Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: MINOR BLADDER PROCEDURES WITH MCC

Facility

$94,573.79

Service Code	MSDRG 662
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$94,573.79
Rate for Payer: Aetna of CA HMO/PPO	$94,573.79
Rate for Payer: EPIC Health Plan Commercial	$69,154.51
Rate for Payer: EPIC Health Plan Senior	$51,225.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$51,225.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$51,225.56
Rate for Payer: Molina Healthcare of CA Medicare	$68,642.25
Rate for Payer: Multiplan WC	$58,278.66
Rate for Payer: Prime Health Services WC	$57,683.98
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: MINOR BLADDER PROCEDURES WITHOUT CC/MCC

Facility

$40,189.93

Service Code	MSDRG 664
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$40,189.93
Rate for Payer: Aetna of CA HMO/PPO	$32,735.22
Rate for Payer: EPIC Health Plan Commercial	$40,189.93
Rate for Payer: EPIC Health Plan Senior	$29,770.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,770.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,770.32
Rate for Payer: Molina Healthcare of CA Medicare	$39,892.23
Rate for Payer: Multiplan WC	$20,172.23
Rate for Payer: Prime Health Services WC	$19,966.39
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: MINOR SKIN DISORDERS WITH MCC

Facility

$48,817.85

Service Code	MSDRG 606
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$48,817.85
Rate for Payer: Aetna of CA HMO/PPO	$48,817.85
Rate for Payer: EPIC Health Plan Commercial	$47,722.86
Rate for Payer: EPIC Health Plan Senior	$35,350.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,350.27
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,350.27
Rate for Payer: Molina Healthcare of CA Medicare	$47,369.36
Rate for Payer: Multiplan WC	$30,082.75
Rate for Payer: Prime Health Services WC	$29,775.78
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: MINOR SKIN DISORDERS WITHOUT MCC

Facility

$37,128.44

Service Code	MSDRG 607
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,128.44
Rate for Payer: Aetna of CA HMO/PPO	$26,199.09
Rate for Payer: EPIC Health Plan Commercial	$37,128.44
Rate for Payer: EPIC Health Plan Senior	$27,502.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,502.55
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,502.55
Rate for Payer: Molina Healthcare of CA Medicare	$36,853.42
Rate for Payer: Multiplan WC	$16,144.51
Rate for Payer: Prime Health Services WC	$15,979.77
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: MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC

Facility

$45,996.19

Service Code	MSDRG 345
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$45,996.19
Rate for Payer: Aetna of CA HMO/PPO	$45,131.43
Rate for Payer: EPIC Health Plan Commercial	$45,996.19
Rate for Payer: EPIC Health Plan Senior	$34,071.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,071.25
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,071.25
Rate for Payer: Molina Healthcare of CA Medicare	$45,655.47
Rate for Payer: Multiplan WC	$27,811.08
Rate for Payer: Prime Health Services WC	$27,527.29
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: MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC

Facility

$81,686.46

Service Code	MSDRG 344
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$81,686.46
Rate for Payer: Aetna of CA HMO/PPO	$81,686.46
Rate for Payer: EPIC Health Plan Commercial	$63,118.20
Rate for Payer: EPIC Health Plan Senior	$46,754.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$46,754.22
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$46,754.22
Rate for Payer: Molina Healthcare of CA Medicare	$62,650.65
Rate for Payer: Multiplan WC	$50,337.18
Rate for Payer: Prime Health Services WC	$49,823.54
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: MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC

Facility

$42,539.96

Service Code	MSDRG 346
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$42,539.96
Rate for Payer: Aetna of CA HMO/PPO	$37,752.51
Rate for Payer: EPIC Health Plan Commercial	$42,539.96
Rate for Payer: EPIC Health Plan Senior	$31,511.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,511.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,511.08
Rate for Payer: Molina Healthcare of CA Medicare	$42,224.85
Rate for Payer: Multiplan WC	$23,264.01
Rate for Payer: Prime Health Services WC	$23,026.63
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: MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC

Facility

$43,714.31

Service Code	MSDRG 640
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$43,714.31
Rate for Payer: Aetna of CA HMO/PPO	$40,259.65
Rate for Payer: EPIC Health Plan Commercial	$43,714.31
Rate for Payer: EPIC Health Plan Senior	$32,380.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,380.97
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,380.97
Rate for Payer: Molina Healthcare of CA Medicare	$43,390.50
Rate for Payer: Multiplan WC	$24,808.97
Rate for Payer: Prime Health Services WC	$24,555.82
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: MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC

Facility

$35,952.71

Service Code	MSDRG 641
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$35,952.71
Rate for Payer: Aetna of CA HMO/PPO	$23,688.92
Rate for Payer: EPIC Health Plan Commercial	$35,952.71
Rate for Payer: EPIC Health Plan Senior	$26,631.64
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,631.64
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,631.64
Rate for Payer: Molina Healthcare of CA Medicare	$35,686.40
Rate for Payer: Multiplan WC	$14,597.69
Rate for Payer: Prime Health Services WC	$14,448.73
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: MOUTH PROCEDURES WITH CC/MCC

Facility

$44,716.79

Service Code	MSDRG 137
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$44,716.79
Rate for Payer: Aetna of CA HMO/PPO	$42,399.96
Rate for Payer: EPIC Health Plan Commercial	$44,716.79
Rate for Payer: EPIC Health Plan Senior	$33,123.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,123.55
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,123.55
Rate for Payer: Molina Healthcare of CA Medicare	$44,385.56
Rate for Payer: Multiplan WC	$26,127.88
Rate for Payer: Prime Health Services WC	$25,861.27
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: MOUTH PROCEDURES WITHOUT CC/MCC

Facility

$36,408.53

Service Code	MSDRG 138
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$36,408.53
Rate for Payer: Aetna of CA HMO/PPO	$24,662.07
Rate for Payer: EPIC Health Plan Commercial	$36,408.53
Rate for Payer: EPIC Health Plan Senior	$26,969.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,969.28
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,969.28
Rate for Payer: Molina Healthcare of CA Medicare	$36,138.84
Rate for Payer: Multiplan WC	$15,197.36
Rate for Payer: Prime Health Services WC	$15,042.28
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: MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC

Facility

$215,325.45

Service Code	MSDRG 427
Min. Negotiated Rate	$93,121.03
Max. Negotiated Rate	$215,325.45
Rate for Payer: Aetna of CA HMO/PPO	$215,325.45
Rate for Payer: EPIC Health Plan Commercial	$125,713.39
Rate for Payer: EPIC Health Plan Senior	$93,121.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$93,121.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$93,121.03
Rate for Payer: Molina Healthcare of CA Medicare	$124,782.18
Rate for Payer: Multiplan WC	$132,688.77
Rate for Payer: Prime Health Services WC	$131,334.80

MS-DRG 42.00: MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE

Facility

$317,572.23

Service Code	MSDRG 426
Min. Negotiated Rate	$128,596.13
Max. Negotiated Rate	$317,572.23
Rate for Payer: Aetna of CA HMO/PPO	$317,572.23
Rate for Payer: EPIC Health Plan Commercial	$173,604.78
Rate for Payer: EPIC Health Plan Senior	$128,596.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$128,596.13
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$128,596.13
Rate for Payer: Molina Healthcare of CA Medicare	$172,318.81
Rate for Payer: Multiplan WC	$195,695.70
Rate for Payer: Prime Health Services WC	$193,698.81

MS-DRG 42.00: MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC

Facility

$166,862.30

Service Code	MSDRG 428
Min. Negotiated Rate	$76,306.46
Max. Negotiated Rate	$166,862.30
Rate for Payer: Aetna of CA HMO/PPO	$166,862.30
Rate for Payer: EPIC Health Plan Commercial	$103,013.72
Rate for Payer: EPIC Health Plan Senior	$76,306.46
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$76,306.46
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$76,306.46
Rate for Payer: Molina Healthcare of CA Medicare	$102,250.66
Rate for Payer: Multiplan WC	$102,824.59
Rate for Payer: Prime Health Services WC	$101,775.36

MS-DRG 42.00: MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE

Facility

$203,259.69

Service Code	MSDRG 447
Min. Negotiated Rate	$88,934.75
Max. Negotiated Rate	$203,259.69
Rate for Payer: Aetna of CA HMO/PPO	$203,259.69
Rate for Payer: EPIC Health Plan Commercial	$120,061.91
Rate for Payer: EPIC Health Plan Senior	$88,934.75
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$88,934.75
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$88,934.75
Rate for Payer: Molina Healthcare of CA Medicare	$119,172.57
Rate for Payer: Multiplan WC	$125,253.55
Rate for Payer: Prime Health Services WC	$123,975.45

MS-DRG 42.00: MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC

Facility

$123,795.39

Service Code	MSDRG 448
Min. Negotiated Rate	$61,364.15
Max. Negotiated Rate	$123,795.39
Rate for Payer: Aetna of CA HMO/PPO	$123,795.39
Rate for Payer: EPIC Health Plan Commercial	$82,841.60
Rate for Payer: EPIC Health Plan Senior	$61,364.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$61,364.15
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$61,364.15
Rate for Payer: Molina Healthcare of CA Medicare	$82,227.96
Rate for Payer: Multiplan WC	$76,285.72
Rate for Payer: Prime Health Services WC	$75,507.29

MS-DRG 42.00: MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC

Facility

$42,231.83

Service Code	MSDRG 059
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$42,231.83
Rate for Payer: Aetna of CA HMO/PPO	$37,094.66
Rate for Payer: EPIC Health Plan Commercial	$42,231.83
Rate for Payer: EPIC Health Plan Senior	$31,282.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,282.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,282.84
Rate for Payer: Molina Healthcare of CA Medicare	$41,919.01
Rate for Payer: Multiplan WC	$22,858.63
Rate for Payer: Prime Health Services WC	$22,625.38
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: MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC

Facility

$55,960.30

Service Code	MSDRG 058
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$55,960.30
Rate for Payer: Aetna of CA HMO/PPO	$55,960.30
Rate for Payer: EPIC Health Plan Commercial	$51,068.31
Rate for Payer: EPIC Health Plan Senior	$37,828.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,828.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,828.38
Rate for Payer: Molina Healthcare of CA Medicare	$50,690.03
Rate for Payer: Multiplan WC	$34,484.09
Rate for Payer: Prime Health Services WC	$34,132.21
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: MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC

Facility

$37,528.89

Service Code	MSDRG 060
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,528.89
Rate for Payer: Aetna of CA HMO/PPO	$27,054.00
Rate for Payer: EPIC Health Plan Commercial	$37,528.89
Rate for Payer: EPIC Health Plan Senior	$27,799.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,799.18
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,799.18
Rate for Payer: Molina Healthcare of CA Medicare	$37,250.90
Rate for Payer: Multiplan WC	$16,671.33
Rate for Payer: Prime Health Services WC	$16,501.21
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: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC

Facility

$71,542.73

Service Code	MSDRG 827
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$71,542.73
Rate for Payer: Aetna of CA HMO/PPO	$71,542.73
Rate for Payer: EPIC Health Plan Commercial	$58,366.99
Rate for Payer: EPIC Health Plan Senior	$43,234.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$43,234.81
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$43,234.81
Rate for Payer: Molina Healthcare of CA Medicare	$57,934.65
Rate for Payer: Multiplan WC	$44,086.36
Rate for Payer: Prime Health Services WC	$43,636.50
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 MAJOR O.R. PROCEDURES WITH MCC

Facility

$144,774.06

Service Code	MSDRG 826
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$144,774.06
Rate for Payer: Aetna of CA HMO/PPO	$144,774.06
Rate for Payer: EPIC Health Plan Commercial	$92,667.81
Rate for Payer: EPIC Health Plan Senior	$68,642.82
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$68,642.82
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$68,642.82
Rate for Payer: Molina Healthcare of CA Medicare	$91,981.38
Rate for Payer: Multiplan WC	$89,213.28
Rate for Payer: Prime Health Services WC	$88,302.94
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 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	$47,617.79
Rate for Payer: EPIC Health Plan Senior	$35,272.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,272.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,272.44
Rate for Payer: Molina Healthcare of CA Medicare	$47,265.07
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	$68,646.15
Rate for Payer: EPIC Health Plan Senior	$50,849.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$50,849.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$50,849.00
Rate for Payer: Molina Healthcare of CA Medicare	$68,137.66
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

$45,624.13

Service Code	MSDRG 830
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$45,624.13
Rate for Payer: Aetna of CA HMO/PPO	$44,337.15
Rate for Payer: EPIC Health Plan Commercial	$45,624.13
Rate for Payer: EPIC Health Plan Senior	$33,795.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,795.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,795.65
Rate for Payer: Molina Healthcare of CA Medicare	$45,286.17
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	$50,453.47
Rate for Payer: EPIC Health Plan Senior	$37,372.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,372.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,372.94
Rate for Payer: Molina Healthcare of CA Medicare	$50,079.74
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

Know your out-of-pocket cost for care.

All Charges