Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$44,953.93

Service Code	MSDRG 757
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$44,953.93
Rate for Payer: Aetna of CA HMO/PPO	$42,906.23
Rate for Payer: EPIC Health Plan Commercial	$44,953.93
Rate for Payer: EPIC Health Plan Senior	$33,299.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,299.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,299.21
Rate for Payer: Molina Healthcare of CA Medicare	$44,620.94
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

$33,944.89

Service Code	MSDRG 759
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$33,944.89
Rate for Payer: Aetna of CA HMO/PPO	$19,402.24
Rate for Payer: EPIC Health Plan Commercial	$33,944.89
Rate for Payer: EPIC Health Plan Senior	$25,144.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,144.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,144.36
Rate for Payer: Molina Healthcare of CA Medicare	$33,693.44
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	$53,229.53
Rate for Payer: EPIC Health Plan Senior	$39,429.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,429.28
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,429.28
Rate for Payer: Molina Healthcare of CA Medicare	$52,835.24
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	$95,874.10
Rate for Payer: EPIC Health Plan Senior	$71,017.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$71,017.85
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$71,017.85
Rate for Payer: Molina Healthcare of CA Medicare	$95,163.92
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	$47,940.12
Rate for Payer: EPIC Health Plan Senior	$35,511.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,511.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,511.20
Rate for Payer: Molina Healthcare of CA Medicare	$47,585.01
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

$45,722.12

Service Code	MSDRG 727
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$45,722.12
Rate for Payer: Aetna of CA HMO/PPO	$44,546.33
Rate for Payer: EPIC Health Plan Commercial	$45,722.12
Rate for Payer: EPIC Health Plan Senior	$33,868.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,868.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,868.24
Rate for Payer: Molina Healthcare of CA Medicare	$45,383.44
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

$36,459.65

Service Code	MSDRG 728
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$36,459.65
Rate for Payer: Aetna of CA HMO/PPO	$24,771.20
Rate for Payer: EPIC Health Plan Commercial	$36,459.65
Rate for Payer: EPIC Health Plan Senior	$27,007.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,007.15
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,007.15
Rate for Payer: Molina Healthcare of CA Medicare	$36,189.58
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

$38,950.28

Service Code	MSDRG 386
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$38,950.28
Rate for Payer: Aetna of CA HMO/PPO	$30,088.63
Rate for Payer: EPIC Health Plan Commercial	$38,950.28
Rate for Payer: EPIC Health Plan Senior	$28,852.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,852.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,852.06
Rate for Payer: Molina Healthcare of CA Medicare	$38,661.76
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	$47,928.77
Rate for Payer: EPIC Health Plan Senior	$35,502.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,502.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,502.79
Rate for Payer: Molina Healthcare of CA Medicare	$47,573.74
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

$34,375.13

Service Code	MSDRG 387
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,375.13
Rate for Payer: Aetna of CA HMO/PPO	$20,320.81
Rate for Payer: EPIC Health Plan Commercial	$34,375.13
Rate for Payer: EPIC Health Plan Senior	$25,463.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,463.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,463.06
Rate for Payer: Molina Healthcare of CA Medicare	$34,120.50
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

$46,220.54

Service Code	MSDRG 351
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$46,220.54
Rate for Payer: Aetna of CA HMO/PPO	$45,610.42
Rate for Payer: EPIC Health Plan Commercial	$46,220.54
Rate for Payer: EPIC Health Plan Senior	$34,237.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,237.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,237.44
Rate for Payer: Molina Healthcare of CA Medicare	$45,878.17
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	$59,201.93
Rate for Payer: EPIC Health Plan Senior	$43,853.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$43,853.28
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$43,853.28
Rate for Payer: Molina Healthcare of CA Medicare	$58,763.40
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

$40,513.68

Service Code	MSDRG 352
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$40,513.68
Rate for Payer: Aetna of CA HMO/PPO	$33,426.42
Rate for Payer: EPIC Health Plan Commercial	$40,513.68
Rate for Payer: EPIC Health Plan Senior	$30,010.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,010.13
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,010.13
Rate for Payer: Molina Healthcare of CA Medicare	$40,213.57
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

$38,914.78

Service Code	MSDRG 197
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$38,914.78
Rate for Payer: Aetna of CA HMO/PPO	$30,012.84
Rate for Payer: EPIC Health Plan Commercial	$38,914.78
Rate for Payer: EPIC Health Plan Senior	$28,825.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,825.76
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,825.76
Rate for Payer: Molina Healthcare of CA Medicare	$38,626.52
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	$51,610.77
Rate for Payer: EPIC Health Plan Senior	$38,230.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$38,230.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$38,230.20
Rate for Payer: Molina Healthcare of CA Medicare	$51,228.47
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

$34,802.53

Service Code	MSDRG 198
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,802.53
Rate for Payer: Aetna of CA HMO/PPO	$21,233.33
Rate for Payer: EPIC Health Plan Commercial	$34,802.53
Rate for Payer: EPIC Health Plan Senior	$25,779.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,779.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,779.65
Rate for Payer: Molina Healthcare of CA Medicare	$34,544.73
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

$39,296.76

Service Code	MSDRG 065
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$39,296.76
Rate for Payer: Aetna of CA HMO/PPO	$30,828.34
Rate for Payer: EPIC Health Plan Commercial	$39,296.76
Rate for Payer: EPIC Health Plan Senior	$29,108.71
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,108.71
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,108.71
Rate for Payer: Molina Healthcare of CA Medicare	$39,005.67
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	$53,103.14
Rate for Payer: EPIC Health Plan Senior	$39,335.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,335.66
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,335.66
Rate for Payer: Molina Healthcare of CA Medicare	$52,709.78
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

$34,630.73

Service Code	MSDRG 066
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,630.73
Rate for Payer: Aetna of CA HMO/PPO	$20,866.50
Rate for Payer: EPIC Health Plan Commercial	$34,630.73
Rate for Payer: EPIC Health Plan Senior	$25,652.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,652.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,652.39
Rate for Payer: Molina Healthcare of CA Medicare	$34,374.20
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	$103,343.16
Rate for Payer: EPIC Health Plan Senior	$76,550.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$76,550.49
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$76,550.49
Rate for Payer: Molina Healthcare of CA Medicare	$102,577.66
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	$139,322.40
Rate for Payer: EPIC Health Plan Senior	$103,201.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$103,201.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$103,201.78
Rate for Payer: Molina Healthcare of CA Medicare	$138,290.39
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

MS-DRG 42.00: INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC

Facility

$107,027.61

Service Code	MSDRG 022
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$107,027.61
Rate for Payer: Aetna of CA HMO/PPO	$107,027.61
Rate for Payer: EPIC Health Plan Commercial	$74,987.75
Rate for Payer: EPIC Health Plan Senior	$55,546.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$55,546.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$55,546.48
Rate for Payer: Molina Healthcare of CA Medicare	$74,432.28
Rate for Payer: Multiplan WC	$65,953.00
Rate for Payer: Prime Health Services WC	$65,280.01
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: INTRAOCULAR PROCEDURES WITH CC/MCC

Facility

$50,585.28

Service Code	MSDRG 116
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$50,585.28
Rate for Payer: Aetna of CA HMO/PPO	$50,585.28
Rate for Payer: EPIC Health Plan Commercial	$48,550.72
Rate for Payer: EPIC Health Plan Senior	$35,963.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,963.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,963.50
Rate for Payer: Molina Healthcare of CA Medicare	$48,191.09
Rate for Payer: Multiplan WC	$31,171.87
Rate for Payer: Prime Health Services WC	$30,853.79
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: INTRAOCULAR PROCEDURES WITHOUT CC/MCC

Facility

$40,172.87

Service Code	MSDRG 117
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$40,172.87
Rate for Payer: Aetna of CA HMO/PPO	$32,698.84
Rate for Payer: EPIC Health Plan Commercial	$40,172.87
Rate for Payer: EPIC Health Plan Senior	$29,757.68
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,757.68
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,757.68
Rate for Payer: Molina Healthcare of CA Medicare	$39,875.29
Rate for Payer: Multiplan WC	$20,149.82
Rate for Payer: Prime Health Services WC	$19,944.21
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: ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC

Facility

$53,989.76

Service Code	MSDRG 062
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$53,989.76
Rate for Payer: Aetna of CA HMO/PPO	$53,989.76
Rate for Payer: EPIC Health Plan Commercial	$50,145.33
Rate for Payer: EPIC Health Plan Senior	$37,144.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,144.69
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,144.69
Rate for Payer: Molina Healthcare of CA Medicare	$49,773.88
Rate for Payer: Multiplan WC	$33,269.80
Rate for Payer: Prime Health Services WC	$32,930.32
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

Know your out-of-pocket cost for care.

All Charges