Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC

Facility

$39,410.59

Service Code	MSDRG 745
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$39,410.59
Rate for Payer: Aetna of CA HMO/PPO	$31,067.84
Rate for Payer: EPIC Health Plan Commercial	$39,410.59
Rate for Payer: EPIC Health Plan Senior	$29,193.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,193.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,193.03
Rate for Payer: Molina Healthcare of CA Medicare	$39,118.66
Rate for Payer: Multiplan WC	$19,144.75
Rate for Payer: Prime Health Services WC	$18,949.40
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: DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC

Facility

$42,295.99

Service Code	MSDRG 294
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$42,295.99
Rate for Payer: Aetna of CA HMO/PPO	$37,228.05
Rate for Payer: EPIC Health Plan Commercial	$42,295.99
Rate for Payer: EPIC Health Plan Senior	$31,330.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,330.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,330.36
Rate for Payer: Molina Healthcare of CA Medicare	$41,982.68
Rate for Payer: Multiplan WC	$22,940.83
Rate for Payer: Prime Health Services WC	$22,706.74
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: DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC

Facility

$36,073.67

Service Code	MSDRG 295
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$36,073.67
Rate for Payer: Aetna of CA HMO/PPO	$23,943.58
Rate for Payer: EPIC Health Plan Commercial	$36,073.67
Rate for Payer: EPIC Health Plan Senior	$26,721.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,721.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,721.24
Rate for Payer: Molina Healthcare of CA Medicare	$35,806.46
Rate for Payer: Multiplan WC	$14,754.62
Rate for Payer: Prime Health Services WC	$14,604.06
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: DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC

Facility

$75,914.30

Service Code	MSDRG 056
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$75,914.30
Rate for Payer: Aetna of CA HMO/PPO	$75,914.30
Rate for Payer: EPIC Health Plan Commercial	$60,416.23
Rate for Payer: EPIC Health Plan Senior	$44,752.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$44,752.76
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$44,752.76
Rate for Payer: Molina Healthcare of CA Medicare	$59,968.70
Rate for Payer: Multiplan WC	$46,780.23
Rate for Payer: Prime Health Services WC	$46,302.88
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: DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC

Facility

$43,806.82

Service Code	MSDRG 057
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$43,806.82
Rate for Payer: Aetna of CA HMO/PPO	$40,453.67
Rate for Payer: EPIC Health Plan Commercial	$43,806.82
Rate for Payer: EPIC Health Plan Senior	$32,449.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,449.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,449.50
Rate for Payer: Molina Healthcare of CA Medicare	$43,482.33
Rate for Payer: Multiplan WC	$24,928.53
Rate for Payer: Prime Health Services WC	$24,674.16
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: DENTAL AND ORAL DISEASES WITH CC

Facility

$38,214.98

Service Code	MSDRG 158
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$38,214.98
Rate for Payer: Aetna of CA HMO/PPO	$28,515.23
Rate for Payer: EPIC Health Plan Commercial	$38,214.98
Rate for Payer: EPIC Health Plan Senior	$28,307.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,307.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,307.39
Rate for Payer: Molina Healthcare of CA Medicare	$37,931.90
Rate for Payer: Multiplan WC	$17,571.77
Rate for Payer: Prime Health Services WC	$17,392.47
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: DENTAL AND ORAL DISEASES WITH MCC

Facility

$49,642.45

Service Code	MSDRG 157
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$49,642.45
Rate for Payer: Aetna of CA HMO/PPO	$49,642.45
Rate for Payer: EPIC Health Plan Commercial	$48,110.76
Rate for Payer: EPIC Health Plan Senior	$35,637.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,637.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,637.60
Rate for Payer: Molina Healthcare of CA Medicare	$47,754.38
Rate for Payer: Multiplan WC	$30,590.88
Rate for Payer: Prime Health Services WC	$30,278.72
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: DENTAL AND ORAL DISEASES WITHOUT CC/MCC

Facility

$34,224.86

Service Code	MSDRG 159
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,224.86
Rate for Payer: Aetna of CA HMO/PPO	$19,996.43
Rate for Payer: EPIC Health Plan Commercial	$34,224.86
Rate for Payer: EPIC Health Plan Senior	$25,351.75
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,351.75
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,351.75
Rate for Payer: Molina Healthcare of CA Medicare	$33,971.35
Rate for Payer: Multiplan WC	$12,322.28
Rate for Payer: Prime Health Services WC	$12,196.55
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: DEPRESSIVE NEUROSES

Facility

$37,838.69

Service Code	MSDRG 881
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,838.69
Rate for Payer: Aetna of CA HMO/PPO	$27,711.86
Rate for Payer: EPIC Health Plan Commercial	$37,838.69
Rate for Payer: EPIC Health Plan Senior	$28,028.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,028.66
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,028.66
Rate for Payer: Molina Healthcare of CA Medicare	$37,558.40
Rate for Payer: Multiplan WC	$17,076.72
Rate for Payer: Prime Health Services WC	$16,902.46
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: DIABETES WITH CC

Facility

$37,882.70

Service Code	MSDRG 638
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,882.70
Rate for Payer: Aetna of CA HMO/PPO	$27,805.84
Rate for Payer: EPIC Health Plan Commercial	$37,882.70
Rate for Payer: EPIC Health Plan Senior	$28,061.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,061.26
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,061.26
Rate for Payer: Molina Healthcare of CA Medicare	$37,602.09
Rate for Payer: Multiplan WC	$17,134.63
Rate for Payer: Prime Health Services WC	$16,959.79
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: DIABETES WITH MCC

Facility

$45,537.77

Service Code	MSDRG 637
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$45,537.77
Rate for Payer: Aetna of CA HMO/PPO	$44,149.19
Rate for Payer: EPIC Health Plan Commercial	$45,537.77
Rate for Payer: EPIC Health Plan Senior	$33,731.68
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,731.68
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,731.68
Rate for Payer: Molina Healthcare of CA Medicare	$45,200.45
Rate for Payer: Multiplan WC	$27,205.80
Rate for Payer: Prime Health Services WC	$26,928.19
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

MS-DRG 42.00: DIABETES WITHOUT CC/MCC

Facility

$33,756.25

Service Code	MSDRG 639
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$33,756.25
Rate for Payer: Aetna of CA HMO/PPO	$18,996.01
Rate for Payer: EPIC Health Plan Commercial	$33,756.25
Rate for Payer: EPIC Health Plan Senior	$25,004.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,004.63
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,004.63
Rate for Payer: Molina Healthcare of CA Medicare	$33,506.20
Rate for Payer: Multiplan WC	$11,705.80
Rate for Payer: Prime Health Services WC	$11,586.35
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: DIGESTIVE MALIGNANCY WITH CC

Facility

$42,305.92

Service Code	MSDRG 375
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$42,305.92
Rate for Payer: Aetna of CA HMO/PPO	$37,249.27
Rate for Payer: EPIC Health Plan Commercial	$42,305.92
Rate for Payer: EPIC Health Plan Senior	$31,337.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,337.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,337.72
Rate for Payer: Molina Healthcare of CA Medicare	$41,992.54
Rate for Payer: Multiplan WC	$22,953.90
Rate for Payer: Prime Health Services WC	$22,719.68
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: DIGESTIVE MALIGNANCY WITH MCC

Facility

$64,009.20

Service Code	MSDRG 374
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$64,009.20
Rate for Payer: Aetna of CA HMO/PPO	$64,009.20
Rate for Payer: EPIC Health Plan Commercial	$54,840.01
Rate for Payer: EPIC Health Plan Senior	$40,622.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$40,622.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,622.23
Rate for Payer: Molina Healthcare of CA Medicare	$54,433.79
Rate for Payer: Multiplan WC	$39,444.02
Rate for Payer: Prime Health Services WC	$39,041.53
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: DIGESTIVE MALIGNANCY WITHOUT CC/MCC

Facility

$37,397.07

Service Code	MSDRG 376
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,397.07
Rate for Payer: Aetna of CA HMO/PPO	$26,769.03
Rate for Payer: EPIC Health Plan Commercial	$37,397.07
Rate for Payer: EPIC Health Plan Senior	$27,701.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,701.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,701.53
Rate for Payer: Molina Healthcare of CA Medicare	$37,120.05
Rate for Payer: Multiplan WC	$16,495.72
Rate for Payer: Prime Health Services WC	$16,327.40
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: DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC

Facility

$38,578.48

Service Code	MSDRG 442
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$38,578.48
Rate for Payer: Aetna of CA HMO/PPO	$29,291.32
Rate for Payer: EPIC Health Plan Commercial	$38,578.48
Rate for Payer: EPIC Health Plan Senior	$28,576.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,576.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,576.65
Rate for Payer: Molina Healthcare of CA Medicare	$38,292.71
Rate for Payer: Multiplan WC	$18,050.02
Rate for Payer: Prime Health Services WC	$17,865.84
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: DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC

Facility

$57,309.37

Service Code	MSDRG 441
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$57,309.37
Rate for Payer: Aetna of CA HMO/PPO	$57,309.37
Rate for Payer: EPIC Health Plan Commercial	$51,701.88
Rate for Payer: EPIC Health Plan Senior	$38,297.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$38,297.69
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$38,297.69
Rate for Payer: Molina Healthcare of CA Medicare	$51,318.90
Rate for Payer: Multiplan WC	$35,315.42
Rate for Payer: Prime Health Services WC	$34,955.06
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: DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC

Facility

$34,836.86

Service Code	MSDRG 443
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,836.86
Rate for Payer: Aetna of CA HMO/PPO	$21,303.05
Rate for Payer: EPIC Health Plan Commercial	$34,836.86
Rate for Payer: EPIC Health Plan Senior	$25,805.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,805.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,805.08
Rate for Payer: Molina Healthcare of CA Medicare	$34,578.81
Rate for Payer: Multiplan WC	$13,127.45
Rate for Payer: Prime Health Services WC	$12,993.50
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: DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC

Facility

$37,073.32

Service Code	MSDRG 439
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,073.32
Rate for Payer: Aetna of CA HMO/PPO	$26,077.82
Rate for Payer: EPIC Health Plan Commercial	$37,073.32
Rate for Payer: EPIC Health Plan Senior	$27,461.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,461.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,461.72
Rate for Payer: Molina Healthcare of CA Medicare	$36,798.70
Rate for Payer: Multiplan WC	$16,069.79
Rate for Payer: Prime Health Services WC	$15,905.81
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: DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC

Facility

$50,436.73

Service Code	MSDRG 438
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$50,436.73
Rate for Payer: Aetna of CA HMO/PPO	$50,436.73
Rate for Payer: EPIC Health Plan Commercial	$48,482.79
Rate for Payer: EPIC Health Plan Senior	$35,913.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,913.18
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,913.18
Rate for Payer: Molina Healthcare of CA Medicare	$48,123.66
Rate for Payer: Multiplan WC	$31,080.34
Rate for Payer: Prime Health Services WC	$30,763.19
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

MS-DRG 42.00: DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC

Facility

$33,592.95

Service Code	MSDRG 440
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$33,592.95
Rate for Payer: Aetna of CA HMO/PPO	$18,647.37
Rate for Payer: EPIC Health Plan Commercial	$33,592.95
Rate for Payer: EPIC Health Plan Senior	$24,883.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,883.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,883.67
Rate for Payer: Molina Healthcare of CA Medicare	$33,344.12
Rate for Payer: Multiplan WC	$11,490.96
Rate for Payer: Prime Health Services WC	$11,373.71
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: DISORDERS OF PERSONALITY AND IMPULSE CONTROL

Facility

$56,202.83

Service Code	MSDRG 883
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$56,202.83
Rate for Payer: Aetna of CA HMO/PPO	$56,202.83
Rate for Payer: EPIC Health Plan Commercial	$51,183.59
Rate for Payer: EPIC Health Plan Senior	$37,913.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,913.77
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,913.77
Rate for Payer: Molina Healthcare of CA Medicare	$50,804.45
Rate for Payer: Multiplan WC	$34,633.54
Rate for Payer: Prime Health Services WC	$34,280.14
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: DISORDERS OF THE BILIARY TRACT WITH CC

Facility

$40,258.31

Service Code	MSDRG 445
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$40,258.31
Rate for Payer: Aetna of CA HMO/PPO	$32,877.70
Rate for Payer: EPIC Health Plan Commercial	$40,258.31
Rate for Payer: EPIC Health Plan Senior	$29,820.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,820.97
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,820.97
Rate for Payer: Molina Healthcare of CA Medicare	$39,960.10
Rate for Payer: Multiplan WC	$20,260.04
Rate for Payer: Prime Health Services WC	$20,053.30
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: DISORDERS OF THE BILIARY TRACT WITH MCC

Facility

$51,064.27

Service Code	MSDRG 444
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$51,064.27
Rate for Payer: Aetna of CA HMO/PPO	$51,064.27
Rate for Payer: EPIC Health Plan Commercial	$48,776.73
Rate for Payer: EPIC Health Plan Senior	$36,130.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,130.91
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,130.91
Rate for Payer: Molina Healthcare of CA Medicare	$48,415.42
Rate for Payer: Multiplan WC	$31,467.05
Rate for Payer: Prime Health Services WC	$31,145.95
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: DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC

Facility

$36,180.16

Service Code	MSDRG 446
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$36,180.16
Rate for Payer: Aetna of CA HMO/PPO	$24,170.95
Rate for Payer: EPIC Health Plan Commercial	$36,180.16
Rate for Payer: EPIC Health Plan Senior	$26,800.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,800.12
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,800.12
Rate for Payer: Molina Healthcare of CA Medicare	$35,912.16
Rate for Payer: Multiplan WC	$14,894.73
Rate for Payer: Prime Health Services WC	$14,742.74
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