Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC

Facility

$113,442.47

Service Code	MSDRG 622
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$113,442.47
Rate for Payer: Aetna of CA HMO/PPO	$113,442.47
Rate for Payer: EPIC Health Plan Commercial	$77,994.08
Rate for Payer: EPIC Health Plan Senior	$57,773.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$57,773.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$57,773.39
Rate for Payer: Molina Healthcare of CA Medicare	$77,416.34
Rate for Payer: Multiplan WC	$69,906.00
Rate for Payer: Prime Health Services WC	$69,192.67
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: SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC

Facility

$39,102.45

Service Code	MSDRG 624
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$39,102.45
Rate for Payer: Aetna of CA HMO/PPO	$30,409.98
Rate for Payer: EPIC Health Plan Commercial	$39,102.45
Rate for Payer: EPIC Health Plan Senior	$28,964.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,964.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,964.78
Rate for Payer: Molina Healthcare of CA Medicare	$38,812.81
Rate for Payer: Multiplan WC	$18,739.36
Rate for Payer: Prime Health Services WC	$18,548.15
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: SKIN GRAFTS FOR INJURIES WITH CC/MCC

Facility

$117,053.11

Service Code	MSDRG 904
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$117,053.11
Rate for Payer: Aetna of CA HMO/PPO	$117,053.11
Rate for Payer: EPIC Health Plan Commercial	$79,685.26
Rate for Payer: EPIC Health Plan Senior	$59,026.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$59,026.12
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$59,026.12
Rate for Payer: Molina Healthcare of CA Medicare	$79,095.00
Rate for Payer: Multiplan WC	$72,130.96
Rate for Payer: Prime Health Services WC	$71,394.93
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: SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC

Facility

$49,966.83

Service Code	MSDRG 905
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$49,966.83
Rate for Payer: Aetna of CA HMO/PPO	$49,966.83
Rate for Payer: EPIC Health Plan Commercial	$48,262.72
Rate for Payer: EPIC Health Plan Senior	$35,750.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,750.16
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,750.16
Rate for Payer: Molina Healthcare of CA Medicare	$47,905.21
Rate for Payer: Multiplan WC	$30,790.78
Rate for Payer: Prime Health Services WC	$30,476.59
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: SKIN ULCERS WITH CC

Facility

$42,220.74

Service Code	MSDRG 593
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$42,220.74
Rate for Payer: Aetna of CA HMO/PPO	$37,067.37
Rate for Payer: EPIC Health Plan Commercial	$42,220.74
Rate for Payer: EPIC Health Plan Senior	$31,274.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,274.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,274.62
Rate for Payer: Molina Healthcare of CA Medicare	$41,907.99
Rate for Payer: Multiplan WC	$22,841.81
Rate for Payer: Prime Health Services WC	$22,608.73
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: SKIN ULCERS WITH MCC

Facility

$62,338.79

Service Code	MSDRG 592
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$62,338.79
Rate for Payer: Aetna of CA HMO/PPO	$62,338.79
Rate for Payer: EPIC Health Plan Commercial	$54,057.60
Rate for Payer: EPIC Health Plan Senior	$40,042.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$40,042.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,042.67
Rate for Payer: Molina Healthcare of CA Medicare	$53,657.18
Rate for Payer: Multiplan WC	$38,414.68
Rate for Payer: Prime Health Services WC	$38,022.69
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: SKIN ULCERS WITHOUT CC/MCC

Facility

$36,910.03

Service Code	MSDRG 594
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$36,910.03
Rate for Payer: Aetna of CA HMO/PPO	$25,729.19
Rate for Payer: EPIC Health Plan Commercial	$36,910.03
Rate for Payer: EPIC Health Plan Senior	$27,340.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,340.76
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,340.76
Rate for Payer: Molina Healthcare of CA Medicare	$36,636.62
Rate for Payer: Multiplan WC	$15,854.95
Rate for Payer: Prime Health Services WC	$15,693.16
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: SOFT TISSUE PROCEDURES WITH CC

Facility

$54,104.97

Service Code	MSDRG 501
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$54,104.97
Rate for Payer: Aetna of CA HMO/PPO	$54,104.97
Rate for Payer: EPIC Health Plan Commercial	$50,200.95
Rate for Payer: EPIC Health Plan Senior	$37,185.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,185.89
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,185.89
Rate for Payer: Molina Healthcare of CA Medicare	$49,829.09
Rate for Payer: Multiplan WC	$33,340.79
Rate for Payer: Prime Health Services WC	$33,000.57
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: SOFT TISSUE PROCEDURES WITH MCC

Facility

$96,062.31

Service Code	MSDRG 500
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$96,062.31
Rate for Payer: Aetna of CA HMO/PPO	$96,062.31
Rate for Payer: EPIC Health Plan Commercial	$69,853.36
Rate for Payer: EPIC Health Plan Senior	$51,743.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$51,743.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$51,743.23
Rate for Payer: Molina Healthcare of CA Medicare	$69,335.93
Rate for Payer: Multiplan WC	$59,195.92
Rate for Payer: Prime Health Services WC	$58,591.88
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: SOFT TISSUE PROCEDURES WITHOUT CC/MCC

Facility

$44,698.58

Service Code	MSDRG 502
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$44,698.58
Rate for Payer: Aetna of CA HMO/PPO	$42,357.52
Rate for Payer: EPIC Health Plan Commercial	$44,698.58
Rate for Payer: EPIC Health Plan Senior	$33,110.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,110.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,110.06
Rate for Payer: Molina Healthcare of CA Medicare	$44,367.48
Rate for Payer: Multiplan WC	$26,101.73
Rate for Payer: Prime Health Services WC	$25,835.39
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: SPINAL DISORDERS AND INJURIES WITH CC/MCC

Facility

$61,010.95

Service Code	MSDRG 052
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$61,010.95
Rate for Payer: Aetna of CA HMO/PPO	$61,010.95
Rate for Payer: EPIC Health Plan Commercial	$53,435.65
Rate for Payer: EPIC Health Plan Senior	$39,581.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,581.96
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,581.96
Rate for Payer: Molina Healthcare of CA Medicare	$53,039.83
Rate for Payer: Multiplan WC	$37,596.43
Rate for Payer: Prime Health Services WC	$37,212.79
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: SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC

Facility

$37,942.36

Service Code	MSDRG 053
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,942.36
Rate for Payer: Aetna of CA HMO/PPO	$27,933.16
Rate for Payer: EPIC Health Plan Commercial	$37,942.36
Rate for Payer: EPIC Health Plan Senior	$28,105.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,105.45
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,105.45
Rate for Payer: Molina Healthcare of CA Medicare	$37,661.30
Rate for Payer: Multiplan WC	$17,213.09
Rate for Payer: Prime Health Services WC	$17,037.45
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: SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC

Facility

$173,995.65

Service Code	MSDRG 457
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$173,995.65
Rate for Payer: Aetna of CA HMO/PPO	$173,995.65
Rate for Payer: EPIC Health Plan Commercial	$106,356.59
Rate for Payer: EPIC Health Plan Senior	$78,782.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$78,782.66
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$78,782.66
Rate for Payer: Molina Healthcare of CA Medicare	$105,568.76
Rate for Payer: Multiplan WC	$107,220.34
Rate for Payer: Prime Health Services WC	$106,126.25
Rate for Payer: United Healthcare All Other Commercial	$90,575.00
Rate for Payer: United Healthcare All Other HMO	$82,014.00
Rate for Payer: United Healthcare HMO Rider	$62,293.00
Rate for Payer: United Healthcare Select/Navigate/Core	$57,072.00

MS-DRG 42.00: SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC

Facility

$256,752.27

Service Code	MSDRG 456
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$256,752.27
Rate for Payer: Aetna of CA HMO/PPO	$256,752.27
Rate for Payer: EPIC Health Plan Commercial	$145,118.95
Rate for Payer: EPIC Health Plan Senior	$107,495.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$107,495.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$107,495.52
Rate for Payer: Molina Healthcare of CA Medicare	$144,044.00
Rate for Payer: Multiplan WC	$158,216.97
Rate for Payer: Prime Health Services WC	$156,602.51
Rate for Payer: United Healthcare All Other Commercial	$112,148.00
Rate for Payer: United Healthcare All Other HMO	$99,575.00
Rate for Payer: United Healthcare HMO Rider	$75,636.00
Rate for Payer: United Healthcare Select/Navigate/Core	$69,294.00

MS-DRG 42.00: SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC

Facility

$130,904.49

Service Code	MSDRG 458
Min. Negotiated Rate	$29,434.00
Max. Negotiated Rate	$130,904.49
Rate for Payer: Aetna of CA HMO/PPO	$130,904.49
Rate for Payer: EPIC Health Plan Commercial	$86,173.11
Rate for Payer: EPIC Health Plan Senior	$63,831.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$63,831.93
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$63,831.93
Rate for Payer: Molina Healthcare of CA Medicare	$85,534.79
Rate for Payer: Multiplan WC	$80,666.51
Rate for Payer: Prime Health Services WC	$79,843.39
Rate for Payer: United Healthcare All Other Commercial	$81,933.00
Rate for Payer: United Healthcare All Other HMO	$71,046.00
Rate for Payer: United Healthcare HMO Rider	$53,969.00
Rate for Payer: United Healthcare Select/Navigate/Core	$49,445.00

MS-DRG 42.00: SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS

Facility

$101,761.72

Service Code	MSDRG 029
Min. Negotiated Rate	$25,608.00
Max. Negotiated Rate	$101,761.72
Rate for Payer: Aetna of CA HMO/PPO	$101,761.72
Rate for Payer: EPIC Health Plan Commercial	$72,522.90
Rate for Payer: EPIC Health Plan Senior	$53,720.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$53,720.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$53,720.67
Rate for Payer: Molina Healthcare of CA Medicare	$71,985.70
Rate for Payer: Multiplan WC	$62,708.03
Rate for Payer: Prime Health Services WC	$62,068.16
Rate for Payer: United Healthcare All Other Commercial	$76,644.00
Rate for Payer: United Healthcare All Other HMO	$48,114.00
Rate for Payer: United Healthcare HMO Rider	$36,551.00
Rate for Payer: United Healthcare Select/Navigate/Core	$33,485.00

MS-DRG 42.00: SPINAL PROCEDURES WITH MCC

Facility

$184,306.12

Service Code	MSDRG 028
Min. Negotiated Rate	$25,608.00
Max. Negotiated Rate	$184,306.12
Rate for Payer: Aetna of CA HMO/PPO	$184,306.12
Rate for Payer: EPIC Health Plan Commercial	$111,185.92
Rate for Payer: EPIC Health Plan Senior	$82,359.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$82,359.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$82,359.94
Rate for Payer: Molina Healthcare of CA Medicare	$110,362.32
Rate for Payer: Multiplan WC	$113,573.90
Rate for Payer: Prime Health Services WC	$112,414.98
Rate for Payer: United Healthcare All Other Commercial	$58,958.00
Rate for Payer: United Healthcare All Other HMO	$71,841.00
Rate for Payer: United Healthcare HMO Rider	$54,569.00
Rate for Payer: United Healthcare Select/Navigate/Core	$49,994.00

MS-DRG 42.00: SPINAL PROCEDURES WITHOUT CC/MCC

Facility

$67,465.23

Service Code	MSDRG 030
Min. Negotiated Rate	$20,798.00
Max. Negotiated Rate	$67,465.23
Rate for Payer: Aetna of CA HMO/PPO	$67,465.23
Rate for Payer: EPIC Health Plan Commercial	$56,458.78
Rate for Payer: EPIC Health Plan Senior	$41,821.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$41,821.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$41,821.32
Rate for Payer: Molina Healthcare of CA Medicare	$56,040.57
Rate for Payer: Multiplan WC	$41,573.71
Rate for Payer: Prime Health Services WC	$41,149.49
Rate for Payer: United Healthcare All Other Commercial	$58,958.00
Rate for Payer: United Healthcare All Other HMO	$29,890.00
Rate for Payer: United Healthcare HMO Rider	$22,701.00
Rate for Payer: United Healthcare Select/Navigate/Core	$20,798.00

MS-DRG 42.00: SPLENIC PROCEDURES WITH CC

Facility

$88,334.76

Service Code	MSDRG 800
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$88,334.76
Rate for Payer: Aetna of CA HMO/PPO	$88,334.76
Rate for Payer: EPIC Health Plan Commercial	$66,233.85
Rate for Payer: EPIC Health Plan Senior	$49,062.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$49,062.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$49,062.11
Rate for Payer: Molina Healthcare of CA Medicare	$65,743.23
Rate for Payer: Multiplan WC	$54,434.02
Rate for Payer: Prime Health Services WC	$53,878.57
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: SPLENIC PROCEDURES WITH MCC

Facility

$144,146.52

Service Code	MSDRG 799
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$144,146.52
Rate for Payer: Aetna of CA HMO/PPO	$144,146.52
Rate for Payer: EPIC Health Plan Commercial	$92,375.53
Rate for Payer: EPIC Health Plan Senior	$68,426.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$68,426.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$68,426.32
Rate for Payer: Molina Healthcare of CA Medicare	$91,691.27
Rate for Payer: Multiplan WC	$88,826.57
Rate for Payer: Prime Health Services WC	$87,920.18
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: SPLENIC PROCEDURES WITHOUT CC/MCC

Facility

$49,769.78

Service Code	MSDRG 801
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$49,769.78
Rate for Payer: Aetna of CA HMO/PPO	$49,769.78
Rate for Payer: EPIC Health Plan Commercial	$48,170.39
Rate for Payer: EPIC Health Plan Senior	$35,681.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,681.77
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,681.77
Rate for Payer: Molina Healthcare of CA Medicare	$47,813.57
Rate for Payer: Multiplan WC	$30,669.35
Rate for Payer: Prime Health Services WC	$30,356.39
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: SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC

Facility

$37,908.27

Service Code	MSDRG 537
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,908.27
Rate for Payer: Aetna of CA HMO/PPO	$27,860.40
Rate for Payer: EPIC Health Plan Commercial	$37,908.27
Rate for Payer: EPIC Health Plan Senior	$28,080.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,080.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,080.20
Rate for Payer: Molina Healthcare of CA Medicare	$37,627.47
Rate for Payer: Multiplan WC	$17,168.26
Rate for Payer: Prime Health Services WC	$16,993.07
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: SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC

Facility

$34,393.83

Service Code	MSDRG 538
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,393.83
Rate for Payer: Aetna of CA HMO/PPO	$20,357.19
Rate for Payer: EPIC Health Plan Commercial	$34,393.83
Rate for Payer: EPIC Health Plan Senior	$25,476.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,476.91
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,476.91
Rate for Payer: Molina Healthcare of CA Medicare	$34,139.06
Rate for Payer: Multiplan WC	$12,544.60
Rate for Payer: Prime Health Services WC	$12,416.59
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: STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC

Facility

$73,610.28

Service Code	MSDRG 327
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$73,610.28
Rate for Payer: Aetna of CA HMO/PPO	$73,610.28
Rate for Payer: EPIC Health Plan Commercial	$59,337.06
Rate for Payer: EPIC Health Plan Senior	$43,953.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$43,953.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$43,953.38
Rate for Payer: Molina Healthcare of CA Medicare	$58,897.53
Rate for Payer: Multiplan WC	$45,360.44
Rate for Payer: Prime Health Services WC	$44,897.58
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: STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC

Facility

$153,974.96

Service Code	MSDRG 326
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$153,974.96
Rate for Payer: Aetna of CA HMO/PPO	$153,974.96
Rate for Payer: EPIC Health Plan Commercial	$96,979.10
Rate for Payer: EPIC Health Plan Senior	$71,836.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$71,836.37
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$71,836.37
Rate for Payer: Molina Healthcare of CA Medicare	$96,260.74
Rate for Payer: Multiplan WC	$94,883.10
Rate for Payer: Prime Health Services WC	$93,914.91
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

Know your out-of-pocket cost for care.

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