Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: HYPERTENSIVE ENCEPHALOPATHY WITH MCC

Facility

$46,877.63

Service Code	MSDRG 077
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$46,877.63
Rate for Payer: Aetna of CA HMO/PPO	$46,877.63
Rate for Payer: EPIC Health Plan Commercial	$46,815.73
Rate for Payer: EPIC Health Plan Senior	$34,678.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,678.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,678.32
Rate for Payer: Molina Healthcare of CA Medicare	$46,468.95
Rate for Payer: Multiplan WC	$28,887.14
Rate for Payer: Prime Health Services WC	$28,592.37
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: HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC

Facility

$34,325.68

Service Code	MSDRG 079
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,325.68
Rate for Payer: Aetna of CA HMO/PPO	$20,211.68
Rate for Payer: EPIC Health Plan Commercial	$34,325.68
Rate for Payer: EPIC Health Plan Senior	$25,426.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,426.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,426.43
Rate for Payer: Molina Healthcare of CA Medicare	$34,071.42
Rate for Payer: Multiplan WC	$12,454.93
Rate for Payer: Prime Health Services WC	$12,327.84
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: INBORN AND OTHER DISORDERS OF METABOLISM

Facility

$42,482.00

Service Code	MSDRG 642
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$42,482.00
Rate for Payer: Aetna of CA HMO/PPO	$37,625.19
Rate for Payer: EPIC Health Plan Commercial	$42,482.00
Rate for Payer: EPIC Health Plan Senior	$31,468.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,468.15
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,468.15
Rate for Payer: Molina Healthcare of CA Medicare	$42,167.32
Rate for Payer: Multiplan WC	$23,185.56
Rate for Payer: Prime Health Services WC	$22,948.97
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: INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC

Facility

$39,332.49

Service Code	MSDRG 758
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$39,332.49
Rate for Payer: Aetna of CA HMO/PPO	$30,901.10
Rate for Payer: EPIC Health Plan Commercial	$39,332.49
Rate for Payer: EPIC Health Plan Senior	$29,135.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,135.18
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,135.18
Rate for Payer: Molina Healthcare of CA Medicare	$39,041.14
Rate for Payer: Multiplan WC	$19,042.01
Rate for Payer: Prime Health Services WC	$18,847.70
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: INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$44,955.59

Service Code	MSDRG 757
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$44,955.59
Rate for Payer: Aetna of CA HMO/PPO	$42,906.23
Rate for Payer: EPIC Health Plan Commercial	$44,955.59
Rate for Payer: EPIC Health Plan Senior	$33,300.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,300.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,300.44
Rate for Payer: Molina Healthcare of CA Medicare	$44,622.59
Rate for Payer: Multiplan WC	$26,439.86
Rate for Payer: Prime Health Services WC	$26,170.07
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: INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility

$33,946.55

Service Code	MSDRG 759
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$33,946.55
Rate for Payer: Aetna of CA HMO/PPO	$19,402.24
Rate for Payer: EPIC Health Plan Commercial	$33,946.55
Rate for Payer: EPIC Health Plan Senior	$25,145.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,145.59
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,145.59
Rate for Payer: Molina Healthcare of CA Medicare	$33,695.09
Rate for Payer: Multiplan WC	$11,956.13
Rate for Payer: Prime Health Services WC	$11,834.13
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: INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC

Facility

$60,574.40

Service Code	MSDRG 854
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$60,574.40
Rate for Payer: Aetna of CA HMO/PPO	$60,574.40
Rate for Payer: EPIC Health Plan Commercial	$53,231.19
Rate for Payer: EPIC Health Plan Senior	$39,430.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,430.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,430.51
Rate for Payer: Molina Healthcare of CA Medicare	$52,836.88
Rate for Payer: Multiplan WC	$37,327.42
Rate for Payer: Prime Health Services WC	$36,946.52
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: INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC

Facility

$151,619.41

Service Code	MSDRG 853
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$151,619.41
Rate for Payer: Aetna of CA HMO/PPO	$151,619.41
Rate for Payer: EPIC Health Plan Commercial	$95,875.76
Rate for Payer: EPIC Health Plan Senior	$71,019.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$71,019.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$71,019.08
Rate for Payer: Molina Healthcare of CA Medicare	$95,165.57
Rate for Payer: Multiplan WC	$93,431.55
Rate for Payer: Prime Health Services WC	$92,478.17
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: INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$49,281.69

Service Code	MSDRG 855
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$49,281.69
Rate for Payer: Aetna of CA HMO/PPO	$49,281.69
Rate for Payer: EPIC Health Plan Commercial	$47,941.78
Rate for Payer: EPIC Health Plan Senior	$35,512.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,512.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,512.43
Rate for Payer: Molina Healthcare of CA Medicare	$47,586.66
Rate for Payer: Multiplan WC	$30,368.57
Rate for Payer: Prime Health Services WC	$30,058.69
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: INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$45,723.78

Service Code	MSDRG 727
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$45,723.78
Rate for Payer: Aetna of CA HMO/PPO	$44,546.33
Rate for Payer: EPIC Health Plan Commercial	$45,723.78
Rate for Payer: EPIC Health Plan Senior	$33,869.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,869.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,869.47
Rate for Payer: Molina Healthcare of CA Medicare	$45,385.09
Rate for Payer: Multiplan WC	$27,450.53
Rate for Payer: Prime Health Services WC	$27,170.42
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: INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC

Facility

$36,461.31

Service Code	MSDRG 728
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$36,461.31
Rate for Payer: Aetna of CA HMO/PPO	$24,771.20
Rate for Payer: EPIC Health Plan Commercial	$36,461.31
Rate for Payer: EPIC Health Plan Senior	$27,008.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,008.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,008.38
Rate for Payer: Molina Healthcare of CA Medicare	$36,191.23
Rate for Payer: Multiplan WC	$15,264.62
Rate for Payer: Prime Health Services WC	$15,108.86
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: INFLAMMATORY BOWEL DISEASE WITH CC

Facility

$38,951.94

Service Code	MSDRG 386
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$38,951.94
Rate for Payer: Aetna of CA HMO/PPO	$30,088.63
Rate for Payer: EPIC Health Plan Commercial	$38,951.94
Rate for Payer: EPIC Health Plan Senior	$28,853.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,853.29
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,853.29
Rate for Payer: Molina Healthcare of CA Medicare	$38,663.41
Rate for Payer: Multiplan WC	$18,541.35
Rate for Payer: Prime Health Services WC	$18,352.15
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: INFLAMMATORY BOWEL DISEASE WITH MCC

Facility

$49,257.44

Service Code	MSDRG 385
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$49,257.44
Rate for Payer: Aetna of CA HMO/PPO	$49,257.44
Rate for Payer: EPIC Health Plan Commercial	$47,930.43
Rate for Payer: EPIC Health Plan Senior	$35,504.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,504.02
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,504.02
Rate for Payer: Molina Healthcare of CA Medicare	$47,575.39
Rate for Payer: Multiplan WC	$30,353.63
Rate for Payer: Prime Health Services WC	$30,043.90
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: INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC

Facility

$34,376.79

Service Code	MSDRG 387
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,376.79
Rate for Payer: Aetna of CA HMO/PPO	$20,320.81
Rate for Payer: EPIC Health Plan Commercial	$34,376.79
Rate for Payer: EPIC Health Plan Senior	$25,464.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,464.29
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,464.29
Rate for Payer: Molina Healthcare of CA Medicare	$34,122.15
Rate for Payer: Multiplan WC	$12,522.18
Rate for Payer: Prime Health Services WC	$12,394.40
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: INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC

Facility

$46,222.20

Service Code	MSDRG 351
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$46,222.20
Rate for Payer: Aetna of CA HMO/PPO	$45,610.42
Rate for Payer: EPIC Health Plan Commercial	$46,222.20
Rate for Payer: EPIC Health Plan Senior	$34,238.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,238.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,238.67
Rate for Payer: Molina Healthcare of CA Medicare	$45,879.82
Rate for Payer: Multiplan WC	$28,106.24
Rate for Payer: Prime Health Services WC	$27,819.44
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: INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC

Facility

$73,325.31

Service Code	MSDRG 350
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$73,325.31
Rate for Payer: Aetna of CA HMO/PPO	$73,325.31
Rate for Payer: EPIC Health Plan Commercial	$59,203.59
Rate for Payer: EPIC Health Plan Senior	$43,854.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$43,854.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$43,854.51
Rate for Payer: Molina Healthcare of CA Medicare	$58,765.04
Rate for Payer: Multiplan WC	$45,184.83
Rate for Payer: Prime Health Services WC	$44,723.76
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: INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC

Facility

$40,515.34

Service Code	MSDRG 352
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$40,515.34
Rate for Payer: Aetna of CA HMO/PPO	$33,426.42
Rate for Payer: EPIC Health Plan Commercial	$40,515.34
Rate for Payer: EPIC Health Plan Senior	$30,011.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,011.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,011.36
Rate for Payer: Molina Healthcare of CA Medicare	$40,215.22
Rate for Payer: Multiplan WC	$20,598.17
Rate for Payer: Prime Health Services WC	$20,387.98
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: INTERSTITIAL LUNG DISEASE WITH CC

Facility

$38,916.44

Service Code	MSDRG 197
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$38,916.44
Rate for Payer: Aetna of CA HMO/PPO	$30,012.84
Rate for Payer: EPIC Health Plan Commercial	$38,916.44
Rate for Payer: EPIC Health Plan Senior	$28,826.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,826.99
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,826.99
Rate for Payer: Molina Healthcare of CA Medicare	$38,628.17
Rate for Payer: Multiplan WC	$18,494.64
Rate for Payer: Prime Health Services WC	$18,305.92
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: INTERSTITIAL LUNG DISEASE WITH MCC

Facility

$57,118.38

Service Code	MSDRG 196
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$57,118.38
Rate for Payer: Aetna of CA HMO/PPO	$57,118.38
Rate for Payer: EPIC Health Plan Commercial	$51,612.43
Rate for Payer: EPIC Health Plan Senior	$38,231.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$38,231.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$38,231.43
Rate for Payer: Molina Healthcare of CA Medicare	$51,230.12
Rate for Payer: Multiplan WC	$35,197.73
Rate for Payer: Prime Health Services WC	$34,838.57
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: INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC

Facility

$34,804.19

Service Code	MSDRG 198
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,804.19
Rate for Payer: Aetna of CA HMO/PPO	$21,233.33
Rate for Payer: EPIC Health Plan Commercial	$34,804.19
Rate for Payer: EPIC Health Plan Senior	$25,780.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,780.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,780.88
Rate for Payer: Molina Healthcare of CA Medicare	$34,546.38
Rate for Payer: Multiplan WC	$13,084.49
Rate for Payer: Prime Health Services WC	$12,950.97
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: INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS

Facility

$39,298.42

Service Code	MSDRG 065
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$39,298.42
Rate for Payer: Aetna of CA HMO/PPO	$30,828.34
Rate for Payer: EPIC Health Plan Commercial	$39,298.42
Rate for Payer: EPIC Health Plan Senior	$29,109.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,109.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,109.94
Rate for Payer: Molina Healthcare of CA Medicare	$39,007.32
Rate for Payer: Multiplan WC	$18,997.17
Rate for Payer: Prime Health Services WC	$18,803.32
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: INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC

Facility

$60,304.59

Service Code	MSDRG 064
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$60,304.59
Rate for Payer: Aetna of CA HMO/PPO	$60,304.59
Rate for Payer: EPIC Health Plan Commercial	$53,104.80
Rate for Payer: EPIC Health Plan Senior	$39,336.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,336.89
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,336.89
Rate for Payer: Molina Healthcare of CA Medicare	$52,711.43
Rate for Payer: Multiplan WC	$37,161.15
Rate for Payer: Prime Health Services WC	$36,781.95
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: INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC

Facility

$34,632.39

Service Code	MSDRG 066
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,632.39
Rate for Payer: Aetna of CA HMO/PPO	$20,866.50
Rate for Payer: EPIC Health Plan Commercial	$34,632.39
Rate for Payer: EPIC Health Plan Senior	$25,653.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,653.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,653.62
Rate for Payer: Molina Healthcare of CA Medicare	$34,375.85
Rate for Payer: Multiplan WC	$12,858.44
Rate for Payer: Prime Health Services WC	$12,727.23
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: INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC

Facility

$167,565.63

Service Code	MSDRG 021
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$167,565.63
Rate for Payer: Aetna of CA HMO/PPO	$167,565.63
Rate for Payer: EPIC Health Plan Commercial	$103,344.82
Rate for Payer: EPIC Health Plan Senior	$76,551.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$76,551.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$76,551.72
Rate for Payer: Molina Healthcare of CA Medicare	$102,579.30
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	$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: INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC

Facility

$244,380.31

Service Code	MSDRG 020
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$244,380.31
Rate for Payer: Aetna of CA HMO/PPO	$244,380.31
Rate for Payer: EPIC Health Plan Commercial	$139,324.06
Rate for Payer: EPIC Health Plan Senior	$103,203.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$103,203.01
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$103,203.01
Rate for Payer: Molina Healthcare of CA Medicare	$138,292.03
Rate for Payer: Multiplan WC	$150,593.07
Rate for Payer: Prime Health Services WC	$149,056.41
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