Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: NEONATE WITH OTHER SIGNIFICANT PROBLEMS

Facility

$45,818.69

Service Code	MSDRG 794
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$45,818.69
Rate for Payer: Aetna of CA HMO/PPO	$44,752.48
Rate for Payer: EPIC Health Plan Commercial	$45,818.69
Rate for Payer: EPIC Health Plan Senior	$33,939.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,939.77
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,939.77
Rate for Payer: Molina Healthcare of CA Medicare	$45,479.29
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

$46,143.85

Service Code	MSDRG 054
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$46,143.85
Rate for Payer: Aetna of CA HMO/PPO	$45,446.72
Rate for Payer: EPIC Health Plan Commercial	$46,143.85
Rate for Payer: EPIC Health Plan Senior	$34,180.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,180.63
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,180.63
Rate for Payer: Molina Healthcare of CA Medicare	$45,802.04
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

$40,348.95

Service Code	MSDRG 055
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$40,348.95
Rate for Payer: Aetna of CA HMO/PPO	$33,074.76
Rate for Payer: EPIC Health Plan Commercial	$40,348.95
Rate for Payer: EPIC Health Plan Senior	$29,888.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,888.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,888.11
Rate for Payer: Molina Healthcare of CA Medicare	$40,050.07
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

$36,262.28

Service Code	MSDRG 123
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$36,262.28
Rate for Payer: Aetna of CA HMO/PPO	$24,349.81
Rate for Payer: EPIC Health Plan Commercial	$36,262.28
Rate for Payer: EPIC Health Plan Senior	$26,860.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,860.95
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,860.95
Rate for Payer: Molina Healthcare of CA Medicare	$35,993.67
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

$38,517.20

Service Code	MSDRG 882
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$38,517.20
Rate for Payer: Aetna of CA HMO/PPO	$29,163.99
Rate for Payer: EPIC Health Plan Commercial	$38,517.20
Rate for Payer: EPIC Health Plan Senior	$28,531.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,531.26
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,531.26
Rate for Payer: Molina Healthcare of CA Medicare	$38,231.89
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	$55,660.51
Rate for Payer: EPIC Health Plan Senior	$41,230.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$41,230.01
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$41,230.01
Rate for Payer: Molina Healthcare of CA Medicare	$55,248.21
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	$75,757.37
Rate for Payer: EPIC Health Plan Senior	$56,116.57
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$56,116.57
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$56,116.57
Rate for Payer: Molina Healthcare of CA Medicare	$75,196.20
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

$44,641.53

Service Code	MSDRG 099
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$44,641.53
Rate for Payer: Aetna of CA HMO/PPO	$42,239.28
Rate for Payer: EPIC Health Plan Commercial	$44,641.53
Rate for Payer: EPIC Health Plan Senior	$33,067.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,067.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,067.80
Rate for Payer: Molina Healthcare of CA Medicare	$44,310.85
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	$56,045.33
Rate for Payer: EPIC Health Plan Senior	$41,515.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$41,515.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$41,515.06
Rate for Payer: Molina Healthcare of CA Medicare	$55,630.18
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	$49,223.78
Rate for Payer: EPIC Health Plan Senior	$36,462.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,462.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,462.06
Rate for Payer: Molina Healthcare of CA Medicare	$48,859.16
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	$74,594.41
Rate for Payer: EPIC Health Plan Senior	$55,255.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$55,255.12
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$55,255.12
Rate for Payer: Molina Healthcare of CA Medicare	$74,041.86
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

$41,264.84

Service Code	MSDRG 989
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$41,264.84
Rate for Payer: Aetna of CA HMO/PPO	$35,030.14
Rate for Payer: EPIC Health Plan Commercial	$41,264.84
Rate for Payer: EPIC Health Plan Senior	$30,566.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,566.55
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,566.55
Rate for Payer: Molina Healthcare of CA Medicare	$40,959.18
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

$38,440.51

Service Code	MSDRG 600
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$38,440.51
Rate for Payer: Aetna of CA HMO/PPO	$29,000.29
Rate for Payer: EPIC Health Plan Commercial	$38,440.51
Rate for Payer: EPIC Health Plan Senior	$28,474.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,474.45
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,474.45
Rate for Payer: Molina Healthcare of CA Medicare	$38,155.76
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

$33,369.80

Service Code	MSDRG 601
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$33,369.80
Rate for Payer: Aetna of CA HMO/PPO	$18,174.44
Rate for Payer: EPIC Health Plan Commercial	$33,369.80
Rate for Payer: EPIC Health Plan Senior	$24,718.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,718.37
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,718.37
Rate for Payer: Molina Healthcare of CA Medicare	$33,122.62
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

$39,822.15

Service Code	MSDRG 071
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$39,822.15
Rate for Payer: Aetna of CA HMO/PPO	$31,950.03
Rate for Payer: EPIC Health Plan Commercial	$39,822.15
Rate for Payer: EPIC Health Plan Senior	$29,497.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,497.89
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,497.89
Rate for Payer: Molina Healthcare of CA Medicare	$39,527.17
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	$49,547.54
Rate for Payer: EPIC Health Plan Senior	$36,701.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,701.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,701.88
Rate for Payer: Molina Healthcare of CA Medicare	$49,180.52
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

$35,509.68

Service Code	MSDRG 072
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$35,509.68
Rate for Payer: Aetna of CA HMO/PPO	$22,743.06
Rate for Payer: EPIC Health Plan Commercial	$35,509.68
Rate for Payer: EPIC Health Plan Senior	$26,303.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,303.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,303.47
Rate for Payer: Molina Healthcare of CA Medicare	$35,246.65
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

$45,516.24

Service Code	MSDRG 067
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$45,516.24
Rate for Payer: Aetna of CA HMO/PPO	$44,106.75
Rate for Payer: EPIC Health Plan Commercial	$45,516.24
Rate for Payer: EPIC Health Plan Senior	$33,715.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,715.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,715.73
Rate for Payer: Molina Healthcare of CA Medicare	$45,179.08
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

$37,374.13

Service Code	MSDRG 068
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,374.13
Rate for Payer: Aetna of CA HMO/PPO	$26,723.55
Rate for Payer: EPIC Health Plan Commercial	$37,374.13
Rate for Payer: EPIC Health Plan Senior	$27,684.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,684.54
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,684.54
Rate for Payer: Molina Healthcare of CA Medicare	$37,097.28
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	$53,083.27
Rate for Payer: EPIC Health Plan Senior	$39,320.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,320.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,320.94
Rate for Payer: Molina Healthcare of CA Medicare	$52,690.06
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

$37,704.96

Service Code	MSDRG 081
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,704.96
Rate for Payer: Aetna of CA HMO/PPO	$27,429.92
Rate for Payer: EPIC Health Plan Commercial	$37,704.96
Rate for Payer: EPIC Health Plan Senior	$27,929.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,929.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,929.60
Rate for Payer: Molina Healthcare of CA Medicare	$37,425.66
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

MS-DRG 42.00: NORMAL NEWBORN

Facility

$27,694.16

Service Code	MSDRG 795
Min. Negotiated Rate	$1,053.00
Max. Negotiated Rate	$27,694.16
Rate for Payer: Aetna of CA HMO/PPO	$6,057.14
Rate for Payer: EPIC Health Plan Commercial	$27,694.16
Rate for Payer: EPIC Health Plan Senior	$20,514.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,514.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,514.19
Rate for Payer: Molina Healthcare of CA Medicare	$27,489.01
Rate for Payer: Multiplan WC	$3,732.56
Rate for Payer: Prime Health Services WC	$3,694.47
Rate for Payer: United Healthcare All Other Commercial	$1,650.00
Rate for Payer: United Healthcare All Other HMO	$1,342.00
Rate for Payer: United Healthcare HMO Rider	$1,149.00
Rate for Payer: United Healthcare Select/Navigate/Core	$1,053.00

MS-DRG 42.00: ORBITAL PROCEDURES WITH CC/MCC

Facility

$68,411.09

Service Code	MSDRG 113
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$68,411.09
Rate for Payer: Aetna of CA HMO/PPO	$68,411.09
Rate for Payer: EPIC Health Plan Commercial	$56,900.15
Rate for Payer: EPIC Health Plan Senior	$42,148.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$42,148.26
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,148.26
Rate for Payer: Molina Healthcare of CA Medicare	$56,478.67
Rate for Payer: Multiplan WC	$42,156.57
Rate for Payer: Prime Health Services WC	$41,726.40
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: ORBITAL PROCEDURES WITHOUT CC/MCC

Facility

$41,642.55

Service Code	MSDRG 114
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$41,642.55
Rate for Payer: Aetna of CA HMO/PPO	$35,836.54
Rate for Payer: EPIC Health Plan Commercial	$41,642.55
Rate for Payer: EPIC Health Plan Senior	$30,846.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,846.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,846.33
Rate for Payer: Molina Healthcare of CA Medicare	$41,334.08
Rate for Payer: Multiplan WC	$22,083.35
Rate for Payer: Prime Health Services WC	$21,858.01
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: ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY

Facility

$50,633.78

Service Code	MSDRG 884
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$50,633.78
Rate for Payer: Aetna of CA HMO/PPO	$50,633.78
Rate for Payer: EPIC Health Plan Commercial	$48,573.43
Rate for Payer: EPIC Health Plan Senior	$35,980.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,980.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,980.32
Rate for Payer: Molina Healthcare of CA Medicare	$48,213.63
Rate for Payer: Multiplan WC	$31,201.76
Rate for Payer: Prime Health Services WC	$30,883.37
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

Know your out-of-pocket cost for care.

All Charges