Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC

Facility

$49,005.81

Service Code	MSDRG 177
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$49,005.81
Rate for Payer: Aetna of CA HMO/PPO	$49,005.81
Rate for Payer: EPIC Health Plan Commercial	$47,812.57
Rate for Payer: EPIC Health Plan Senior	$35,416.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,416.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,416.72
Rate for Payer: Molina Healthcare of CA Medicare	$47,458.40
Rate for Payer: Multiplan WC	$30,198.57
Rate for Payer: Prime Health Services WC	$29,890.42
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: RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC

Facility

$35,788.26

Service Code	MSDRG 179
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$35,788.26
Rate for Payer: Aetna of CA HMO/PPO	$23,334.23
Rate for Payer: EPIC Health Plan Commercial	$35,788.26
Rate for Payer: EPIC Health Plan Senior	$26,509.82
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,509.82
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,509.82
Rate for Payer: Molina Healthcare of CA Medicare	$35,523.16
Rate for Payer: Multiplan WC	$14,379.12
Rate for Payer: Prime Health Services WC	$14,232.39
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 NEOPLASMS WITH CC

Facility

$40,624.67

Service Code	MSDRG 181
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$40,624.67
Rate for Payer: Aetna of CA HMO/PPO	$33,659.85
Rate for Payer: EPIC Health Plan Commercial	$40,624.67
Rate for Payer: EPIC Health Plan Senior	$30,092.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,092.35
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,092.35
Rate for Payer: Molina Healthcare of CA Medicare	$40,323.75
Rate for Payer: Multiplan WC	$20,742.01
Rate for Payer: Prime Health Services WC	$20,530.36
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: RESPIRATORY NEOPLASMS WITH MCC

Facility

$52,986.30

Service Code	MSDRG 180
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$52,986.30
Rate for Payer: Aetna of CA HMO/PPO	$52,986.30
Rate for Payer: EPIC Health Plan Commercial	$49,677.00
Rate for Payer: EPIC Health Plan Senior	$36,797.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,797.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,797.78
Rate for Payer: Molina Healthcare of CA Medicare	$49,309.03
Rate for Payer: Multiplan WC	$32,651.44
Rate for Payer: Prime Health Services WC	$32,318.27
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: RESPIRATORY NEOPLASMS WITHOUT CC/MCC

Facility

$36,751.00

Service Code	MSDRG 182
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$36,751.00
Rate for Payer: Aetna of CA HMO/PPO	$25,389.65
Rate for Payer: EPIC Health Plan Commercial	$36,751.00
Rate for Payer: EPIC Health Plan Senior	$27,222.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,222.96
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,222.96
Rate for Payer: Molina Healthcare of CA Medicare	$36,478.77
Rate for Payer: Multiplan WC	$15,645.72
Rate for Payer: Prime Health Services WC	$15,486.07
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 SIGNS AND SYMPTOMS

Facility

$36,374.71

Service Code	MSDRG 204
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$36,374.71
Rate for Payer: Aetna of CA HMO/PPO	$24,586.28
Rate for Payer: EPIC Health Plan Commercial	$36,374.71
Rate for Payer: EPIC Health Plan Senior	$26,944.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,944.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,944.23
Rate for Payer: Molina Healthcare of CA Medicare	$36,105.27
Rate for Payer: Multiplan WC	$15,150.66
Rate for Payer: Prime Health Services WC	$14,996.06
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: RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS

Facility

$81,362.08

Service Code	MSDRG 208
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$81,362.08
Rate for Payer: Aetna of CA HMO/PPO	$81,362.08
Rate for Payer: EPIC Health Plan Commercial	$62,967.92
Rate for Payer: EPIC Health Plan Senior	$46,642.90
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$46,642.90
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$46,642.90
Rate for Payer: Molina Healthcare of CA Medicare	$62,501.49
Rate for Payer: Multiplan WC	$50,137.29
Rate for Payer: Prime Health Services WC	$49,625.68
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 SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS

Facility

$196,059.64

Service Code	MSDRG 207
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$196,059.64
Rate for Payer: Aetna of CA HMO/PPO	$196,059.64
Rate for Payer: EPIC Health Plan Commercial	$116,691.14
Rate for Payer: EPIC Health Plan Senior	$86,437.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$86,437.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$86,437.88
Rate for Payer: Molina Healthcare of CA Medicare	$115,826.76
Rate for Payer: Multiplan WC	$120,816.70
Rate for Payer: Prime Health Services WC	$119,583.88
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: RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC

Facility

$39,287.07

Service Code	MSDRG 815
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$39,287.07
Rate for Payer: Aetna of CA HMO/PPO	$30,804.09
Rate for Payer: EPIC Health Plan Commercial	$39,287.07
Rate for Payer: EPIC Health Plan Senior	$29,101.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,101.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,101.53
Rate for Payer: Molina Healthcare of CA Medicare	$38,996.05
Rate for Payer: Multiplan WC	$18,982.23
Rate for Payer: Prime Health Services WC	$18,788.53
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: RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC

Facility

$63,375.60

Service Code	MSDRG 814
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$63,375.60
Rate for Payer: Aetna of CA HMO/PPO	$63,375.60
Rate for Payer: EPIC Health Plan Commercial	$54,543.24
Rate for Payer: EPIC Health Plan Senior	$40,402.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$40,402.40
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,402.40
Rate for Payer: Molina Healthcare of CA Medicare	$54,139.22
Rate for Payer: Multiplan WC	$39,053.58
Rate for Payer: Prime Health Services WC	$38,655.07
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: RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC

Facility

$34,222.01

Service Code	MSDRG 816
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,222.01
Rate for Payer: Aetna of CA HMO/PPO	$19,990.37
Rate for Payer: EPIC Health Plan Commercial	$34,222.01
Rate for Payer: EPIC Health Plan Senior	$25,349.64
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,349.64
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,349.64
Rate for Payer: Molina Healthcare of CA Medicare	$33,968.52
Rate for Payer: Multiplan WC	$12,318.55
Rate for Payer: Prime Health Services WC	$12,192.85
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: REVISION OF HIP OR KNEE REPLACEMENT WITH CC

Facility

$103,838.36

Service Code	MSDRG 467
Min. Negotiated Rate	$32,499.00
Max. Negotiated Rate	$103,838.36
Rate for Payer: Aetna of CA HMO/PPO	$103,838.36
Rate for Payer: EPIC Health Plan Commercial	$73,495.58
Rate for Payer: EPIC Health Plan Senior	$54,441.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$54,441.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$54,441.17
Rate for Payer: Molina Healthcare of CA Medicare	$72,951.17
Rate for Payer: Multiplan WC	$63,987.72
Rate for Payer: Prime Health Services WC	$63,334.78
Rate for Payer: United Healthcare All Other Commercial	$36,468.00
Rate for Payer: United Healthcare All Other HMO	$33,770.00
Rate for Payer: United Healthcare HMO Rider	$35,474.00
Rate for Payer: United Healthcare Select/Navigate/Core	$32,499.00

MS-DRG 42.00: REVISION OF HIP OR KNEE REPLACEMENT WITH MCC

Facility

$154,447.89

Service Code	MSDRG 466
Min. Negotiated Rate	$39,477.00
Max. Negotiated Rate	$154,447.89
Rate for Payer: Aetna of CA HMO/PPO	$154,447.89
Rate for Payer: EPIC Health Plan Commercial	$97,200.59
Rate for Payer: EPIC Health Plan Senior	$72,000.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$72,000.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$72,000.44
Rate for Payer: Molina Healthcare of CA Medicare	$96,480.59
Rate for Payer: Multiplan WC	$95,174.53
Rate for Payer: Prime Health Services WC	$94,203.36
Rate for Payer: United Healthcare All Other Commercial	$39,477.00
Rate for Payer: United Healthcare All Other HMO	$43,441.00
Rate for Payer: United Healthcare HMO Rider	$45,640.00
Rate for Payer: United Healthcare Select/Navigate/Core	$41,813.00

MS-DRG 42.00: REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC

Facility

$79,527.96

Service Code	MSDRG 468
Min. Negotiated Rate	$28,986.00
Max. Negotiated Rate	$79,527.96
Rate for Payer: Aetna of CA HMO/PPO	$79,527.96
Rate for Payer: EPIC Health Plan Commercial	$62,108.84
Rate for Payer: EPIC Health Plan Senior	$46,006.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$46,006.55
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$46,006.55
Rate for Payer: Molina Healthcare of CA Medicare	$61,648.78
Rate for Payer: Multiplan WC	$49,007.06
Rate for Payer: Prime Health Services WC	$48,506.98
Rate for Payer: United Healthcare All Other Commercial	$39,477.00
Rate for Payer: United Healthcare All Other HMO	$30,116.00
Rate for Payer: United Healthcare HMO Rider	$31,639.00
Rate for Payer: United Healthcare Select/Navigate/Core	$28,986.00

MS-DRG 42.00: SALIVARY GLAND PROCEDURES

Facility

$44,354.93

Service Code	MSDRG 139
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$44,354.93
Rate for Payer: Aetna of CA HMO/PPO	$41,623.87
Rate for Payer: EPIC Health Plan Commercial	$44,354.93
Rate for Payer: EPIC Health Plan Senior	$32,855.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,855.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,855.50
Rate for Payer: Molina Healthcare of CA Medicare	$44,026.37
Rate for Payer: Multiplan WC	$25,649.64
Rate for Payer: Prime Health Services WC	$25,387.91
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: SEIZURES WITH MCC

Facility

$60,186.35

Service Code	MSDRG 100
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$60,186.35
Rate for Payer: Aetna of CA HMO/PPO	$60,186.35
Rate for Payer: EPIC Health Plan Commercial	$53,049.42
Rate for Payer: EPIC Health Plan Senior	$39,295.87
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,295.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,295.87
Rate for Payer: Molina Healthcare of CA Medicare	$52,656.47
Rate for Payer: Multiplan WC	$37,088.29
Rate for Payer: Prime Health Services WC	$36,709.83
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: SEIZURES WITHOUT MCC

Facility

$37,946.60

Service Code	MSDRG 101
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,946.60
Rate for Payer: Aetna of CA HMO/PPO	$27,942.26
Rate for Payer: EPIC Health Plan Commercial	$37,946.60
Rate for Payer: EPIC Health Plan Senior	$28,108.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,108.59
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,108.59
Rate for Payer: Molina Healthcare of CA Medicare	$37,665.51
Rate for Payer: Multiplan WC	$17,218.70
Rate for Payer: Prime Health Services WC	$17,043.00
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: SEPTIC ARTHRITIS WITH CC

Facility

$41,970.78

Service Code	MSDRG 549
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$41,970.78
Rate for Payer: Aetna of CA HMO/PPO	$36,533.81
Rate for Payer: EPIC Health Plan Commercial	$41,970.78
Rate for Payer: EPIC Health Plan Senior	$31,089.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,089.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,089.47
Rate for Payer: Molina Healthcare of CA Medicare	$41,659.89
Rate for Payer: Multiplan WC	$22,513.02
Rate for Payer: Prime Health Services WC	$22,283.30
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: SEPTIC ARTHRITIS WITH MCC

Facility

$61,074.61

Service Code	MSDRG 548
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$61,074.61
Rate for Payer: Aetna of CA HMO/PPO	$61,074.61
Rate for Payer: EPIC Health Plan Commercial	$53,465.48
Rate for Payer: EPIC Health Plan Senior	$39,604.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,604.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,604.06
Rate for Payer: Molina Healthcare of CA Medicare	$53,069.44
Rate for Payer: Multiplan WC	$37,635.66
Rate for Payer: Prime Health Services WC	$37,251.62
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: SEPTIC ARTHRITIS WITHOUT CC/MCC

Facility

$37,100.31

Service Code	MSDRG 550
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,100.31
Rate for Payer: Aetna of CA HMO/PPO	$26,135.42
Rate for Payer: EPIC Health Plan Commercial	$37,100.31
Rate for Payer: EPIC Health Plan Senior	$27,481.71
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,481.71
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,481.71
Rate for Payer: Molina Healthcare of CA Medicare	$36,825.49
Rate for Payer: Multiplan WC	$16,105.28
Rate for Payer: Prime Health Services WC	$15,940.94
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: SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS

Facility

$210,893.25

Service Code	MSDRG 870
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$210,893.25
Rate for Payer: Aetna of CA HMO/PPO	$210,893.25
Rate for Payer: EPIC Health Plan Commercial	$123,639.05
Rate for Payer: EPIC Health Plan Senior	$91,584.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$91,584.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$91,584.48
Rate for Payer: Molina Healthcare of CA Medicare	$122,723.20
Rate for Payer: Multiplan WC	$129,957.54
Rate for Payer: Prime Health Services WC	$128,631.44
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: SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC

Facility

$59,483.02

Service Code	MSDRG 871
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$59,483.02
Rate for Payer: Aetna of CA HMO/PPO	$59,483.02
Rate for Payer: EPIC Health Plan Commercial	$52,719.98
Rate for Payer: EPIC Health Plan Senior	$39,051.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,051.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,051.84
Rate for Payer: Molina Healthcare of CA Medicare	$52,329.47
Rate for Payer: Multiplan WC	$36,654.88
Rate for Payer: Prime Health Services WC	$36,280.85
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: SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC

Facility

$39,498.62

Service Code	MSDRG 872
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$39,498.62
Rate for Payer: Aetna of CA HMO/PPO	$31,255.80
Rate for Payer: EPIC Health Plan Commercial	$39,498.62
Rate for Payer: EPIC Health Plan Senior	$29,258.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,258.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,258.24
Rate for Payer: Molina Healthcare of CA Medicare	$39,206.04
Rate for Payer: Multiplan WC	$19,260.58
Rate for Payer: Prime Health Services WC	$19,064.04
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: SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC

Facility

$59,455.74

Service Code	MSDRG 511
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$59,455.74
Rate for Payer: Aetna of CA HMO/PPO	$59,455.74
Rate for Payer: EPIC Health Plan Commercial	$52,707.21
Rate for Payer: EPIC Health Plan Senior	$39,042.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,042.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,042.38
Rate for Payer: Molina Healthcare of CA Medicare	$52,316.79
Rate for Payer: Multiplan WC	$36,638.06
Rate for Payer: Prime Health Services WC	$36,264.21
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: SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC

Facility

$86,646.16

Service Code	MSDRG 510
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$86,646.16
Rate for Payer: Aetna of CA HMO/PPO	$86,646.16
Rate for Payer: EPIC Health Plan Commercial	$65,442.92
Rate for Payer: EPIC Health Plan Senior	$48,476.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$48,476.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$48,476.24
Rate for Payer: Molina Healthcare of CA Medicare	$64,958.16
Rate for Payer: Multiplan WC	$53,393.47
Rate for Payer: Prime Health Services WC	$52,848.64
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