan Senior	$33,250.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,250.81
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,250.81
Rate for Payer: Molina Healthcare of CA Medicare	$44,556.09
Rate for Payer: Multiplan WC	$26,353.92
Rate for Payer: Prime Health Services WC	$26,085.01
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: CONCUSSION WITHOUT CC/MCC

Facility

$37,030.47

Service Code	MSDRG 090
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,030.47
Rate for Payer: Aetna of CA HMO/PPO	$25,989.91
Rate for Payer: EPIC Health Plan Commercial	$37,030.47
Rate for Payer: EPIC Health Plan Senior	$27,429.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,429.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,429.98
Rate for Payer: Molina Healthcare of CA Medicare	$36,756.17
Rate for Payer: Multiplan WC	$16,015.61
Rate for Payer: Prime Health Services WC	$15,852.19
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