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Charge Type Setting Price  
Service Code MSDRG 578
Min. Negotiated Rate $7,611.00
Max. Negotiated Rate $107,754.90
Rate for Payer: Aetna of CA HMO/PPO $48,699.62
Rate for Payer: EPIC Health Plan Commercial $107,754.90
Rate for Payer: EPIC Health Plan Senior $71,836.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage $65,306.00
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage $91,428.40
Rate for Payer: Molina Healthcare of CA Medicare $87,510.04
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
Service Code APR-DRG 3124
Min. Negotiated Rate $115,452.51
Max. Negotiated Rate $144,553.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $115,452.51
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $144,553.39
Rate for Payer: Molina Healthcare of CA Medi-Cal $129,337.24
Service Code APR-DRG 3123
Min. Negotiated Rate $49,908.92
Max. Negotiated Rate $62,488.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $49,908.92
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $62,488.93
Rate for Payer: Molina Healthcare of CA Medi-Cal $55,911.15
Service Code APR-DRG 3121
Min. Negotiated Rate $20,084.32
Max. Negotiated Rate $25,146.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $20,084.32
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $25,146.77
Rate for Payer: Molina Healthcare of CA Medi-Cal $22,499.74
Service Code APR-DRG 3122
Min. Negotiated Rate $31,596.75
Max. Negotiated Rate $39,561.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $31,596.75
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $39,561.00
Rate for Payer: Molina Healthcare of CA Medi-Cal $35,396.69
Service Code APR-DRG 3611
Min. Negotiated Rate $23,965.22
Max. Negotiated Rate $30,005.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $23,965.22
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $30,005.88
Rate for Payer: Molina Healthcare of CA Medi-Cal $26,847.37
Service Code APR-DRG 3612
Min. Negotiated Rate $31,837.82
Max. Negotiated Rate $39,862.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $31,837.82
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $39,862.84
Rate for Payer: Molina Healthcare of CA Medi-Cal $35,666.75
Service Code APR-DRG 3614
Min. Negotiated Rate $108,712.85
Max. Negotiated Rate $136,114.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $108,712.85
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $136,114.94
Rate for Payer: Molina Healthcare of CA Medi-Cal $121,787.05
Service Code APR-DRG 3613
Min. Negotiated Rate $44,016.97
Max. Negotiated Rate $55,111.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $44,016.97
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $55,111.86
Rate for Payer: Molina Healthcare of CA Medi-Cal $49,310.61
Service Code MSDRG 574
Min. Negotiated Rate $7,611.00
Max. Negotiated Rate $140,849.02
Rate for Payer: Aetna of CA HMO/PPO $105,238.96
Rate for Payer: EPIC Health Plan Commercial $140,849.02
Rate for Payer: EPIC Health Plan Senior $93,899.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage $85,363.04
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage $119,508.26
Rate for Payer: Molina Healthcare of CA Medicare $114,386.47
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
Service Code MSDRG 573
Min. Negotiated Rate $7,611.00
Max. Negotiated Rate $198,612.24
Rate for Payer: Aetna of CA HMO/PPO $198,612.24
Rate for Payer: EPIC Health Plan Commercial $195,503.05
Rate for Payer: EPIC Health Plan Senior $130,335.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage $118,486.70
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage $165,881.38
Rate for Payer: Molina Healthcare of CA Medicare $158,772.18
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
Service Code MSDRG 575
Min. Negotiated Rate $7,611.00
Max. Negotiated Rate $111,137.07
Rate for Payer: Aetna of CA HMO/PPO $49,524.22
Rate for Payer: EPIC Health Plan Commercial $111,137.07
Rate for Payer: EPIC Health Plan Senior $74,091.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage $67,355.80
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage $94,298.12
Rate for Payer: Molina Healthcare of CA Medicare $90,256.77
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
Service Code MSDRG 623
Min. Negotiated Rate $7,611.00
Max. Negotiated Rate $111,082.06
Rate for Payer: Aetna of CA HMO/PPO $54,383.87
Rate for Payer: EPIC Health Plan Commercial $111,082.06
Rate for Payer: EPIC Health Plan Senior $74,054.71
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage $67,322.46
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage $94,251.44
Rate for Payer: Molina Healthcare of CA Medicare $90,212.10
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
Service Code MSDRG 622
Min. Negotiated Rate $7,611.00
Max. Negotiated Rate $142,407.01
Rate for Payer: Aetna of CA HMO/PPO $107,900.71
Rate for Payer: EPIC Health Plan Commercial $142,407.01
Rate for Payer: EPIC Health Plan Senior $94,938.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage $86,307.28
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage $120,830.19
Rate for Payer: Molina Healthcare of CA Medicare $115,651.76
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
Service Code MSDRG 624
Min. Negotiated Rate $7,611.00
Max. Negotiated Rate $101,464.37
Rate for Payer: Aetna of CA HMO/PPO $37,952.60
Rate for Payer: EPIC Health Plan Commercial $101,464.37
Rate for Payer: EPIC Health Plan Senior $67,642.92
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage $61,493.56
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage $86,090.98
Rate for Payer: Molina Healthcare of CA Medicare $82,401.37
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
Service Code MSDRG 904
Min. Negotiated Rate $7,611.00
Max. Negotiated Rate $144,428.13
Rate for Payer: Aetna of CA HMO/PPO $111,353.70
Rate for Payer: EPIC Health Plan Commercial $144,428.13
Rate for Payer: EPIC Health Plan Senior $96,285.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage $87,532.20
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage $122,545.08
Rate for Payer: Molina Healthcare of CA Medicare $117,293.15
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
Service Code MSDRG 905
Min. Negotiated Rate $7,611.00
Max. Negotiated Rate $105,572.28
Rate for Payer: Aetna of CA HMO/PPO $43,406.45
Rate for Payer: EPIC Health Plan Commercial $105,572.28
Rate for Payer: EPIC Health Plan Senior $70,381.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage $63,983.20
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage $89,576.48
Rate for Payer: Molina Healthcare of CA Medicare $85,737.49
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
Service Code APR-DRG 3803
Min. Negotiated Rate $17,439.13
Max. Negotiated Rate $21,834.82
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $17,439.13
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $21,834.82
Rate for Payer: Molina Healthcare of CA Medi-Cal $19,536.42
Service Code APR-DRG 3804
Min. Negotiated Rate $37,459.43
Max. Negotiated Rate $46,901.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $37,459.43
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $46,901.42
Rate for Payer: Molina Healthcare of CA Medi-Cal $41,964.43
Service Code APR-DRG 3801
Min. Negotiated Rate $9,232.09
Max. Negotiated Rate $11,559.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $9,232.09
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $11,559.12
Rate for Payer: Molina Healthcare of CA Medi-Cal $10,342.38
Service Code APR-DRG 3802
Min. Negotiated Rate $11,933.76
Max. Negotiated Rate $14,941.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal $11,933.76
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal $14,941.77
Rate for Payer: Molina Healthcare of CA Medi-Cal $13,368.95
Service Code MSDRG 593
Min. Negotiated Rate $6,823.00
Max. Negotiated Rate $100,300.33
Rate for Payer: Aetna of CA HMO/PPO $35,963.87
Rate for Payer: EPIC Health Plan Commercial $100,300.33
Rate for Payer: EPIC Health Plan Senior $66,866.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage $60,788.08
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage $85,103.31
Rate for Payer: Molina Healthcare of CA Medicare $81,456.03
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
Service Code MSDRG 592
Min. Negotiated Rate $6,823.00
Max. Negotiated Rate $113,591.16
Rate for Payer: Aetna of CA HMO/PPO $58,670.55
Rate for Payer: EPIC Health Plan Commercial $113,591.16
Rate for Payer: EPIC Health Plan Senior $75,727.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage $68,843.13
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage $96,380.38
Rate for Payer: Molina Healthcare of CA Medicare $92,249.79
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
Service Code MSDRG 594
Min. Negotiated Rate $6,823.00
Max. Negotiated Rate $94,630.83
Rate for Payer: Aetna of CA HMO/PPO $26,277.91
Rate for Payer: EPIC Health Plan Commercial $94,630.83
Rate for Payer: EPIC Health Plan Senior $63,087.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage $57,352.02
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage $80,292.83
Rate for Payer: Molina Healthcare of CA Medicare $76,851.71
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
Service Code HCPCS J3490
Hospital Charge Code 901700025
Hospital Revenue Code 636
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.09
Rate for Payer: Adventist Health Commercial $0.02
Rate for Payer: Adventist Health Commercial $0.06
Rate for Payer: Adventist Health Commercial $0.15
Rate for Payer: Blue Shield of California Commercial $0.23
Rate for Payer: Blue Shield of California Commercial $0.06
Rate for Payer: Blue Shield of California Commercial $0.08
Rate for Payer: Blue Shield of California Commercial $0.57
Rate for Payer: Blue Shield of California Commercial $0.38
Rate for Payer: Blue Shield of California Commercial $0.15
Rate for Payer: Cash Price $0.33
Rate for Payer: Cash Price $0.14
Rate for Payer: Cash Price $0.05
Rate for Payer: Cigna of CA HMO $0.52
Rate for Payer: Cigna of CA HMO $0.21
Rate for Payer: Cigna of CA HMO $0.08
Rate for Payer: Cigna of CA PPO $0.08
Rate for Payer: Cigna of CA PPO $0.52
Rate for Payer: Cigna of CA PPO $0.21
Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant $0.52
Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant $0.21
Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant $0.08
Rate for Payer: EPIC Health Plan Commercial $0.12
Rate for Payer: EPIC Health Plan Commercial $0.30
Rate for Payer: EPIC Health Plan Commercial $0.04
Rate for Payer: EPIC Health Plan Senior $0.12
Rate for Payer: EPIC Health Plan Senior $0.04
Rate for Payer: EPIC Health Plan Senior $0.30
Rate for Payer: Galaxy Health WC $0.63
Rate for Payer: Galaxy Health WC $0.09
Rate for Payer: Galaxy Health WC $0.26
Rate for Payer: Global Benefits Group Commercial $0.18
Rate for Payer: Global Benefits Group Commercial $0.07
Rate for Payer: Global Benefits Group Commercial $0.44
Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded $0.07
Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded $0.19
Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded $0.47
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage $0.18
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage $0.06
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage $0.44
Rate for Payer: LLUH Dept of Risk Management WC $0.03
Rate for Payer: LLUH Dept of Risk Management WC $0.07
Rate for Payer: LLUH Dept of Risk Management WC $0.18
Rate for Payer: Multiplan Commercial $0.09
Rate for Payer: Multiplan Commercial $0.24
Rate for Payer: Multiplan Commercial $0.59
Rate for Payer: Networks By Design Commercial $0.15
Rate for Payer: Networks By Design Commercial $0.37
Rate for Payer: Networks By Design Commercial $0.06
Rate for Payer: Prime Health Services Commercial $0.09
Rate for Payer: Prime Health Services Commercial $0.26
Rate for Payer: Prime Health Services Commercial $0.63
Rate for Payer: United Healthcare All Other Commercial $0.11
Rate for Payer: United Healthcare All Other Commercial $0.04
Rate for Payer: United Healthcare All Other Commercial $0.28
Rate for Payer: United Healthcare All Other HMO $0.27
Rate for Payer: United Healthcare All Other HMO $0.04
Rate for Payer: United Healthcare All Other HMO $0.11
Rate for Payer: United Healthcare HMO Rider $0.11
Rate for Payer: United Healthcare HMO Rider $0.26
Rate for Payer: United Healthcare HMO Rider $0.04
Rate for Payer: United Healthcare Select/Navigate/Core $0.24
Rate for Payer: United Healthcare Select/Navigate/Core $0.04
Rate for Payer: United Healthcare Select/Navigate/Core $0.10