Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC

Facility

$136,773.67

Service Code	MSDRG 856
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$136,773.67
Rate for Payer: Aetna of CA HMO/PPO	$136,773.67
Rate for Payer: EPIC Health Plan Commercial	$88,922.16
Rate for Payer: EPIC Health Plan Senior	$65,868.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$65,868.27
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$65,868.27
Rate for Payer: Molina Healthcare of CA Medicare	$88,263.48
Rate for Payer: Multiplan WC	$84,283.24
Rate for Payer: Prime Health Services WC	$83,423.21
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: POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$43,153.63

Service Code	MSDRG 858
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$43,153.63
Rate for Payer: Aetna of CA HMO/PPO	$39,059.13
Rate for Payer: EPIC Health Plan Commercial	$43,153.63
Rate for Payer: EPIC Health Plan Senior	$31,965.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,965.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,965.65
Rate for Payer: Molina Healthcare of CA Medicare	$42,833.97
Rate for Payer: Multiplan WC	$24,069.18
Rate for Payer: Prime Health Services WC	$23,823.58
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: POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES

Facility

$44,589.24

Service Code	MSDRG 769
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$44,589.24
Rate for Payer: Aetna of CA HMO/PPO	$42,124.08
Rate for Payer: EPIC Health Plan Commercial	$44,589.24
Rate for Payer: EPIC Health Plan Senior	$33,029.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,029.07
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,029.07
Rate for Payer: Molina Healthcare of CA Medicare	$44,258.95
Rate for Payer: Multiplan WC	$25,957.88
Rate for Payer: Prime Health Services WC	$25,693.00
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: POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES

Facility

$34,990.22

Service Code	MSDRG 776
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,990.22
Rate for Payer: Aetna of CA HMO/PPO	$21,630.47
Rate for Payer: EPIC Health Plan Commercial	$34,990.22
Rate for Payer: EPIC Health Plan Senior	$25,918.68
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,918.68
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,918.68
Rate for Payer: Molina Healthcare of CA Medicare	$34,731.03
Rate for Payer: Multiplan WC	$13,329.22
Rate for Payer: Prime Health Services WC	$13,193.20
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: PREMATURITY WITH MAJOR PROBLEMS

Facility

$123,079.93

Service Code	MSDRG 791
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$123,079.93
Rate for Payer: Aetna of CA HMO/PPO	$123,079.93
Rate for Payer: EPIC Health Plan Commercial	$82,508.17
Rate for Payer: EPIC Health Plan Senior	$61,117.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$61,117.16
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$61,117.16
Rate for Payer: Molina Healthcare of CA Medicare	$81,896.99
Rate for Payer: Multiplan WC	$75,844.84
Rate for Payer: Prime Health Services WC	$75,070.91
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: PREMATURITY WITHOUT MAJOR PROBLEMS

Facility

$74,265.11

Service Code	MSDRG 792
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$74,265.11
Rate for Payer: Aetna of CA HMO/PPO	$74,265.11
Rate for Payer: EPIC Health Plan Commercial	$59,643.76
Rate for Payer: EPIC Health Plan Senior	$44,180.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$44,180.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$44,180.56
Rate for Payer: Molina Healthcare of CA Medicare	$59,201.95
Rate for Payer: Multiplan WC	$45,763.96
Rate for Payer: Prime Health Services WC	$45,296.98
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: PROSTATECTOMY WITH CC

Facility

$49,939.55

Service Code	MSDRG 666
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$49,939.55
Rate for Payer: Aetna of CA HMO/PPO	$49,939.55
Rate for Payer: EPIC Health Plan Commercial	$48,249.92
Rate for Payer: EPIC Health Plan Senior	$35,740.68
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,740.68
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,740.68
Rate for Payer: Molina Healthcare of CA Medicare	$47,892.51
Rate for Payer: Multiplan WC	$30,773.96
Rate for Payer: Prime Health Services WC	$30,459.94
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: PROSTATECTOMY WITH MCC

Facility

$104,093.02

Service Code	MSDRG 665
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$104,093.02
Rate for Payer: Aetna of CA HMO/PPO	$104,093.02
Rate for Payer: EPIC Health Plan Commercial	$73,614.88
Rate for Payer: EPIC Health Plan Senior	$54,529.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$54,529.54
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$54,529.54
Rate for Payer: Molina Healthcare of CA Medicare	$73,069.58
Rate for Payer: Multiplan WC	$64,144.64
Rate for Payer: Prime Health Services WC	$63,490.10
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: PROSTATECTOMY WITHOUT CC/MCC

Facility

$39,453.20

Service Code	MSDRG 667
Min. Negotiated Rate	$19,004.87
Max. Negotiated Rate	$39,453.20
Rate for Payer: Aetna of CA HMO/PPO	$31,158.78
Rate for Payer: EPIC Health Plan Commercial	$39,453.20
Rate for Payer: EPIC Health Plan Senior	$29,224.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,224.59
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,224.59
Rate for Payer: Molina Healthcare of CA Medicare	$39,160.95
Rate for Payer: Multiplan WC	$19,200.80
Rate for Payer: Prime Health Services WC	$19,004.87
Rate for Payer: United Healthcare All Other Commercial	$24,996.00
Rate for Payer: United Healthcare All Other HMO	$24,494.00
Rate for Payer: United Healthcare HMO Rider	$24,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,398.00

MS-DRG 42.00: PSYCHOSES

Facility

$44,874.65

Service Code	MSDRG 885
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$44,874.65
Rate for Payer: Aetna of CA HMO/PPO	$42,733.43
Rate for Payer: EPIC Health Plan Commercial	$44,874.65
Rate for Payer: EPIC Health Plan Senior	$33,240.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,240.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,240.48
Rate for Payer: Molina Healthcare of CA Medicare	$44,542.24
Rate for Payer: Multiplan WC	$26,333.37
Rate for Payer: Prime Health Services WC	$26,064.67
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: PULMONARY EDEMA AND RESPIRATORY FAILURE

Facility

$42,429.46

Service Code	MSDRG 189
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$42,429.46
Rate for Payer: Aetna of CA HMO/PPO	$37,513.02
Rate for Payer: EPIC Health Plan Commercial	$42,429.46
Rate for Payer: EPIC Health Plan Senior	$31,429.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,429.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,429.23
Rate for Payer: Molina Healthcare of CA Medicare	$42,115.17
Rate for Payer: Multiplan WC	$23,116.43
Rate for Payer: Prime Health Services WC	$22,880.54
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: PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE

Facility

$44,867.55

Service Code	MSDRG 175
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$44,867.55
Rate for Payer: Aetna of CA HMO/PPO	$42,718.28
Rate for Payer: EPIC Health Plan Commercial	$44,867.55
Rate for Payer: EPIC Health Plan Senior	$33,235.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,235.22
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,235.22
Rate for Payer: Molina Healthcare of CA Medicare	$44,535.19
Rate for Payer: Multiplan WC	$26,324.03
Rate for Payer: Prime Health Services WC	$26,055.42
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: PULMONARY EMBOLISM WITHOUT MCC

Facility

$36,424.39

Service Code	MSDRG 176
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$36,424.39
Rate for Payer: Aetna of CA HMO/PPO	$24,692.38
Rate for Payer: EPIC Health Plan Commercial	$36,424.39
Rate for Payer: EPIC Health Plan Senior	$26,981.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,981.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,981.03
Rate for Payer: Molina Healthcare of CA Medicare	$36,154.58
Rate for Payer: Multiplan WC	$15,216.05
Rate for Payer: Prime Health Services WC	$15,060.78
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: RADIOTHERAPY

Facility

$80,977.07

Service Code	MSDRG 849
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$80,977.07
Rate for Payer: Aetna of CA HMO/PPO	$80,977.07
Rate for Payer: EPIC Health Plan Commercial	$62,787.60
Rate for Payer: EPIC Health Plan Senior	$46,509.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$46,509.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$46,509.33
Rate for Payer: Molina Healthcare of CA Medicare	$62,322.50
Rate for Payer: Multiplan WC	$49,900.03
Rate for Payer: Prime Health Services WC	$49,390.85
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: RECTAL RESECTION WITH CC

Facility

$64,430.59

Service Code	MSDRG 333
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$64,430.59
Rate for Payer: Aetna of CA HMO/PPO	$64,430.59
Rate for Payer: EPIC Health Plan Commercial	$55,037.39
Rate for Payer: EPIC Health Plan Senior	$40,768.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$40,768.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,768.44
Rate for Payer: Molina Healthcare of CA Medicare	$54,629.71
Rate for Payer: Multiplan WC	$39,703.69
Rate for Payer: Prime Health Services WC	$39,298.55
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: RECTAL RESECTION WITH MCC

Facility

$105,157.11

Service Code	MSDRG 332
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$105,157.11
Rate for Payer: Aetna of CA HMO/PPO	$105,157.11
Rate for Payer: EPIC Health Plan Commercial	$74,113.27
Rate for Payer: EPIC Health Plan Senior	$54,898.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$54,898.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$54,898.72
Rate for Payer: Molina Healthcare of CA Medicare	$73,564.28
Rate for Payer: Multiplan WC	$64,800.36
Rate for Payer: Prime Health Services WC	$64,139.14
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: RECTAL RESECTION WITHOUT CC/MCC

Facility

$50,282.12

Service Code	MSDRG 334
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$50,282.12
Rate for Payer: Aetna of CA HMO/PPO	$50,282.12
Rate for Payer: EPIC Health Plan Commercial	$48,410.38
Rate for Payer: EPIC Health Plan Senior	$35,859.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,859.54
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,859.54
Rate for Payer: Molina Healthcare of CA Medicare	$48,051.78
Rate for Payer: Multiplan WC	$30,985.06
Rate for Payer: Prime Health Services WC	$30,668.89
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: RED BLOOD CELL DISORDERS WITH MCC

Facility

$44,836.32

Service Code	MSDRG 811
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$44,836.32
Rate for Payer: Aetna of CA HMO/PPO	$42,651.58
Rate for Payer: EPIC Health Plan Commercial	$44,836.32
Rate for Payer: EPIC Health Plan Senior	$33,212.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,212.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,212.09
Rate for Payer: Molina Healthcare of CA Medicare	$44,504.20
Rate for Payer: Multiplan WC	$26,282.93
Rate for Payer: Prime Health Services WC	$26,014.74
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: RED BLOOD CELL DISORDERS WITHOUT MCC

Facility

$37,963.65

Service Code	MSDRG 812
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,963.65
Rate for Payer: Aetna of CA HMO/PPO	$27,978.64
Rate for Payer: EPIC Health Plan Commercial	$37,963.65
Rate for Payer: EPIC Health Plan Senior	$28,121.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,121.22
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,121.22
Rate for Payer: Molina Healthcare of CA Medicare	$37,682.43
Rate for Payer: Multiplan WC	$17,241.11
Rate for Payer: Prime Health Services WC	$17,065.18
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: REHABILITATION WITH CC/MCC

Facility

$46,534.59

Service Code	MSDRG 945
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$46,534.59
Rate for Payer: Aetna of CA HMO/PPO	$46,277.37
Rate for Payer: EPIC Health Plan Commercial	$46,534.59
Rate for Payer: EPIC Health Plan Senior	$34,470.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,470.07
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,470.07
Rate for Payer: Molina Healthcare of CA Medicare	$46,189.89
Rate for Payer: Multiplan WC	$28,517.24
Rate for Payer: Prime Health Services WC	$28,226.24
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: REHABILITATION WITHOUT CC/MCC

Facility

$40,712.71

Service Code	MSDRG 946
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$40,712.71
Rate for Payer: Aetna of CA HMO/PPO	$33,847.81
Rate for Payer: EPIC Health Plan Commercial	$40,712.71
Rate for Payer: EPIC Health Plan Senior	$30,157.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,157.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,157.56
Rate for Payer: Molina Healthcare of CA Medicare	$40,411.13
Rate for Payer: Multiplan WC	$20,857.84
Rate for Payer: Prime Health Services WC	$20,645.00
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: RENAL FAILURE WITH CC

Facility

$37,480.86

Service Code	MSDRG 683
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,480.86
Rate for Payer: Aetna of CA HMO/PPO	$26,947.89
Rate for Payer: EPIC Health Plan Commercial	$37,480.86
Rate for Payer: EPIC Health Plan Senior	$27,763.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,763.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,763.60
Rate for Payer: Molina Healthcare of CA Medicare	$37,203.22
Rate for Payer: Multiplan WC	$16,605.94
Rate for Payer: Prime Health Services WC	$16,436.49
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: RENAL FAILURE WITH MCC

Facility

$46,185.28

Service Code	MSDRG 682
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$46,185.28
Rate for Payer: Aetna of CA HMO/PPO	$45,531.60
Rate for Payer: EPIC Health Plan Commercial	$46,185.28
Rate for Payer: EPIC Health Plan Senior	$34,211.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,211.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,211.32
Rate for Payer: Molina Healthcare of CA Medicare	$45,843.17
Rate for Payer: Multiplan WC	$28,057.67
Rate for Payer: Prime Health Services WC	$27,771.37
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

MS-DRG 42.00: RENAL FAILURE WITHOUT CC/MCC

Facility

$33,483.62

Service Code	MSDRG 684
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$33,483.62
Rate for Payer: Aetna of CA HMO/PPO	$18,413.94
Rate for Payer: EPIC Health Plan Commercial	$33,483.62
Rate for Payer: EPIC Health Plan Senior	$24,802.68
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,802.68
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,802.68
Rate for Payer: Molina Healthcare of CA Medicare	$33,235.59
Rate for Payer: Multiplan WC	$11,347.12
Rate for Payer: Prime Health Services WC	$11,231.33
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: RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC

Facility

$38,946.27

Service Code	MSDRG 178
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$38,946.27
Rate for Payer: Aetna of CA HMO/PPO	$30,076.50
Rate for Payer: EPIC Health Plan Commercial	$38,946.27
Rate for Payer: EPIC Health Plan Senior	$28,849.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,849.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,849.09
Rate for Payer: Molina Healthcare of CA Medicare	$38,657.78
Rate for Payer: Multiplan WC	$18,533.87
Rate for Payer: Prime Health Services WC	$18,344.75
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