Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC

Facility

$70,108.78

Service Code	MSDRG 250
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$70,108.78
Rate for Payer: Aetna of CA HMO/PPO	$70,108.78
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$57,696.99
Rate for Payer: EPIC Health Plan Senior	$42,738.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$42,738.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,738.51
Rate for Payer: Molina Healthcare of CA Medicare	$57,269.60
Rate for Payer: Multiplan WC	$43,202.73
Rate for Payer: Prime Health Services WC	$42,761.89
Rate for Payer: United Healthcare All Other Commercial	$32,556.00
Rate for Payer: United Healthcare All Other HMO	$35,635.00
Rate for Payer: United Healthcare HMO Rider	$27,066.00
Rate for Payer: United Healthcare Select/Navigate/Core	$24,796.00

MS-DRG 42.00: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC

Facility

$47,371.78

Service Code	MSDRG 251
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$47,371.78
Rate for Payer: Aetna of CA HMO/PPO	$47,371.78
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$47,047.22
Rate for Payer: EPIC Health Plan Senior	$34,849.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,849.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,849.79
Rate for Payer: Molina Healthcare of CA Medicare	$46,698.72
Rate for Payer: Multiplan WC	$29,191.64
Rate for Payer: Prime Health Services WC	$28,893.77
Rate for Payer: United Healthcare All Other Commercial	$41,406.00
Rate for Payer: United Healthcare All Other HMO	$29,656.00
Rate for Payer: United Healthcare HMO Rider	$22,531.00
Rate for Payer: United Healthcare Select/Navigate/Core	$20,641.00

MS-DRG 42.00: PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR

Facility

$68,459.59

Service Code	MSDRG 041
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$68,459.59
Rate for Payer: Aetna of CA HMO/PPO	$68,459.59
Rate for Payer: EPIC Health Plan Commercial	$56,924.55
Rate for Payer: EPIC Health Plan Senior	$42,166.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$42,166.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,166.33
Rate for Payer: Molina Healthcare of CA Medicare	$56,502.88
Rate for Payer: Multiplan WC	$42,186.46
Rate for Payer: Prime Health Services WC	$41,755.99
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: PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC

Facility

$114,354.98

Service Code	MSDRG 040
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$114,354.98
Rate for Payer: Aetna of CA HMO/PPO	$114,354.98
Rate for Payer: EPIC Health Plan Commercial	$78,421.47
Rate for Payer: EPIC Health Plan Senior	$58,089.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$58,089.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$58,089.98
Rate for Payer: Molina Healthcare of CA Medicare	$77,840.57
Rate for Payer: Multiplan WC	$70,468.31
Rate for Payer: Prime Health Services WC	$69,749.25
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: PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC

Facility

$53,283.40

Service Code	MSDRG 042
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$53,283.40
Rate for Payer: Aetna of CA HMO/PPO	$53,283.40
Rate for Payer: EPIC Health Plan Commercial	$49,816.16
Rate for Payer: EPIC Health Plan Senior	$36,900.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,900.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,900.86
Rate for Payer: Molina Healthcare of CA Medicare	$49,447.15
Rate for Payer: Multiplan WC	$32,834.53
Rate for Payer: Prime Health Services WC	$32,499.48
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: PERIPHERAL VASCULAR DISORDERS WITH CC

Facility

$40,060.95

Service Code	MSDRG 300
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$40,060.95
Rate for Payer: Aetna of CA HMO/PPO	$32,456.31
Rate for Payer: EPIC Health Plan Commercial	$40,060.95
Rate for Payer: EPIC Health Plan Senior	$29,674.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,674.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,674.78
Rate for Payer: Molina Healthcare of CA Medicare	$39,764.21
Rate for Payer: Multiplan WC	$20,000.37
Rate for Payer: Prime Health Services WC	$19,796.28
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: PERIPHERAL VASCULAR DISORDERS WITH MCC

Facility

$49,039.16

Service Code	MSDRG 299
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$49,039.16
Rate for Payer: Aetna of CA HMO/PPO	$49,039.16
Rate for Payer: EPIC Health Plan Commercial	$47,828.19
Rate for Payer: EPIC Health Plan Senior	$35,428.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,428.29
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,428.29
Rate for Payer: Molina Healthcare of CA Medicare	$47,473.91
Rate for Payer: Multiplan WC	$30,219.12
Rate for Payer: Prime Health Services WC	$29,910.76
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: PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC

Facility

$34,988.80

Service Code	MSDRG 301
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,988.80
Rate for Payer: Aetna of CA HMO/PPO	$21,627.43
Rate for Payer: EPIC Health Plan Commercial	$34,988.80
Rate for Payer: EPIC Health Plan Senior	$25,917.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,917.63
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,917.63
Rate for Payer: Molina Healthcare of CA Medicare	$34,729.62
Rate for Payer: Multiplan WC	$13,327.35
Rate for Payer: Prime Health Services WC	$13,191.36
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: PERITONEAL ADHESIOLYSIS WITH CC

Facility

$64,036.49

Service Code	MSDRG 336
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$64,036.49
Rate for Payer: Aetna of CA HMO/PPO	$64,036.49
Rate for Payer: EPIC Health Plan Commercial	$54,852.79
Rate for Payer: EPIC Health Plan Senior	$40,631.70
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$40,631.70
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,631.70
Rate for Payer: Molina Healthcare of CA Medicare	$54,446.48
Rate for Payer: Multiplan WC	$39,460.84
Rate for Payer: Prime Health Services WC	$39,058.18
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: PERITONEAL ADHESIOLYSIS WITH MCC

Facility

$109,846.99

Service Code	MSDRG 335
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$109,846.99
Rate for Payer: Aetna of CA HMO/PPO	$109,846.99
Rate for Payer: EPIC Health Plan Commercial	$76,309.98
Rate for Payer: EPIC Health Plan Senior	$56,525.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$56,525.91
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$56,525.91
Rate for Payer: Molina Healthcare of CA Medicare	$75,744.72
Rate for Payer: Multiplan WC	$67,690.38
Rate for Payer: Prime Health Services WC	$66,999.67
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: PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC

Facility

$46,656.70

Service Code	MSDRG 337
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$46,656.70
Rate for Payer: Aetna of CA HMO/PPO	$46,538.09
Rate for Payer: EPIC Health Plan Commercial	$46,656.70
Rate for Payer: EPIC Health Plan Senior	$34,560.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,560.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,560.52
Rate for Payer: Molina Healthcare of CA Medicare	$46,311.10
Rate for Payer: Multiplan WC	$28,677.90
Rate for Payer: Prime Health Services WC	$28,385.27
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: PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC

Facility

$68,295.88

Service Code	MSDRG 243
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$68,295.88
Rate for Payer: Aetna of CA HMO/PPO	$68,295.88
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$56,847.85
Rate for Payer: EPIC Health Plan Senior	$42,109.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$42,109.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,109.52
Rate for Payer: Molina Healthcare of CA Medicare	$56,426.76
Rate for Payer: Multiplan WC	$42,085.58
Rate for Payer: Prime Health Services WC	$41,656.14
Rate for Payer: United Healthcare All Other Commercial	$29,923.00
Rate for Payer: United Healthcare All Other HMO	$27,707.00
Rate for Payer: United Healthcare HMO Rider	$24,583.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,521.00

MS-DRG 42.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC

Facility

$102,831.87

Service Code	MSDRG 242
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$102,831.87
Rate for Payer: Aetna of CA HMO/PPO	$102,831.87
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$73,024.17
Rate for Payer: EPIC Health Plan Senior	$54,091.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$54,091.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$54,091.98
Rate for Payer: Molina Healthcare of CA Medicare	$72,483.25
Rate for Payer: Multiplan WC	$63,367.50
Rate for Payer: Prime Health Services WC	$62,720.89
Rate for Payer: United Healthcare All Other Commercial	$38,262.00
Rate for Payer: United Healthcare All Other HMO	$35,430.00
Rate for Payer: United Healthcare HMO Rider	$36,089.00
Rate for Payer: United Healthcare Select/Navigate/Core	$33,062.00

MS-DRG 42.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC

Facility

$54,711.29

Service Code	MSDRG 244
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$54,711.29
Rate for Payer: Aetna of CA HMO/PPO	$54,711.29
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$50,484.94
Rate for Payer: EPIC Health Plan Senior	$37,396.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,396.25
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,396.25
Rate for Payer: Molina Healthcare of CA Medicare	$50,110.97
Rate for Payer: Multiplan WC	$33,714.42
Rate for Payer: Prime Health Services WC	$33,370.40
Rate for Payer: United Healthcare All Other Commercial	$25,087.00
Rate for Payer: United Healthcare All Other HMO	$23,231.00
Rate for Payer: United Healthcare HMO Rider	$20,612.00
Rate for Payer: United Healthcare Select/Navigate/Core	$18,884.00

MS-DRG 42.00: PLEURAL EFFUSION WITH CC

Facility

$39,115.24

Service Code	MSDRG 187
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$39,115.24
Rate for Payer: Aetna of CA HMO/PPO	$30,437.26
Rate for Payer: EPIC Health Plan Commercial	$39,115.24
Rate for Payer: EPIC Health Plan Senior	$28,974.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,974.25
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,974.25
Rate for Payer: Molina Healthcare of CA Medicare	$38,825.50
Rate for Payer: Multiplan WC	$18,756.18
Rate for Payer: Prime Health Services WC	$18,564.79
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: PLEURAL EFFUSION WITH MCC

Facility

$47,899.28

Service Code	MSDRG 186
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$47,899.28
Rate for Payer: Aetna of CA HMO/PPO	$47,899.28
Rate for Payer: EPIC Health Plan Commercial	$47,294.28
Rate for Payer: EPIC Health Plan Senior	$35,032.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,032.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,032.80
Rate for Payer: Molina Healthcare of CA Medicare	$46,943.95
Rate for Payer: Multiplan WC	$29,516.70
Rate for Payer: Prime Health Services WC	$29,215.51
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: PLEURAL EFFUSION WITHOUT CC/MCC

Facility

$35,284.15

Service Code	MSDRG 188
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$35,284.15
Rate for Payer: Aetna of CA HMO/PPO	$22,258.01
Rate for Payer: EPIC Health Plan Commercial	$35,284.15
Rate for Payer: EPIC Health Plan Senior	$26,136.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,136.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,136.41
Rate for Payer: Molina Healthcare of CA Medicare	$35,022.79
Rate for Payer: Multiplan WC	$13,715.92
Rate for Payer: Prime Health Services WC	$13,575.96
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: PNEUMOTHORAX WITH CC

Facility

$40,584.90

Service Code	MSDRG 200
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$40,584.90
Rate for Payer: Aetna of CA HMO/PPO	$33,574.97
Rate for Payer: EPIC Health Plan Commercial	$40,584.90
Rate for Payer: EPIC Health Plan Senior	$30,062.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,062.89
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,062.89
Rate for Payer: Molina Healthcare of CA Medicare	$40,284.27
Rate for Payer: Multiplan WC	$20,689.71
Rate for Payer: Prime Health Services WC	$20,478.59
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: PNEUMOTHORAX WITH MCC

Facility

$53,516.83

Service Code	MSDRG 199
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$53,516.83
Rate for Payer: Aetna of CA HMO/PPO	$53,516.83
Rate for Payer: EPIC Health Plan Commercial	$49,925.48
Rate for Payer: EPIC Health Plan Senior	$36,981.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,981.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,981.84
Rate for Payer: Molina Healthcare of CA Medicare	$49,555.67
Rate for Payer: Multiplan WC	$32,978.37
Rate for Payer: Prime Health Services WC	$32,641.86
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: PNEUMOTHORAX WITHOUT CC/MCC

Facility

$34,473.37

Service Code	MSDRG 201
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,473.37
Rate for Payer: Aetna of CA HMO/PPO	$20,526.96
Rate for Payer: EPIC Health Plan Commercial	$34,473.37
Rate for Payer: EPIC Health Plan Senior	$25,535.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,535.83
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,535.83
Rate for Payer: Molina Healthcare of CA Medicare	$34,218.01
Rate for Payer: Multiplan WC	$12,649.21
Rate for Payer: Prime Health Services WC	$12,520.14
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: POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC

Facility

$49,709.15

Service Code	MSDRG 917
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$49,709.15
Rate for Payer: Aetna of CA HMO/PPO	$49,709.15
Rate for Payer: EPIC Health Plan Commercial	$48,141.99
Rate for Payer: EPIC Health Plan Senior	$35,660.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,660.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,660.73
Rate for Payer: Molina Healthcare of CA Medicare	$47,785.38
Rate for Payer: Multiplan WC	$30,631.98
Rate for Payer: Prime Health Services WC	$30,319.41
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: POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC

Facility

$37,419.80

Service Code	MSDRG 918
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,419.80
Rate for Payer: Aetna of CA HMO/PPO	$26,817.53
Rate for Payer: EPIC Health Plan Commercial	$37,419.80
Rate for Payer: EPIC Health Plan Senior	$27,718.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,718.37
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,718.37
Rate for Payer: Molina Healthcare of CA Medicare	$37,142.62
Rate for Payer: Multiplan WC	$16,525.61
Rate for Payer: Prime Health Services WC	$16,356.98
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: POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC

Facility

$55,742.03

Service Code	MSDRG 862
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$55,742.03
Rate for Payer: Aetna of CA HMO/PPO	$55,742.03
Rate for Payer: EPIC Health Plan Commercial	$50,967.75
Rate for Payer: EPIC Health Plan Senior	$37,753.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,753.89
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,753.89
Rate for Payer: Molina Healthcare of CA Medicare	$50,590.21
Rate for Payer: Multiplan WC	$34,349.59
Rate for Payer: Prime Health Services WC	$33,999.08
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: POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC

Facility

$39,057.01

Service Code	MSDRG 863
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$39,057.01
Rate for Payer: Aetna of CA HMO/PPO	$30,312.97
Rate for Payer: EPIC Health Plan Commercial	$39,057.01
Rate for Payer: EPIC Health Plan Senior	$28,931.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,931.12
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,931.12
Rate for Payer: Molina Healthcare of CA Medicare	$38,767.70
Rate for Payer: Multiplan WC	$18,679.58
Rate for Payer: Prime Health Services WC	$18,488.98
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: POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC

Facility

$66,055.53

Service Code	MSDRG 857
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$66,055.53
Rate for Payer: Aetna of CA HMO/PPO	$66,055.53
Rate for Payer: EPIC Health Plan Commercial	$55,798.48
Rate for Payer: EPIC Health Plan Senior	$41,332.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$41,332.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$41,332.21
Rate for Payer: Molina Healthcare of CA Medicare	$55,385.16
Rate for Payer: Multiplan WC	$40,705.02
Rate for Payer: Prime Health Services WC	$40,289.66
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