Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC

Facility

$48,593.52

Service Code	MSDRG 828
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$48,593.52
Rate for Payer: Aetna of CA HMO/PPO	$48,593.52
Rate for Payer: EPIC Health Plan Commercial	$47,619.45
Rate for Payer: EPIC Health Plan Senior	$35,273.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,273.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,273.67
Rate for Payer: Molina Healthcare of CA Medicare	$47,266.72
Rate for Payer: Multiplan WC	$29,944.50
Rate for Payer: Prime Health Services WC	$29,638.94
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: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC

Facility

$93,488.48

Service Code	MSDRG 829
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$93,488.48
Rate for Payer: Aetna of CA HMO/PPO	$93,488.48
Rate for Payer: EPIC Health Plan Commercial	$68,647.81
Rate for Payer: EPIC Health Plan Senior	$50,850.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$50,850.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$50,850.23
Rate for Payer: Molina Healthcare of CA Medicare	$68,139.31
Rate for Payer: Multiplan WC	$57,609.87
Rate for Payer: Prime Health Services WC	$57,022.01
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: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC

Facility

$45,625.79

Service Code	MSDRG 830
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$45,625.79
Rate for Payer: Aetna of CA HMO/PPO	$44,337.15
Rate for Payer: EPIC Health Plan Commercial	$45,625.79
Rate for Payer: EPIC Health Plan Senior	$33,796.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,796.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,796.88
Rate for Payer: Molina Healthcare of CA Medicare	$45,287.82
Rate for Payer: Multiplan WC	$27,321.63
Rate for Payer: Prime Health Services WC	$27,042.83
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: NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY

Facility

$54,647.62

Service Code	MSDRG 789
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$54,647.62
Rate for Payer: Aetna of CA HMO/PPO	$54,647.62
Rate for Payer: EPIC Health Plan Commercial	$50,455.13
Rate for Payer: EPIC Health Plan Senior	$37,374.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,374.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,374.17
Rate for Payer: Molina Healthcare of CA Medicare	$50,081.39
Rate for Payer: Multiplan WC	$33,675.19
Rate for Payer: Prime Health Services WC	$33,331.57
Rate for Payer: United Healthcare All Other Commercial	$10,809.00
Rate for Payer: United Healthcare All Other HMO	$8,601.00
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: NEONATE WITH OTHER SIGNIFICANT PROBLEMS

Facility

$45,820.35

Service Code	MSDRG 794
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$45,820.35
Rate for Payer: Aetna of CA HMO/PPO	$44,752.48
Rate for Payer: EPIC Health Plan Commercial	$45,820.35
Rate for Payer: EPIC Health Plan Senior	$33,941.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,941.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,941.00
Rate for Payer: Molina Healthcare of CA Medicare	$45,480.94
Rate for Payer: Multiplan WC	$27,577.56
Rate for Payer: Prime Health Services WC	$27,296.16
Rate for Payer: United Healthcare All Other Commercial	$10,809.00
Rate for Payer: United Healthcare All Other HMO	$8,601.00
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: NERVOUS SYSTEM NEOPLASMS WITH MCC

Facility

$46,145.51

Service Code	MSDRG 054
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$46,145.51
Rate for Payer: Aetna of CA HMO/PPO	$45,446.72
Rate for Payer: EPIC Health Plan Commercial	$46,145.51
Rate for Payer: EPIC Health Plan Senior	$34,181.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,181.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,181.86
Rate for Payer: Molina Healthcare of CA Medicare	$45,803.69
Rate for Payer: Multiplan WC	$28,005.37
Rate for Payer: Prime Health Services WC	$27,719.60
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: NERVOUS SYSTEM NEOPLASMS WITHOUT MCC

Facility

$40,350.61

Service Code	MSDRG 055
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$40,350.61
Rate for Payer: Aetna of CA HMO/PPO	$33,074.76
Rate for Payer: EPIC Health Plan Commercial	$40,350.61
Rate for Payer: EPIC Health Plan Senior	$29,889.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,889.34
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,889.34
Rate for Payer: Molina Healthcare of CA Medicare	$40,051.72
Rate for Payer: Multiplan WC	$20,381.46
Rate for Payer: Prime Health Services WC	$20,173.49
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: NEUROLOGICAL EYE DISORDERS

Facility

$36,263.94

Service Code	MSDRG 123
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$36,263.94
Rate for Payer: Aetna of CA HMO/PPO	$24,349.81
Rate for Payer: EPIC Health Plan Commercial	$36,263.94
Rate for Payer: EPIC Health Plan Senior	$26,862.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,862.18
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,862.18
Rate for Payer: Molina Healthcare of CA Medicare	$35,995.32
Rate for Payer: Multiplan WC	$15,004.95
Rate for Payer: Prime Health Services WC	$14,851.83
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: NEUROSES EXCEPT DEPRESSIVE

Facility

$38,518.86

Service Code	MSDRG 882
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$38,518.86
Rate for Payer: Aetna of CA HMO/PPO	$29,163.99
Rate for Payer: EPIC Health Plan Commercial	$38,518.86
Rate for Payer: EPIC Health Plan Senior	$28,532.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,532.49
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,532.49
Rate for Payer: Molina Healthcare of CA Medicare	$38,233.54
Rate for Payer: Multiplan WC	$17,971.56
Rate for Payer: Prime Health Services WC	$17,788.18
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: NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC

Facility

$65,764.50

Service Code	MSDRG 098
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$65,764.50
Rate for Payer: Aetna of CA HMO/PPO	$65,764.50
Rate for Payer: EPIC Health Plan Commercial	$55,662.17
Rate for Payer: EPIC Health Plan Senior	$41,231.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$41,231.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$41,231.24
Rate for Payer: Molina Healthcare of CA Medicare	$55,249.86
Rate for Payer: Multiplan WC	$40,525.68
Rate for Payer: Prime Health Services WC	$40,112.15
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: NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC

Facility

$108,670.73

Service Code	MSDRG 097
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$108,670.73
Rate for Payer: Aetna of CA HMO/PPO	$108,670.73
Rate for Payer: EPIC Health Plan Commercial	$75,759.03
Rate for Payer: EPIC Health Plan Senior	$56,117.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$56,117.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$56,117.80
Rate for Payer: Molina Healthcare of CA Medicare	$75,197.85
Rate for Payer: Multiplan WC	$66,965.54
Rate for Payer: Prime Health Services WC	$66,282.21
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: NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$44,643.19

Service Code	MSDRG 099
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$44,643.19
Rate for Payer: Aetna of CA HMO/PPO	$42,239.28
Rate for Payer: EPIC Health Plan Commercial	$44,643.19
Rate for Payer: EPIC Health Plan Senior	$33,069.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,069.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,069.03
Rate for Payer: Molina Healthcare of CA Medicare	$44,312.50
Rate for Payer: Multiplan WC	$26,028.87
Rate for Payer: Prime Health Services WC	$25,763.27
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: NON-EXTENSIVE BURNS

Facility

$66,586.06

Service Code	MSDRG 935
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$66,586.06
Rate for Payer: Aetna of CA HMO/PPO	$66,586.06
Rate for Payer: EPIC Health Plan Commercial	$56,046.99
Rate for Payer: EPIC Health Plan Senior	$41,516.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$41,516.29
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$41,516.29
Rate for Payer: Molina Healthcare of CA Medicare	$55,631.83
Rate for Payer: Multiplan WC	$41,031.94
Rate for Payer: Prime Health Services WC	$40,613.25
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: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC

Facility

$52,022.26

Service Code	MSDRG 988
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$52,022.26
Rate for Payer: Aetna of CA HMO/PPO	$52,022.26
Rate for Payer: EPIC Health Plan Commercial	$49,225.44
Rate for Payer: EPIC Health Plan Senior	$36,463.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,463.29
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,463.29
Rate for Payer: Molina Healthcare of CA Medicare	$48,860.81
Rate for Payer: Multiplan WC	$32,057.38
Rate for Payer: Prime Health Services WC	$31,730.26
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: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC

Facility

$106,187.85

Service Code	MSDRG 987
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$106,187.85
Rate for Payer: Aetna of CA HMO/PPO	$106,187.85
Rate for Payer: EPIC Health Plan Commercial	$74,596.07
Rate for Payer: EPIC Health Plan Senior	$55,256.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$55,256.35
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$55,256.35
Rate for Payer: Molina Healthcare of CA Medicare	$74,043.51
Rate for Payer: Multiplan WC	$65,435.53
Rate for Payer: Prime Health Services WC	$64,767.82
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: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC

Facility

$41,266.50

Service Code	MSDRG 989
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$41,266.50
Rate for Payer: Aetna of CA HMO/PPO	$35,030.14
Rate for Payer: EPIC Health Plan Commercial	$41,266.50
Rate for Payer: EPIC Health Plan Senior	$30,567.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,567.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,567.78
Rate for Payer: Molina Healthcare of CA Medicare	$40,960.83
Rate for Payer: Multiplan WC	$21,586.42
Rate for Payer: Prime Health Services WC	$21,366.15
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: NON-MALIGNANT BREAST DISORDERS WITH CC/MCC

Facility

$38,442.17

Service Code	MSDRG 600
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$38,442.17
Rate for Payer: Aetna of CA HMO/PPO	$29,000.29
Rate for Payer: EPIC Health Plan Commercial	$38,442.17
Rate for Payer: EPIC Health Plan Senior	$28,475.68
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,475.68
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,475.68
Rate for Payer: Molina Healthcare of CA Medicare	$38,157.41
Rate for Payer: Multiplan WC	$17,870.68
Rate for Payer: Prime Health Services WC	$17,688.33
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: NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility

$33,371.46

Service Code	MSDRG 601
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$33,371.46
Rate for Payer: Aetna of CA HMO/PPO	$18,174.44
Rate for Payer: EPIC Health Plan Commercial	$33,371.46
Rate for Payer: EPIC Health Plan Senior	$24,719.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,719.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,719.60
Rate for Payer: Molina Healthcare of CA Medicare	$33,124.26
Rate for Payer: Multiplan WC	$11,199.53
Rate for Payer: Prime Health Services WC	$11,085.25
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: NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC

Facility

$39,823.81

Service Code	MSDRG 071
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$39,823.81
Rate for Payer: Aetna of CA HMO/PPO	$31,950.03
Rate for Payer: EPIC Health Plan Commercial	$39,823.81
Rate for Payer: EPIC Health Plan Senior	$29,499.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,499.12
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,499.12
Rate for Payer: Molina Healthcare of CA Medicare	$39,528.82
Rate for Payer: Multiplan WC	$19,688.39
Rate for Payer: Prime Health Services WC	$19,487.48
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: NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC

Facility

$52,713.46

Service Code	MSDRG 070
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$52,713.46
Rate for Payer: Aetna of CA HMO/PPO	$52,713.46
Rate for Payer: EPIC Health Plan Commercial	$49,549.20
Rate for Payer: EPIC Health Plan Senior	$36,703.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,703.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,703.11
Rate for Payer: Molina Healthcare of CA Medicare	$49,182.17
Rate for Payer: Multiplan WC	$32,483.32
Rate for Payer: Prime Health Services WC	$32,151.85
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: NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC

Facility

$35,511.35

Service Code	MSDRG 072
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$35,511.35
Rate for Payer: Aetna of CA HMO/PPO	$22,743.06
Rate for Payer: EPIC Health Plan Commercial	$35,511.35
Rate for Payer: EPIC Health Plan Senior	$26,304.70
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,304.70
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,304.70
Rate for Payer: Molina Healthcare of CA Medicare	$35,248.30
Rate for Payer: Multiplan WC	$14,014.82
Rate for Payer: Prime Health Services WC	$13,871.81
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: NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC

Facility

$45,517.90

Service Code	MSDRG 067
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$45,517.90
Rate for Payer: Aetna of CA HMO/PPO	$44,106.75
Rate for Payer: EPIC Health Plan Commercial	$45,517.90
Rate for Payer: EPIC Health Plan Senior	$33,716.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,716.96
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,716.96
Rate for Payer: Molina Healthcare of CA Medicare	$45,180.73
Rate for Payer: Multiplan WC	$27,179.64
Rate for Payer: Prime Health Services WC	$26,902.30
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: NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC

Facility

$37,375.79

Service Code	MSDRG 068
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,375.79
Rate for Payer: Aetna of CA HMO/PPO	$26,723.55
Rate for Payer: EPIC Health Plan Commercial	$37,375.79
Rate for Payer: EPIC Health Plan Senior	$27,685.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,685.77
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,685.77
Rate for Payer: Molina Healthcare of CA Medicare	$37,098.93
Rate for Payer: Multiplan WC	$16,467.70
Rate for Payer: Prime Health Services WC	$16,299.67
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: NONTRAUMATIC STUPOR AND COMA WITH MCC

Facility

$60,262.14

Service Code	MSDRG 080
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$60,262.14
Rate for Payer: Aetna of CA HMO/PPO	$60,262.14
Rate for Payer: EPIC Health Plan Commercial	$53,084.93
Rate for Payer: EPIC Health Plan Senior	$39,322.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,322.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,322.17
Rate for Payer: Molina Healthcare of CA Medicare	$52,691.71
Rate for Payer: Multiplan WC	$37,134.99
Rate for Payer: Prime Health Services WC	$36,756.06
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: NONTRAUMATIC STUPOR AND COMA WITHOUT MCC

Facility

$37,706.62

Service Code	MSDRG 081
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,706.62
Rate for Payer: Aetna of CA HMO/PPO	$27,429.92
Rate for Payer: EPIC Health Plan Commercial	$37,706.62
Rate for Payer: EPIC Health Plan Senior	$27,930.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,930.83
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,930.83
Rate for Payer: Molina Healthcare of CA Medicare	$37,427.31
Rate for Payer: Multiplan WC	$16,902.98
Rate for Payer: Prime Health Services WC	$16,730.50
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

Know your out-of-pocket cost for care.

All Charges