Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

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	$74,989.41
Rate for Payer: EPIC Health Plan Senior	$55,547.71
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$55,547.71
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$55,547.71
Rate for Payer: Molina Healthcare of CA Medicare	$74,433.93
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	$48,552.39
Rate for Payer: EPIC Health Plan Senior	$35,964.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,964.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,964.73
Rate for Payer: Molina Healthcare of CA Medicare	$48,192.74
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

$40,174.53

Service Code	MSDRG 117
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$40,174.53
Rate for Payer: Aetna of CA HMO/PPO	$32,698.84
Rate for Payer: EPIC Health Plan Commercial	$40,174.53
Rate for Payer: EPIC Health Plan Senior	$29,758.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,758.91
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,758.91
Rate for Payer: Molina Healthcare of CA Medicare	$39,876.94
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	$50,146.99
Rate for Payer: EPIC Health Plan Senior	$37,145.92
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,145.92
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,145.92
Rate for Payer: Molina Healthcare of CA Medicare	$49,775.53
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

MS-DRG 42.00: ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC

Facility

$81,956.27

Service Code	MSDRG 061
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$81,956.27
Rate for Payer: Aetna of CA HMO/PPO	$81,956.27
Rate for Payer: EPIC Health Plan Commercial	$63,246.23
Rate for Payer: EPIC Health Plan Senior	$46,849.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$46,849.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$46,849.06
Rate for Payer: Molina Healthcare of CA Medicare	$62,777.74
Rate for Payer: Multiplan WC	$50,503.44
Rate for Payer: Prime Health Services WC	$49,988.10
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: ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC

Facility

$44,806.47

Service Code	MSDRG 063
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$44,806.47
Rate for Payer: Aetna of CA HMO/PPO	$42,587.92
Rate for Payer: EPIC Health Plan Commercial	$44,806.47
Rate for Payer: EPIC Health Plan Senior	$33,189.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,189.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,189.98
Rate for Payer: Molina Healthcare of CA Medicare	$44,474.57
Rate for Payer: Multiplan WC	$26,243.70
Rate for Payer: Prime Health Services WC	$25,975.91
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: KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC

Facility

$55,420.68

Service Code	MSDRG 657
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$55,420.68
Rate for Payer: Aetna of CA HMO/PPO	$55,420.68
Rate for Payer: EPIC Health Plan Commercial	$50,817.23
Rate for Payer: EPIC Health Plan Senior	$37,642.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,642.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,642.39
Rate for Payer: Molina Healthcare of CA Medicare	$50,440.80
Rate for Payer: Multiplan WC	$34,151.57
Rate for Payer: Prime Health Services WC	$33,803.08
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: KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC

Facility

$98,769.53

Service Code	MSDRG 656
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$98,769.53
Rate for Payer: Aetna of CA HMO/PPO	$98,769.53
Rate for Payer: EPIC Health Plan Commercial	$71,121.40
Rate for Payer: EPIC Health Plan Senior	$52,682.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$52,682.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$52,682.52
Rate for Payer: Molina Healthcare of CA Medicare	$70,594.58
Rate for Payer: Multiplan WC	$60,864.17
Rate for Payer: Prime Health Services WC	$60,243.11
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: KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC

Facility

$46,215.09

Service Code	MSDRG 658
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$46,215.09
Rate for Payer: Aetna of CA HMO/PPO	$45,595.26
Rate for Payer: EPIC Health Plan Commercial	$46,215.09
Rate for Payer: EPIC Health Plan Senior	$34,233.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,233.40
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,233.40
Rate for Payer: Molina Healthcare of CA Medicare	$45,872.76
Rate for Payer: Multiplan WC	$28,096.90
Rate for Payer: Prime Health Services WC	$27,810.20
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: KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC

Facility

$43,886.34

Service Code	MSDRG 660
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$43,886.34
Rate for Payer: Aetna of CA HMO/PPO	$40,623.44
Rate for Payer: EPIC Health Plan Commercial	$43,886.34
Rate for Payer: EPIC Health Plan Senior	$32,508.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,508.40
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,508.40
Rate for Payer: Molina Healthcare of CA Medicare	$43,561.26
Rate for Payer: Multiplan WC	$25,033.15
Rate for Payer: Prime Health Services WC	$24,777.71
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: KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC

Facility

$78,345.64

Service Code	MSDRG 659
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$78,345.64
Rate for Payer: Aetna of CA HMO/PPO	$78,345.64
Rate for Payer: EPIC Health Plan Commercial	$61,555.07
Rate for Payer: EPIC Health Plan Senior	$45,596.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$45,596.35
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$45,596.35
Rate for Payer: Molina Healthcare of CA Medicare	$61,099.11
Rate for Payer: Multiplan WC	$48,278.48
Rate for Payer: Prime Health Services WC	$47,785.85
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: KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC

Facility

$39,436.16

Service Code	MSDRG 661
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$39,436.16
Rate for Payer: Aetna of CA HMO/PPO	$31,122.41
Rate for Payer: EPIC Health Plan Commercial	$39,436.16
Rate for Payer: EPIC Health Plan Senior	$29,211.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,211.97
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,211.97
Rate for Payer: Molina Healthcare of CA Medicare	$39,144.04
Rate for Payer: Multiplan WC	$19,178.38
Rate for Payer: Prime Health Services WC	$18,982.69
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: KIDNEY AND URINARY TRACT INFECTIONS WITH MCC

Facility

$41,476.67

Service Code	MSDRG 689
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$41,476.67
Rate for Payer: Aetna of CA HMO/PPO	$35,478.81
Rate for Payer: EPIC Health Plan Commercial	$41,476.67
Rate for Payer: EPIC Health Plan Senior	$30,723.46
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,723.46
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,723.46
Rate for Payer: Molina Healthcare of CA Medicare	$41,169.44
Rate for Payer: Multiplan WC	$21,862.91
Rate for Payer: Prime Health Services WC	$21,639.82
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: KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC

Facility

$36,255.41

Service Code	MSDRG 690
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$36,255.41
Rate for Payer: Aetna of CA HMO/PPO	$24,331.62
Rate for Payer: EPIC Health Plan Commercial	$36,255.41
Rate for Payer: EPIC Health Plan Senior	$26,855.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,855.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,855.86
Rate for Payer: Molina Healthcare of CA Medicare	$35,986.85
Rate for Payer: Multiplan WC	$14,993.74
Rate for Payer: Prime Health Services WC	$14,840.74
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: KIDNEY AND URINARY TRACT NEOPLASMS WITH CC

Facility

$39,806.76

Service Code	MSDRG 687
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$39,806.76
Rate for Payer: Aetna of CA HMO/PPO	$31,913.65
Rate for Payer: EPIC Health Plan Commercial	$39,806.76
Rate for Payer: EPIC Health Plan Senior	$29,486.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,486.49
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,486.49
Rate for Payer: Molina Healthcare of CA Medicare	$39,511.90
Rate for Payer: Multiplan WC	$19,665.96
Rate for Payer: Prime Health Services WC	$19,465.29
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: KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC

Facility

$57,166.88

Service Code	MSDRG 686
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$57,166.88
Rate for Payer: Aetna of CA HMO/PPO	$57,166.88
Rate for Payer: EPIC Health Plan Commercial	$51,635.14
Rate for Payer: EPIC Health Plan Senior	$38,248.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$38,248.25
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$38,248.25
Rate for Payer: Molina Healthcare of CA Medicare	$51,252.65
Rate for Payer: Multiplan WC	$35,227.62
Rate for Payer: Prime Health Services WC	$34,868.15
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: KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC

Facility

$35,142.16

Service Code	MSDRG 688
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$35,142.16
Rate for Payer: Aetna of CA HMO/PPO	$21,954.85
Rate for Payer: EPIC Health Plan Commercial	$35,142.16
Rate for Payer: EPIC Health Plan Senior	$26,031.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,031.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,031.23
Rate for Payer: Molina Healthcare of CA Medicare	$34,881.85
Rate for Payer: Multiplan WC	$13,529.11
Rate for Payer: Prime Health Services WC	$13,391.05
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: KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC

Facility

$40,873.17

Service Code	MSDRG 695
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$40,873.17
Rate for Payer: Aetna of CA HMO/PPO	$34,190.38
Rate for Payer: EPIC Health Plan Commercial	$40,873.17
Rate for Payer: EPIC Health Plan Senior	$30,276.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,276.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,276.42
Rate for Payer: Molina Healthcare of CA Medicare	$40,570.40
Rate for Payer: Multiplan WC	$21,068.94
Rate for Payer: Prime Health Services WC	$20,853.95
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: KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC

Facility

$34,682.09

Service Code	MSDRG 696
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,682.09
Rate for Payer: Aetna of CA HMO/PPO	$20,972.61
Rate for Payer: EPIC Health Plan Commercial	$34,682.09
Rate for Payer: EPIC Health Plan Senior	$25,690.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,690.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,690.44
Rate for Payer: Molina Healthcare of CA Medicare	$34,425.19
Rate for Payer: Multiplan WC	$12,923.83
Rate for Payer: Prime Health Services WC	$12,791.95
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: KIDNEY TRANSPLANT

Facility

$322,497.00

Service Code	MSDRG 652
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$322,497.00
Rate for Payer: Aetna of CA HMO/PPO	$120,250.00
Rate for Payer: Aetna of CA HMO/PPO	$93,112.56
Rate for Payer: Blue Distinction Transplant	$115,724.00
Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant	$90,000.00
Rate for Payer: EPIC Health Plan Commercial	$68,471.74
Rate for Payer: EPIC Health Plan Senior	$50,719.81
Rate for Payer: EPIC Health Plan Transplant	$322,497.00
Rate for Payer: Heritage Provider Network Transplant	$63,280.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$50,719.81
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$50,719.81
Rate for Payer: Molina Healthcare of CA Medicare	$67,964.55
Rate for Payer: Multiplan WC	$57,378.22
Rate for Payer: OptumHealth Care Solutions (URN) Commercial	$122,356.00
Rate for Payer: Prime Health Services WC	$56,792.72
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: KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC

Facility

$139,674.91

Service Code	MSDRG 650
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$139,674.91
Rate for Payer: Aetna of CA HMO/PPO	$120,250.00
Rate for Payer: Aetna of CA HMO/PPO	$139,674.91
Rate for Payer: Blue Distinction Transplant	$115,724.00
Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant	$90,000.00
Rate for Payer: EPIC Health Plan Commercial	$90,281.07
Rate for Payer: EPIC Health Plan Senior	$66,874.87
Rate for Payer: Heritage Provider Network Transplant	$63,280.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$66,874.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$66,874.87
Rate for Payer: Molina Healthcare of CA Medicare	$89,612.33
Rate for Payer: Multiplan WC	$86,071.06
Rate for Payer: OptumHealth Care Solutions (URN) Commercial	$122,356.00
Rate for Payer: Prime Health Services WC	$85,192.78
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: KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC

Facility

$122,356.00

Service Code	MSDRG 651
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$122,356.00
Rate for Payer: Aetna of CA HMO/PPO	$105,272.31
Rate for Payer: Aetna of CA HMO/PPO	$120,250.00
Rate for Payer: Blue Distinction Transplant	$115,724.00
Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant	$90,000.00
Rate for Payer: EPIC Health Plan Commercial	$74,167.23
Rate for Payer: EPIC Health Plan Senior	$54,938.69
Rate for Payer: Heritage Provider Network Transplant	$63,280.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$54,938.69
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$54,938.69
Rate for Payer: Molina Healthcare of CA Medicare	$73,617.84
Rate for Payer: Multiplan WC	$64,871.35
Rate for Payer: OptumHealth Care Solutions (URN) Commercial	$122,356.00
Rate for Payer: Prime Health Services WC	$64,209.39
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: KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC

Facility

$59,583.07

Service Code	MSDRG 488
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$59,583.07
Rate for Payer: Aetna of CA HMO/PPO	$59,583.07
Rate for Payer: EPIC Health Plan Commercial	$52,766.84
Rate for Payer: EPIC Health Plan Senior	$39,086.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,086.55
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,086.55
Rate for Payer: Molina Healthcare of CA Medicare	$52,375.98
Rate for Payer: Multiplan WC	$36,716.53
Rate for Payer: Prime Health Services WC	$36,341.87
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: KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

$42,443.65

Service Code	MSDRG 489
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$42,443.65
Rate for Payer: Aetna of CA HMO/PPO	$37,543.33
Rate for Payer: EPIC Health Plan Commercial	$42,443.65
Rate for Payer: EPIC Health Plan Senior	$31,439.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,439.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,439.74
Rate for Payer: Molina Healthcare of CA Medicare	$42,129.25
Rate for Payer: Multiplan WC	$23,135.11
Rate for Payer: Prime Health Services WC	$22,899.04
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: KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC

Facility

$64,297.20

Service Code	MSDRG 486
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$64,297.20
Rate for Payer: Aetna of CA HMO/PPO	$64,297.20
Rate for Payer: EPIC Health Plan Commercial	$54,974.92
Rate for Payer: EPIC Health Plan Senior	$40,722.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$40,722.16
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,722.16
Rate for Payer: Molina Healthcare of CA Medicare	$54,567.69
Rate for Payer: Multiplan WC	$39,621.50
Rate for Payer: Prime Health Services WC	$39,217.20
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