Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

INPATIENT MS-DRG 355: HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC

Facility

$41,308.58

Service Code	MSDRG 355
Min. Negotiated Rate	$7,235.00
Max. Negotiated Rate	$41,308.58
Rate for Payer: Aetna of CA HMO/PPO	$41,308.58
Rate for Payer: EPIC Health Plan Commercial	$39,175.50
Rate for Payer: EPIC Health Plan Medicare/Senior	$29,018.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,018.89
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,018.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$36,563.80
Rate for Payer: Molina Healthcare of CA Medicare	$38,885.31
Rate for Payer: Multiplan WC	$28,182.20
Rate for Payer: Prime Health Services WC	$27,894.63
Rate for Payer: United Healthcare All Other Commercial	$12,192.00
Rate for Payer: United Healthcare All Other HMO	$10,308.00
Rate for Payer: United Healthcare HMO Rider	$7,911.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,235.00

INPATIENT MS-DRG 356: OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC

Facility

$129,713.07

Service Code	MSDRG 356
Min. Negotiated Rate	$7,235.00
Max. Negotiated Rate	$129,713.07
Rate for Payer: Aetna of CA HMO/PPO	$129,713.07
Rate for Payer: EPIC Health Plan Commercial	$82,826.12
Rate for Payer: EPIC Health Plan Medicare/Senior	$61,352.68
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$61,352.68
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$61,352.68
Rate for Payer: Molina Healthcare of CA Medi-Cal	$77,304.38
Rate for Payer: Molina Healthcare of CA Medicare	$82,212.59
Rate for Payer: Multiplan WC	$86,715.27
Rate for Payer: Prime Health Services WC	$85,830.42
Rate for Payer: United Healthcare All Other Commercial	$12,192.00
Rate for Payer: United Healthcare All Other HMO	$10,308.00
Rate for Payer: United Healthcare HMO Rider	$7,911.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,235.00

INPATIENT MS-DRG 357: OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC

Facility

$66,598.19

Service Code	MSDRG 357
Min. Negotiated Rate	$7,235.00
Max. Negotiated Rate	$66,598.19
Rate for Payer: Aetna of CA HMO/PPO	$66,598.19
Rate for Payer: EPIC Health Plan Commercial	$51,662.50
Rate for Payer: EPIC Health Plan Medicare/Senior	$38,268.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$38,268.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$38,268.52
Rate for Payer: Molina Healthcare of CA Medi-Cal	$48,218.34
Rate for Payer: Molina Healthcare of CA Medicare	$51,279.82
Rate for Payer: Multiplan WC	$46,129.03
Rate for Payer: Prime Health Services WC	$45,658.33
Rate for Payer: United Healthcare All Other Commercial	$12,192.00
Rate for Payer: United Healthcare All Other HMO	$10,308.00
Rate for Payer: United Healthcare HMO Rider	$7,911.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,235.00

INPATIENT MS-DRG 358: OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$38,837.83

Service Code	MSDRG 358
Min. Negotiated Rate	$7,235.00
Max. Negotiated Rate	$38,837.83
Rate for Payer: Aetna of CA HMO/PPO	$38,837.83
Rate for Payer: EPIC Health Plan Commercial	$37,955.52
Rate for Payer: EPIC Health Plan Medicare/Senior	$28,115.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,115.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,115.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,425.15
Rate for Payer: Molina Healthcare of CA Medicare	$37,674.37
Rate for Payer: Multiplan WC	$28,488.20
Rate for Payer: Prime Health Services WC	$28,197.50
Rate for Payer: United Healthcare All Other Commercial	$12,192.00
Rate for Payer: United Healthcare All Other HMO	$10,308.00
Rate for Payer: United Healthcare HMO Rider	$7,911.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,235.00

INPATIENT MS-DRG 368: MAJOR ESOPHAGEAL DISORDERS WITH MCC

Facility

$50,082.03

Service Code	MSDRG 368
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$50,082.03
Rate for Payer: Aetna of CA HMO/PPO	$50,082.03
Rate for Payer: EPIC Health Plan Commercial	$43,507.46
Rate for Payer: EPIC Health Plan Medicare/Senior	$32,227.75
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,227.75
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,227.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$40,606.96
Rate for Payer: Molina Healthcare of CA Medicare	$43,185.18
Rate for Payer: Multiplan WC	$36,025.08
Rate for Payer: Prime Health Services WC	$35,657.48
Rate for Payer: United Healthcare All Other Commercial	$9,972.00
Rate for Payer: United Healthcare All Other HMO	$7,986.00
Rate for Payer: United Healthcare HMO Rider	$7,093.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,486.00

INPATIENT MS-DRG 369: MAJOR ESOPHAGEAL DISORDERS WITH CC

Facility

$33,572.65

Service Code	MSDRG 369
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$33,572.65
Rate for Payer: Aetna of CA HMO/PPO	$29,961.30
Rate for Payer: EPIC Health Plan Commercial	$33,572.65
Rate for Payer: EPIC Health Plan Medicare/Senior	$24,868.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,868.63
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,868.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,334.47
Rate for Payer: Molina Healthcare of CA Medicare	$33,323.96
Rate for Payer: Multiplan WC	$20,990.34
Rate for Payer: Prime Health Services WC	$20,776.15
Rate for Payer: United Healthcare All Other Commercial	$9,972.00
Rate for Payer: United Healthcare All Other HMO	$7,986.00
Rate for Payer: United Healthcare HMO Rider	$7,093.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,486.00

INPATIENT MS-DRG 370: MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC

Facility

$29,911.28

Service Code	MSDRG 370
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$29,911.28
Rate for Payer: Aetna of CA HMO/PPO	$22,546.01
Rate for Payer: EPIC Health Plan Commercial	$29,911.28
Rate for Payer: EPIC Health Plan Medicare/Senior	$22,156.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,156.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,156.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,917.19
Rate for Payer: Molina Healthcare of CA Medicare	$29,689.71
Rate for Payer: Multiplan WC	$15,375.66
Rate for Payer: Prime Health Services WC	$15,218.77
Rate for Payer: United Healthcare All Other Commercial	$9,972.00
Rate for Payer: United Healthcare All Other HMO	$7,986.00
Rate for Payer: United Healthcare HMO Rider	$7,093.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,486.00

INPATIENT MS-DRG 371: MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC

Facility

$52,983.27

Service Code	MSDRG 371
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$52,983.27
Rate for Payer: Aetna of CA HMO/PPO	$52,983.27
Rate for Payer: EPIC Health Plan Commercial	$44,939.99
Rate for Payer: EPIC Health Plan Medicare/Senior	$33,288.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,288.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,288.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$41,943.99
Rate for Payer: Molina Healthcare of CA Medicare	$44,607.10
Rate for Payer: Multiplan WC	$34,743.61
Rate for Payer: Prime Health Services WC	$34,389.08
Rate for Payer: United Healthcare All Other Commercial	$9,972.00
Rate for Payer: United Healthcare All Other HMO	$7,986.00
Rate for Payer: United Healthcare HMO Rider	$7,093.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,486.00

INPATIENT MS-DRG 372: MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC

Facility

$34,380.98

Service Code	MSDRG 372
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$34,380.98
Rate for Payer: Aetna of CA HMO/PPO	$31,598.37
Rate for Payer: EPIC Health Plan Commercial	$34,380.98
Rate for Payer: EPIC Health Plan Medicare/Senior	$25,467.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,467.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,467.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,088.91
Rate for Payer: Molina Healthcare of CA Medicare	$34,126.30
Rate for Payer: Multiplan WC	$20,906.13
Rate for Payer: Prime Health Services WC	$20,692.81
Rate for Payer: United Healthcare All Other Commercial	$9,972.00
Rate for Payer: United Healthcare All Other HMO	$7,986.00
Rate for Payer: United Healthcare HMO Rider	$7,093.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,486.00

INPATIENT MS-DRG 373: MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC

Facility

$29,504.13

Service Code	MSDRG 373
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$29,504.13
Rate for Payer: Aetna of CA HMO/PPO	$21,721.41
Rate for Payer: EPIC Health Plan Commercial	$29,504.13
Rate for Payer: EPIC Health Plan Medicare/Senior	$21,854.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,854.91
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,854.91
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,537.19
Rate for Payer: Molina Healthcare of CA Medicare	$29,285.58
Rate for Payer: Multiplan WC	$14,909.48
Rate for Payer: Prime Health Services WC	$14,757.35
Rate for Payer: United Healthcare All Other Commercial	$9,972.00
Rate for Payer: United Healthcare All Other HMO	$7,986.00
Rate for Payer: United Healthcare HMO Rider	$7,093.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,486.00

INPATIENT MS-DRG 374: DIGESTIVE MALIGNANCY WITH MCC

Facility

$63,633.28

Service Code	MSDRG 374
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$63,633.28
Rate for Payer: Aetna of CA HMO/PPO	$63,633.28
Rate for Payer: EPIC Health Plan Commercial	$50,198.55
Rate for Payer: EPIC Health Plan Medicare/Senior	$37,184.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,184.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,184.11
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,851.98
Rate for Payer: Molina Healthcare of CA Medicare	$49,826.71
Rate for Payer: Multiplan WC	$40,935.35
Rate for Payer: Prime Health Services WC	$40,517.65
Rate for Payer: United Healthcare All Other Commercial	$9,972.00
Rate for Payer: United Healthcare All Other HMO	$7,986.00
Rate for Payer: United Healthcare HMO Rider	$7,093.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,486.00

INPATIENT MS-DRG 375: DIGESTIVE MALIGNANCY WITH CC

Facility

$36,716.13

Service Code	MSDRG 375
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$36,716.13
Rate for Payer: Aetna of CA HMO/PPO	$36,327.66
Rate for Payer: EPIC Health Plan Commercial	$36,716.13
Rate for Payer: EPIC Health Plan Medicare/Senior	$27,197.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,197.13
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,197.13
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,268.38
Rate for Payer: Molina Healthcare of CA Medicare	$36,444.15
Rate for Payer: Multiplan WC	$24,738.24
Rate for Payer: Prime Health Services WC	$24,485.81
Rate for Payer: United Healthcare All Other Commercial	$9,972.00
Rate for Payer: United Healthcare All Other HMO	$7,986.00
Rate for Payer: United Healthcare HMO Rider	$7,093.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,486.00

INPATIENT MS-DRG 376: DIGESTIVE MALIGNANCY WITHOUT CC/MCC

Facility

$32,122.18

Service Code	MSDRG 376
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$32,122.18
Rate for Payer: Aetna of CA HMO/PPO	$27,023.68
Rate for Payer: EPIC Health Plan Commercial	$32,122.18
Rate for Payer: EPIC Health Plan Medicare/Senior	$23,794.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,794.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,794.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,980.70
Rate for Payer: Molina Healthcare of CA Medicare	$31,884.24
Rate for Payer: Multiplan WC	$18,026.92
Rate for Payer: Prime Health Services WC	$17,842.98
Rate for Payer: United Healthcare All Other Commercial	$9,972.00
Rate for Payer: United Healthcare All Other HMO	$7,986.00
Rate for Payer: United Healthcare HMO Rider	$7,093.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,486.00

INPATIENT MS-DRG 377: GASTROINTESTINAL HEMORRHAGE WITH MCC

Facility

$54,274.73

Service Code	MSDRG 377
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$54,274.73
Rate for Payer: Aetna of CA HMO/PPO	$54,274.73
Rate for Payer: EPIC Health Plan Commercial	$45,577.66
Rate for Payer: EPIC Health Plan Medicare/Senior	$33,761.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,761.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,761.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,539.15
Rate for Payer: Molina Healthcare of CA Medicare	$45,240.05
Rate for Payer: Multiplan WC	$36,513.86
Rate for Payer: Prime Health Services WC	$36,141.27
Rate for Payer: United Healthcare All Other Commercial	$9,972.00
Rate for Payer: United Healthcare All Other HMO	$7,986.00
Rate for Payer: United Healthcare HMO Rider	$7,093.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,486.00

INPATIENT MS-DRG 378: GASTROINTESTINAL HEMORRHAGE WITH CC

Facility

$33,505.30

Service Code	MSDRG 378
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$33,505.30
Rate for Payer: Aetna of CA HMO/PPO	$29,824.88
Rate for Payer: EPIC Health Plan Commercial	$33,505.30
Rate for Payer: EPIC Health Plan Medicare/Senior	$24,818.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,818.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,818.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,271.61
Rate for Payer: Molina Healthcare of CA Medicare	$33,257.11
Rate for Payer: Multiplan WC	$20,228.42
Rate for Payer: Prime Health Services WC	$20,022.01
Rate for Payer: United Healthcare All Other Commercial	$9,972.00
Rate for Payer: United Healthcare All Other HMO	$7,986.00
Rate for Payer: United Healthcare HMO Rider	$7,093.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,486.00

INPATIENT MS-DRG 379: GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC

Facility

$28,257.23

Service Code	MSDRG 379
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$28,257.23
Rate for Payer: Aetna of CA HMO/PPO	$19,196.09
Rate for Payer: EPIC Health Plan Commercial	$28,257.23
Rate for Payer: EPIC Health Plan Medicare/Senior	$20,931.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,931.28
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,931.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,373.41
Rate for Payer: Molina Healthcare of CA Medicare	$28,047.92
Rate for Payer: Multiplan WC	$13,016.02
Rate for Payer: Prime Health Services WC	$12,883.20
Rate for Payer: United Healthcare All Other Commercial	$9,972.00
Rate for Payer: United Healthcare All Other HMO	$7,986.00
Rate for Payer: United Healthcare HMO Rider	$7,093.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,486.00

INPATIENT MS-DRG 380: COMPLICATED PEPTIC ULCER WITH MCC

Facility

$59,070.73

Service Code	MSDRG 380
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$59,070.73
Rate for Payer: Aetna of CA HMO/PPO	$59,070.73
Rate for Payer: EPIC Health Plan Commercial	$47,945.72
Rate for Payer: EPIC Health Plan Medicare/Senior	$35,515.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,515.35
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,515.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$44,749.34
Rate for Payer: Molina Healthcare of CA Medicare	$47,590.57
Rate for Payer: Multiplan WC	$39,103.51
Rate for Payer: Prime Health Services WC	$38,704.49
Rate for Payer: United Healthcare All Other Commercial	$9,972.00
Rate for Payer: United Healthcare All Other HMO	$7,986.00
Rate for Payer: United Healthcare HMO Rider	$7,093.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,486.00

INPATIENT MS-DRG 381: COMPLICATED PEPTIC ULCER WITH CC

Facility

$34,840.52

Service Code	MSDRG 381
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$34,840.52
Rate for Payer: Aetna of CA HMO/PPO	$32,529.07
Rate for Payer: EPIC Health Plan Commercial	$34,840.52
Rate for Payer: EPIC Health Plan Medicare/Senior	$25,807.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,807.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,807.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,517.82
Rate for Payer: Molina Healthcare of CA Medicare	$34,582.44
Rate for Payer: Multiplan WC	$21,676.25
Rate for Payer: Prime Health Services WC	$21,455.06
Rate for Payer: United Healthcare All Other Commercial	$9,972.00
Rate for Payer: United Healthcare All Other HMO	$7,986.00
Rate for Payer: United Healthcare HMO Rider	$7,093.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,486.00

INPATIENT MS-DRG 382: COMPLICATED PEPTIC ULCER WITHOUT CC/MCC

Facility

$30,111.86

Service Code	MSDRG 382
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$30,111.86
Rate for Payer: Aetna of CA HMO/PPO	$22,952.24
Rate for Payer: EPIC Health Plan Commercial	$30,111.86
Rate for Payer: EPIC Health Plan Medicare/Senior	$22,305.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,305.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,305.08
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,104.40
Rate for Payer: Molina Healthcare of CA Medicare	$29,888.81
Rate for Payer: Multiplan WC	$15,808.98
Rate for Payer: Prime Health Services WC	$15,647.66
Rate for Payer: United Healthcare All Other Commercial	$9,972.00
Rate for Payer: United Healthcare All Other HMO	$7,986.00
Rate for Payer: United Healthcare HMO Rider	$7,093.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,486.00

INPATIENT MS-DRG 383: UNCOMPLICATED PEPTIC ULCER WITH MCC

Facility

$42,387.83

Service Code	MSDRG 383
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$42,387.83
Rate for Payer: Aetna of CA HMO/PPO	$42,387.83
Rate for Payer: EPIC Health Plan Commercial	$39,708.37
Rate for Payer: EPIC Health Plan Medicare/Senior	$29,413.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,413.61
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,413.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,061.15
Rate for Payer: Molina Healthcare of CA Medicare	$39,414.24
Rate for Payer: Multiplan WC	$27,929.61
Rate for Payer: Prime Health Services WC	$27,644.61
Rate for Payer: United Healthcare All Other Commercial	$9,972.00
Rate for Payer: United Healthcare All Other HMO	$7,986.00
Rate for Payer: United Healthcare HMO Rider	$7,093.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,486.00

INPATIENT MS-DRG 384: UNCOMPLICATED PEPTIC ULCER WITHOUT MCC

Facility

$31,887.16

Service Code	MSDRG 384
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$31,887.16
Rate for Payer: Aetna of CA HMO/PPO	$26,547.72
Rate for Payer: EPIC Health Plan Commercial	$31,887.16
Rate for Payer: EPIC Health Plan Medicare/Senior	$23,620.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,620.12
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,620.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,761.35
Rate for Payer: Molina Healthcare of CA Medicare	$31,650.96
Rate for Payer: Multiplan WC	$18,515.69
Rate for Payer: Prime Health Services WC	$18,326.75
Rate for Payer: United Healthcare All Other Commercial	$9,972.00
Rate for Payer: United Healthcare All Other HMO	$7,986.00
Rate for Payer: United Healthcare HMO Rider	$7,093.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,486.00

INPATIENT MS-DRG 385: INFLAMMATORY BOWEL DISEASE WITH MCC

Facility

$47,502.14

Service Code	MSDRG 385
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$47,502.14
Rate for Payer: Aetna of CA HMO/PPO	$47,502.14
Rate for Payer: EPIC Health Plan Commercial	$42,233.63
Rate for Payer: EPIC Health Plan Medicare/Senior	$31,284.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,284.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,284.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$39,418.05
Rate for Payer: Molina Healthcare of CA Medicare	$41,920.79
Rate for Payer: Multiplan WC	$33,447.76
Rate for Payer: Prime Health Services WC	$33,106.46
Rate for Payer: United Healthcare All Other Commercial	$9,972.00
Rate for Payer: United Healthcare All Other HMO	$7,986.00
Rate for Payer: United Healthcare HMO Rider	$7,093.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,486.00

INPATIENT MS-DRG 386: INFLAMMATORY BOWEL DISEASE WITH CC

Facility

$33,322.68

Service Code	MSDRG 386
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$33,322.68
Rate for Payer: Aetna of CA HMO/PPO	$29,455.03
Rate for Payer: EPIC Health Plan Commercial	$33,322.68
Rate for Payer: EPIC Health Plan Medicare/Senior	$24,683.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,683.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,683.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,101.17
Rate for Payer: Molina Healthcare of CA Medicare	$33,075.85
Rate for Payer: Multiplan WC	$20,327.00
Rate for Payer: Prime Health Services WC	$20,119.58
Rate for Payer: United Healthcare All Other Commercial	$9,972.00
Rate for Payer: United Healthcare All Other HMO	$7,986.00
Rate for Payer: United Healthcare HMO Rider	$7,093.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,486.00

INPATIENT MS-DRG 387: INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC

Facility

$29,019.13

Service Code	MSDRG 387
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$29,019.13
Rate for Payer: Aetna of CA HMO/PPO	$20,739.18
Rate for Payer: EPIC Health Plan Commercial	$29,019.13
Rate for Payer: EPIC Health Plan Medicare/Senior	$21,495.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,495.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,495.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,084.52
Rate for Payer: Molina Healthcare of CA Medicare	$28,804.17
Rate for Payer: Multiplan WC	$14,203.02
Rate for Payer: Prime Health Services WC	$14,058.09
Rate for Payer: United Healthcare All Other Commercial	$9,972.00
Rate for Payer: United Healthcare All Other HMO	$7,986.00
Rate for Payer: United Healthcare HMO Rider	$7,093.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,486.00

INPATIENT MS-DRG 388: GASTROINTESTINAL OBSTRUCTION WITH MCC

Facility

$44,064.31

Service Code	MSDRG 388
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$44,064.31
Rate for Payer: Aetna of CA HMO/PPO	$44,064.31
Rate for Payer: EPIC Health Plan Commercial	$40,536.17
Rate for Payer: EPIC Health Plan Medicare/Senior	$30,026.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,026.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,026.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,833.76
Rate for Payer: Molina Healthcare of CA Medicare	$40,235.90
Rate for Payer: Multiplan WC	$30,135.23
Rate for Payer: Prime Health Services WC	$29,827.72
Rate for Payer: United Healthcare All Other Commercial	$9,972.00
Rate for Payer: United Healthcare All Other HMO	$7,986.00
Rate for Payer: United Healthcare HMO Rider	$7,093.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,486.00

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