Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: O.R. PROCEDURES FOR OBESITY WITH CC

Facility

$48,414.65

Service Code	MSDRG 620
Min. Negotiated Rate	$12,166.00
Max. Negotiated Rate	$48,414.65
Rate for Payer: Aetna of CA HMO/PPO	$48,414.65
Rate for Payer: EPIC Health Plan Commercial	$47,534.00
Rate for Payer: EPIC Health Plan Senior	$35,210.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,210.37
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,210.37
Rate for Payer: Molina Healthcare of CA Medicare	$47,181.90
Rate for Payer: Multiplan WC	$29,834.28
Rate for Payer: Prime Health Services WC	$29,529.85
Rate for Payer: United Healthcare All Other Commercial	$28,919.00
Rate for Payer: United Healthcare All Other HMO	$28,337.00
Rate for Payer: United Healthcare HMO Rider	$28,283.00
Rate for Payer: United Healthcare Select/Navigate/Core	$25,912.00

MS-DRG 42.00: O.R. PROCEDURES FOR OBESITY WITH MCC

Facility

$82,656.57

Service Code	MSDRG 619
Min. Negotiated Rate	$12,166.00
Max. Negotiated Rate	$82,656.57
Rate for Payer: Aetna of CA HMO/PPO	$82,656.57
Rate for Payer: EPIC Health Plan Commercial	$63,572.58
Rate for Payer: EPIC Health Plan Senior	$47,090.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$47,090.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$47,090.80
Rate for Payer: Molina Healthcare of CA Medicare	$63,101.67
Rate for Payer: Multiplan WC	$50,934.98
Rate for Payer: Prime Health Services WC	$50,415.24
Rate for Payer: United Healthcare All Other Commercial	$28,919.00
Rate for Payer: United Healthcare All Other HMO	$28,337.00
Rate for Payer: United Healthcare HMO Rider	$28,283.00
Rate for Payer: United Healthcare Select/Navigate/Core	$25,912.00

MS-DRG 42.00: O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC

Facility

$45,614.21

Service Code	MSDRG 621
Min. Negotiated Rate	$12,166.00
Max. Negotiated Rate	$45,614.21
Rate for Payer: Aetna of CA HMO/PPO	$44,315.93
Rate for Payer: EPIC Health Plan Commercial	$45,614.21
Rate for Payer: EPIC Health Plan Senior	$33,788.30
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,788.30
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,788.30
Rate for Payer: Molina Healthcare of CA Medicare	$45,276.32
Rate for Payer: Multiplan WC	$27,308.55
Rate for Payer: Prime Health Services WC	$27,029.89
Rate for Payer: United Healthcare All Other Commercial	$28,919.00
Rate for Payer: United Healthcare All Other HMO	$28,337.00
Rate for Payer: United Healthcare HMO Rider	$28,283.00
Rate for Payer: United Healthcare Select/Navigate/Core	$25,912.00

MS-DRG 42.00: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC

Facility

$64,009.20

Service Code	MSDRG 940
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$64,009.20
Rate for Payer: Aetna of CA HMO/PPO	$64,009.20
Rate for Payer: EPIC Health Plan Commercial	$54,838.35
Rate for Payer: EPIC Health Plan Senior	$40,621.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$40,621.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,621.00
Rate for Payer: Molina Healthcare of CA Medicare	$54,432.14
Rate for Payer: Multiplan WC	$39,444.02
Rate for Payer: Prime Health Services WC	$39,041.53
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: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC

Facility

$96,222.98

Service Code	MSDRG 939
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$96,222.98
Rate for Payer: Aetna of CA HMO/PPO	$96,222.98
Rate for Payer: EPIC Health Plan Commercial	$69,926.96
Rate for Payer: EPIC Health Plan Senior	$51,797.75
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$51,797.75
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$51,797.75
Rate for Payer: Molina Healthcare of CA Medicare	$69,408.99
Rate for Payer: Multiplan WC	$59,294.94
Rate for Payer: Prime Health Services WC	$58,689.89
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: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC

Facility

$59,246.56

Service Code	MSDRG 941
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$59,246.56
Rate for Payer: Aetna of CA HMO/PPO	$59,246.56
Rate for Payer: EPIC Health Plan Commercial	$52,607.57
Rate for Payer: EPIC Health Plan Senior	$38,968.57
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$38,968.57
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$38,968.57
Rate for Payer: Molina Healthcare of CA Medicare	$52,217.88
Rate for Payer: Multiplan WC	$36,509.17
Rate for Payer: Prime Health Services WC	$36,136.62
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: O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS

Facility

$119,129.75

Service Code	MSDRG 876
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$119,129.75
Rate for Payer: Aetna of CA HMO/PPO	$119,129.75
Rate for Payer: EPIC Health Plan Commercial	$80,656.28
Rate for Payer: EPIC Health Plan Senior	$59,745.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$59,745.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$59,745.39
Rate for Payer: Molina Healthcare of CA Medicare	$80,058.82
Rate for Payer: Multiplan WC	$73,410.64
Rate for Payer: Prime Health Services WC	$72,661.56
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: OSTEOMYELITIS WITH CC

Facility

$43,232.93

Service Code	MSDRG 540
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$43,232.93
Rate for Payer: Aetna of CA HMO/PPO	$39,231.94
Rate for Payer: EPIC Health Plan Commercial	$43,232.93
Rate for Payer: EPIC Health Plan Senior	$32,024.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,024.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,024.39
Rate for Payer: Molina Healthcare of CA Medicare	$42,912.68
Rate for Payer: Multiplan WC	$24,175.67
Rate for Payer: Prime Health Services WC	$23,928.98
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: OSTEOMYELITIS WITH MCC

Facility

$61,311.08

Service Code	MSDRG 539
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$61,311.08
Rate for Payer: Aetna of CA HMO/PPO	$61,311.08
Rate for Payer: EPIC Health Plan Commercial	$53,574.56
Rate for Payer: EPIC Health Plan Senior	$39,684.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,684.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,684.86
Rate for Payer: Molina Healthcare of CA Medicare	$53,177.71
Rate for Payer: Multiplan WC	$37,781.37
Rate for Payer: Prime Health Services WC	$37,395.85
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: OSTEOMYELITIS WITHOUT CC/MCC

Facility

$37,280.40

Service Code	MSDRG 541
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,280.40
Rate for Payer: Aetna of CA HMO/PPO	$26,523.47
Rate for Payer: EPIC Health Plan Commercial	$37,280.40
Rate for Payer: EPIC Health Plan Senior	$27,615.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,615.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,615.11
Rate for Payer: Molina Healthcare of CA Medicare	$37,004.25
Rate for Payer: Multiplan WC	$16,344.40
Rate for Payer: Prime Health Services WC	$16,177.62
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: OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC

Facility

$43,146.28

Service Code	MSDRG 818
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$43,146.28
Rate for Payer: Aetna of CA HMO/PPO	$39,047.01
Rate for Payer: EPIC Health Plan Commercial	$43,146.28
Rate for Payer: EPIC Health Plan Senior	$31,960.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,960.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,960.21
Rate for Payer: Molina Healthcare of CA Medicare	$42,826.68
Rate for Payer: Multiplan WC	$24,061.71
Rate for Payer: Prime Health Services WC	$23,816.19
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: OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC

Facility

$76,854.09

Service Code	MSDRG 817
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$76,854.09
Rate for Payer: Aetna of CA HMO/PPO	$76,854.09
Rate for Payer: EPIC Health Plan Commercial	$60,854.77
Rate for Payer: EPIC Health Plan Senior	$45,077.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$45,077.61
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$45,077.61
Rate for Payer: Molina Healthcare of CA Medicare	$60,404.00
Rate for Payer: Multiplan WC	$47,359.35
Rate for Payer: Prime Health Services WC	$46,876.09
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: OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$36,451.13

Service Code	MSDRG 819
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$36,451.13
Rate for Payer: Aetna of CA HMO/PPO	$24,753.01
Rate for Payer: EPIC Health Plan Commercial	$36,451.13
Rate for Payer: EPIC Health Plan Senior	$27,000.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,000.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,000.84
Rate for Payer: Molina Healthcare of CA Medicare	$36,181.13
Rate for Payer: Multiplan WC	$15,253.41
Rate for Payer: Prime Health Services WC	$15,097.76
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: OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC

Facility

$35,469.93

Service Code	MSDRG 832
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$35,469.93
Rate for Payer: Aetna of CA HMO/PPO	$22,658.18
Rate for Payer: EPIC Health Plan Commercial	$35,469.93
Rate for Payer: EPIC Health Plan Senior	$26,274.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,274.02
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,274.02
Rate for Payer: Molina Healthcare of CA Medicare	$35,207.19
Rate for Payer: Multiplan WC	$13,962.52
Rate for Payer: Prime Health Services WC	$13,820.05
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: OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC

Facility

$41,200.93

Service Code	MSDRG 831
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$41,200.93
Rate for Payer: Aetna of CA HMO/PPO	$34,893.72
Rate for Payer: EPIC Health Plan Commercial	$41,200.93
Rate for Payer: EPIC Health Plan Senior	$30,519.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,519.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,519.21
Rate for Payer: Molina Healthcare of CA Medicare	$40,895.74
Rate for Payer: Multiplan WC	$21,502.36
Rate for Payer: Prime Health Services WC	$21,282.94
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: OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$32,238.08

Service Code	MSDRG 833
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$32,238.08
Rate for Payer: Aetna of CA HMO/PPO	$15,758.26
Rate for Payer: EPIC Health Plan Commercial	$32,238.08
Rate for Payer: EPIC Health Plan Senior	$23,880.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,880.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,880.06
Rate for Payer: Molina Healthcare of CA Medicare	$31,999.28
Rate for Payer: Multiplan WC	$9,710.62
Rate for Payer: Prime Health Services WC	$9,611.54
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: OTHER CARDIOTHORACIC PROCEDURES WITH MCC

Facility

$151,073.72

Service Code	MSDRG 228
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$151,073.72
Rate for Payer: Aetna of CA HMO/PPO	$151,073.72
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$95,618.52
Rate for Payer: EPIC Health Plan Senior	$70,828.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$70,828.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$70,828.53
Rate for Payer: Molina Healthcare of CA Medicare	$94,910.23
Rate for Payer: Multiplan WC	$93,095.29
Rate for Payer: Prime Health Services WC	$92,145.33
Rate for Payer: United Healthcare All Other Commercial	$120,397.00
Rate for Payer: United Healthcare All Other HMO	$83,596.00
Rate for Payer: United Healthcare HMO Rider	$86,872.00
Rate for Payer: United Healthcare Select/Navigate/Core	$79,589.00

MS-DRG 42.00: OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC

Facility

$94,170.59

Service Code	MSDRG 229
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$94,170.59
Rate for Payer: Aetna of CA HMO/PPO	$94,170.59
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$68,965.64
Rate for Payer: EPIC Health Plan Senior	$51,085.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$51,085.66
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$51,085.66
Rate for Payer: Molina Healthcare of CA Medicare	$68,454.78
Rate for Payer: Multiplan WC	$58,030.20
Rate for Payer: Prime Health Services WC	$57,438.06
Rate for Payer: United Healthcare All Other Commercial	$71,243.00
Rate for Payer: United Healthcare All Other HMO	$65,974.00
Rate for Payer: United Healthcare HMO Rider	$68,556.00
Rate for Payer: United Healthcare Select/Navigate/Core	$62,809.00

MS-DRG 42.00: OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC

Facility

$38,521.47

Service Code	MSDRG 315
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$38,521.47
Rate for Payer: Aetna of CA HMO/PPO	$29,173.09
Rate for Payer: EPIC Health Plan Commercial	$38,521.47
Rate for Payer: EPIC Health Plan Senior	$28,534.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,534.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,534.42
Rate for Payer: Molina Healthcare of CA Medicare	$38,236.12
Rate for Payer: Multiplan WC	$17,977.16
Rate for Payer: Prime Health Services WC	$17,793.72
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: OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC

Facility

$65,285.51

Service Code	MSDRG 314
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$65,285.51
Rate for Payer: Aetna of CA HMO/PPO	$65,285.51
Rate for Payer: EPIC Health Plan Commercial	$55,436.16
Rate for Payer: EPIC Health Plan Senior	$41,063.82
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$41,063.82
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$41,063.82
Rate for Payer: Molina Healthcare of CA Medicare	$55,025.52
Rate for Payer: Multiplan WC	$40,230.51
Rate for Payer: Prime Health Services WC	$39,819.99
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: OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$34,551.22

Service Code	MSDRG 316
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,551.22
Rate for Payer: Aetna of CA HMO/PPO	$20,696.73
Rate for Payer: EPIC Health Plan Commercial	$34,551.22
Rate for Payer: EPIC Health Plan Senior	$25,593.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,593.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,593.50
Rate for Payer: Molina Healthcare of CA Medicare	$34,295.29
Rate for Payer: Multiplan WC	$12,753.83
Rate for Payer: Prime Health Services WC	$12,623.69
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: OTHER CIRCULATORY SYSTEM O.R. PROCEDURES

Facility

$105,957.45

Service Code	MSDRG 264
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$105,957.45
Rate for Payer: Aetna of CA HMO/PPO	$105,957.45
Rate for Payer: EPIC Health Plan Commercial	$74,486.51
Rate for Payer: EPIC Health Plan Senior	$55,175.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$55,175.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$55,175.19
Rate for Payer: Molina Healthcare of CA Medicare	$73,934.75
Rate for Payer: Multiplan WC	$65,293.55
Rate for Payer: Prime Health Services WC	$64,627.29
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: OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC

Facility

$38,223.27

Service Code	MSDRG 394
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$38,223.27
Rate for Payer: Aetna of CA HMO/PPO	$28,536.45
Rate for Payer: EPIC Health Plan Commercial	$38,223.27
Rate for Payer: EPIC Health Plan Senior	$28,313.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,313.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,313.53
Rate for Payer: Molina Healthcare of CA Medicare	$37,940.13
Rate for Payer: Multiplan WC	$17,584.86
Rate for Payer: Prime Health Services WC	$17,405.42
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: OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC

Facility

$50,203.30

Service Code	MSDRG 393
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$50,203.30
Rate for Payer: Aetna of CA HMO/PPO	$50,203.30
Rate for Payer: EPIC Health Plan Commercial	$48,371.80
Rate for Payer: EPIC Health Plan Senior	$35,830.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,830.96
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,830.96
Rate for Payer: Molina Healthcare of CA Medicare	$48,013.49
Rate for Payer: Multiplan WC	$30,936.48
Rate for Payer: Prime Health Services WC	$30,620.80
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: OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$33,893.76

Service Code	MSDRG 395
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$33,893.76
Rate for Payer: Aetna of CA HMO/PPO	$19,293.10
Rate for Payer: EPIC Health Plan Commercial	$33,893.76
Rate for Payer: EPIC Health Plan Senior	$25,106.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,106.49
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,106.49
Rate for Payer: Molina Healthcare of CA Medicare	$33,642.70
Rate for Payer: Multiplan WC	$11,888.88
Rate for Payer: Prime Health Services WC	$11,767.56
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