Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: RESPIRATORY NEOPLASMS WITHOUT CC/MCC

Facility

$36,749.34

Service Code	MSDRG 182
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$36,749.34
Rate for Payer: Aetna of CA HMO/PPO	$25,389.65
Rate for Payer: EPIC Health Plan Commercial	$36,749.34
Rate for Payer: EPIC Health Plan Senior	$27,221.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,221.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,221.73
Rate for Payer: Molina Healthcare of CA Medicare	$36,477.12
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

$36,373.05

Service Code	MSDRG 204
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$36,373.05
Rate for Payer: Aetna of CA HMO/PPO	$24,586.28
Rate for Payer: EPIC Health Plan Commercial	$36,373.05
Rate for Payer: EPIC Health Plan Senior	$26,943.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,943.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,943.00
Rate for Payer: Molina Healthcare of CA Medicare	$36,103.62
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	$62,966.25
Rate for Payer: EPIC Health Plan Senior	$46,641.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$46,641.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$46,641.67
Rate for Payer: Molina Healthcare of CA Medicare	$62,499.84
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	$116,689.48
Rate for Payer: EPIC Health Plan Senior	$86,436.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$86,436.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$86,436.65
Rate for Payer: Molina Healthcare of CA Medicare	$115,825.11
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

$39,285.40

Service Code	MSDRG 815
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$39,285.40
Rate for Payer: Aetna of CA HMO/PPO	$30,804.09
Rate for Payer: EPIC Health Plan Commercial	$39,285.40
Rate for Payer: EPIC Health Plan Senior	$29,100.30
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,100.30
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,100.30
Rate for Payer: Molina Healthcare of CA Medicare	$38,994.40
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	$54,541.58
Rate for Payer: EPIC Health Plan Senior	$40,401.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$40,401.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,401.17
Rate for Payer: Molina Healthcare of CA Medicare	$54,137.57
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

$34,220.35

Service Code	MSDRG 816
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,220.35
Rate for Payer: Aetna of CA HMO/PPO	$19,990.37
Rate for Payer: EPIC Health Plan Commercial	$34,220.35
Rate for Payer: EPIC Health Plan Senior	$25,348.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,348.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,348.41
Rate for Payer: Molina Healthcare of CA Medicare	$33,966.87
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	$73,493.92
Rate for Payer: EPIC Health Plan Senior	$54,439.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$54,439.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$54,439.94
Rate for Payer: Molina Healthcare of CA Medicare	$72,949.52
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	$97,198.93
Rate for Payer: EPIC Health Plan Senior	$71,999.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$71,999.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$71,999.21
Rate for Payer: Molina Healthcare of CA Medicare	$96,478.94
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	$62,107.18
Rate for Payer: EPIC Health Plan Senior	$46,005.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$46,005.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$46,005.32
Rate for Payer: Molina Healthcare of CA Medicare	$61,647.13
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

$44,353.26

Service Code	MSDRG 139
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$44,353.26
Rate for Payer: Aetna of CA HMO/PPO	$41,623.87
Rate for Payer: EPIC Health Plan Commercial	$44,353.26
Rate for Payer: EPIC Health Plan Senior	$32,854.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,854.27
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,854.27
Rate for Payer: Molina Healthcare of CA Medicare	$44,024.72
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	$53,047.76
Rate for Payer: EPIC Health Plan Senior	$39,294.64
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,294.64
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,294.64
Rate for Payer: Molina Healthcare of CA Medicare	$52,654.82
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

$37,944.94

Service Code	MSDRG 101
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,944.94
Rate for Payer: Aetna of CA HMO/PPO	$27,942.26
Rate for Payer: EPIC Health Plan Commercial	$37,944.94
Rate for Payer: EPIC Health Plan Senior	$28,107.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,107.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,107.36
Rate for Payer: Molina Healthcare of CA Medicare	$37,663.86
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

$41,969.12

Service Code	MSDRG 549
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$41,969.12
Rate for Payer: Aetna of CA HMO/PPO	$36,533.81
Rate for Payer: EPIC Health Plan Commercial	$41,969.12
Rate for Payer: EPIC Health Plan Senior	$31,088.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,088.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,088.24
Rate for Payer: Molina Healthcare of CA Medicare	$41,658.24
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	$53,463.82
Rate for Payer: EPIC Health Plan Senior	$39,602.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,602.83
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,602.83
Rate for Payer: Molina Healthcare of CA Medicare	$53,067.79
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

$37,098.65

Service Code	MSDRG 550
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,098.65
Rate for Payer: Aetna of CA HMO/PPO	$26,135.42
Rate for Payer: EPIC Health Plan Commercial	$37,098.65
Rate for Payer: EPIC Health Plan Senior	$27,480.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,480.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,480.48
Rate for Payer: Molina Healthcare of CA Medicare	$36,823.84
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	$123,637.39
Rate for Payer: EPIC Health Plan Senior	$91,583.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$91,583.25
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$91,583.25
Rate for Payer: Molina Healthcare of CA Medicare	$122,721.55
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	$52,718.32
Rate for Payer: EPIC Health Plan Senior	$39,050.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,050.61
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,050.61
Rate for Payer: Molina Healthcare of CA Medicare	$52,327.82
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

$39,496.96

Service Code	MSDRG 872
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$39,496.96
Rate for Payer: Aetna of CA HMO/PPO	$31,255.80
Rate for Payer: EPIC Health Plan Commercial	$39,496.96
Rate for Payer: EPIC Health Plan Senior	$29,257.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,257.01
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,257.01
Rate for Payer: Molina Healthcare of CA Medicare	$39,204.39
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	$52,705.55
Rate for Payer: EPIC Health Plan Senior	$39,041.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,041.15
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,041.15
Rate for Payer: Molina Healthcare of CA Medicare	$52,315.14
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	$65,441.26
Rate for Payer: EPIC Health Plan Senior	$48,475.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$48,475.01
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$48,475.01
Rate for Payer: Molina Healthcare of CA Medicare	$64,956.51
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

MS-DRG 42.00: SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC

Facility

$48,742.06

Service Code	MSDRG 512
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$48,742.06
Rate for Payer: Aetna of CA HMO/PPO	$48,742.06
Rate for Payer: EPIC Health Plan Commercial	$47,687.36
Rate for Payer: EPIC Health Plan Senior	$35,323.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,323.97
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,323.97
Rate for Payer: Molina Healthcare of CA Medicare	$47,334.12
Rate for Payer: Multiplan WC	$30,036.04
Rate for Payer: Prime Health Services WC	$29,729.55
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: SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$43,978.41

Service Code	MSDRG 555
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$43,978.41
Rate for Payer: Aetna of CA HMO/PPO	$40,823.53
Rate for Payer: EPIC Health Plan Commercial	$43,978.41
Rate for Payer: EPIC Health Plan Senior	$32,576.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,576.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,576.60
Rate for Payer: Molina Healthcare of CA Medicare	$43,652.64
Rate for Payer: Multiplan WC	$25,156.44
Rate for Payer: Prime Health Services WC	$24,899.74
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: SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC

Facility

$36,451.13

Service Code	MSDRG 556
Min. Negotiated Rate	$6,823.00
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	$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: SIGNS AND SYMPTOMS WITH MCC

Facility

$43,120.74

Service Code	MSDRG 947
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$43,120.74
Rate for Payer: Aetna of CA HMO/PPO	$38,992.44
Rate for Payer: EPIC Health Plan Commercial	$43,120.74
Rate for Payer: EPIC Health Plan Senior	$31,941.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,941.29
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,941.29
Rate for Payer: Molina Healthcare of CA Medicare	$42,801.33
Rate for Payer: Multiplan WC	$24,028.09
Rate for Payer: Prime Health Services WC	$23,782.91
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