Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

INPATIENT MS-DRG 545: CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$75,583.85

Service Code	MSDRG 545
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$75,583.85
Rate for Payer: Aetna of CA HMO/PPO	$75,583.85
Rate for Payer: EPIC Health Plan Commercial	$56,099.26
Rate for Payer: EPIC Health Plan Medicare/Senior	$41,555.01
Rate for Payer: Heritage Provider Network Commercial	$17,258.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$41,555.01
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$41,555.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$52,359.31
Rate for Payer: Molina Healthcare of CA Medicare	$55,683.71
Rate for Payer: Multiplan WC	$51,517.81
Rate for Payer: Prime Health Services WC	$50,992.11
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 546: CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$36,731.07

Service Code	MSDRG 546
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$36,731.07
Rate for Payer: Aetna of CA HMO/PPO	$36,357.98
Rate for Payer: EPIC Health Plan Commercial	$36,731.07
Rate for Payer: EPIC Health Plan Medicare/Senior	$27,208.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,208.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,208.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,282.33
Rate for Payer: Molina Healthcare of CA Medicare	$36,458.99
Rate for Payer: Multiplan WC	$24,758.78
Rate for Payer: Prime Health Services WC	$24,506.14
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 547: CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$31,102.80

Service Code	MSDRG 547
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$31,102.80
Rate for Payer: Aetna of CA HMO/PPO	$24,659.03
Rate for Payer: EPIC Health Plan Commercial	$31,102.80
Rate for Payer: EPIC Health Plan Medicare/Senior	$23,039.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,039.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,039.11
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,029.28
Rate for Payer: Molina Healthcare of CA Medicare	$30,872.41
Rate for Payer: Multiplan WC	$18,786.77
Rate for Payer: Prime Health Services WC	$18,595.06
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 548: SEPTIC ARTHRITIS WITH MCC

Facility

$59,110.14

Service Code	MSDRG 548
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$59,110.14
Rate for Payer: Aetna of CA HMO/PPO	$59,110.14
Rate for Payer: EPIC Health Plan Commercial	$47,965.20
Rate for Payer: EPIC Health Plan Medicare/Senior	$35,529.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,529.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,529.78
Rate for Payer: Molina Healthcare of CA Medi-Cal	$44,767.52
Rate for Payer: Molina Healthcare of CA Medicare	$47,609.91
Rate for Payer: Multiplan WC	$39,838.72
Rate for Payer: Prime Health Services WC	$39,432.20
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 549: SEPTIC ARTHRITIS WITH CC

Facility

$36,834.37

Service Code	MSDRG 549
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$36,834.37
Rate for Payer: Aetna of CA HMO/PPO	$36,567.16
Rate for Payer: EPIC Health Plan Commercial	$36,834.37
Rate for Payer: EPIC Health Plan Medicare/Senior	$27,284.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,284.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,284.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,378.75
Rate for Payer: Molina Healthcare of CA Medicare	$36,561.52
Rate for Payer: Multiplan WC	$24,884.05
Rate for Payer: Prime Health Services WC	$24,630.13
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 550: SEPTIC ARTHRITIS WITHOUT CC/MCC

Facility

$32,902.05

Service Code	MSDRG 550
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$32,902.05
Rate for Payer: Aetna of CA HMO/PPO	$27,914.97
Rate for Payer: EPIC Health Plan Commercial	$32,902.05
Rate for Payer: EPIC Health Plan Medicare/Senior	$24,371.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,371.89
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,371.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,708.58
Rate for Payer: Molina Healthcare of CA Medicare	$32,658.33
Rate for Payer: Multiplan WC	$21,528.39
Rate for Payer: Prime Health Services WC	$21,308.71
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 551: MEDICAL BACK PROBLEMS WITH MCC

Facility

$56,843.00

Service Code	MSDRG 551
Min. Negotiated Rate	$13,055.00
Max. Negotiated Rate	$56,843.00
Rate for Payer: Aetna of CA HMO/PPO	$51,594.80
Rate for Payer: EPIC Health Plan Commercial	$44,254.40
Rate for Payer: EPIC Health Plan Medicare/Senior	$32,781.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,781.04
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,781.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$41,304.11
Rate for Payer: Molina Healthcare of CA Medicare	$43,926.59
Rate for Payer: Multiplan WC	$34,365.74
Rate for Payer: Prime Health Services WC	$34,015.07
Rate for Payer: United Healthcare All Other Commercial	$56,843.00
Rate for Payer: United Healthcare All Other HMO	$18,799.00
Rate for Payer: United Healthcare HMO Rider	$14,276.00
Rate for Payer: United Healthcare Select/Navigate/Core	$13,055.00

INPATIENT MS-DRG 552: MEDICAL BACK PROBLEMS WITHOUT MCC

Facility

$56,843.00

Service Code	MSDRG 552
Min. Negotiated Rate	$13,097.00
Max. Negotiated Rate	$56,843.00
Rate for Payer: Aetna of CA HMO/PPO	$29,294.35
Rate for Payer: EPIC Health Plan Commercial	$33,243.33
Rate for Payer: EPIC Health Plan Medicare/Senior	$24,624.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,624.69
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,624.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,027.11
Rate for Payer: Molina Healthcare of CA Medicare	$32,997.08
Rate for Payer: Multiplan WC	$19,725.28
Rate for Payer: Prime Health Services WC	$19,524.00
Rate for Payer: United Healthcare All Other Commercial	$56,843.00
Rate for Payer: United Healthcare All Other HMO	$18,854.00
Rate for Payer: United Healthcare HMO Rider	$14,322.00
Rate for Payer: United Healthcare Select/Navigate/Core	$13,097.00

INPATIENT MS-DRG 553: BONE DISEASES AND ARTHROPATHIES WITH MCC

Facility

$40,972.07

Service Code	MSDRG 553
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$40,972.07
Rate for Payer: Aetna of CA HMO/PPO	$40,972.07
Rate for Payer: EPIC Health Plan Commercial	$39,009.34
Rate for Payer: EPIC Health Plan Medicare/Senior	$28,895.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,895.81
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,895.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$36,408.72
Rate for Payer: Molina Healthcare of CA Medicare	$38,720.39
Rate for Payer: Multiplan WC	$27,229.31
Rate for Payer: Prime Health Services WC	$26,951.46
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 554: BONE DISEASES AND ARTHROPATHIES WITHOUT MCC

Facility

$31,080.33

Service Code	MSDRG 554
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$31,080.33
Rate for Payer: Aetna of CA HMO/PPO	$24,913.69
Rate for Payer: EPIC Health Plan Commercial	$31,080.33
Rate for Payer: EPIC Health Plan Medicare/Senior	$23,022.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,022.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,022.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,008.31
Rate for Payer: Molina Healthcare of CA Medicare	$30,850.11
Rate for Payer: Multiplan WC	$16,844.01
Rate for Payer: Prime Health Services WC	$16,672.14
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 555: SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$42,412.08

Service Code	MSDRG 555
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$42,412.08
Rate for Payer: Aetna of CA HMO/PPO	$42,412.08
Rate for Payer: EPIC Health Plan Commercial	$39,720.36
Rate for Payer: EPIC Health Plan Medicare/Senior	$29,422.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,422.49
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,422.49
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,072.34
Rate for Payer: Molina Healthcare of CA Medicare	$39,426.14
Rate for Payer: Multiplan WC	$27,338.16
Rate for Payer: Prime Health Services WC	$27,059.20
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 556: SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC

Facility

$31,119.27

Service Code	MSDRG 556
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$31,119.27
Rate for Payer: Aetna of CA HMO/PPO	$24,992.51
Rate for Payer: EPIC Health Plan Commercial	$31,119.27
Rate for Payer: EPIC Health Plan Medicare/Senior	$23,051.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,051.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,051.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,044.65
Rate for Payer: Molina Healthcare of CA Medicare	$30,888.76
Rate for Payer: Multiplan WC	$16,593.48
Rate for Payer: Prime Health Services WC	$16,424.16
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 557: TENDONITIS, MYOSITIS AND BURSITIS WITH MCC

Facility

$47,195.95

Service Code	MSDRG 557
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$47,195.95
Rate for Payer: Aetna of CA HMO/PPO	$47,195.95
Rate for Payer: EPIC Health Plan Commercial	$42,082.43
Rate for Payer: EPIC Health Plan Medicare/Senior	$31,172.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,172.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,172.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$39,276.93
Rate for Payer: Molina Healthcare of CA Medicare	$41,770.71
Rate for Payer: Multiplan WC	$29,406.18
Rate for Payer: Prime Health Services WC	$29,106.12
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 558: TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC

Facility

$31,927.57

Service Code	MSDRG 558
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$31,927.57
Rate for Payer: Aetna of CA HMO/PPO	$26,629.57
Rate for Payer: EPIC Health Plan Commercial	$31,927.57
Rate for Payer: EPIC Health Plan Medicare/Senior	$23,650.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,650.05
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,650.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,799.06
Rate for Payer: Molina Healthcare of CA Medicare	$31,691.07
Rate for Payer: Multiplan WC	$17,846.20
Rate for Payer: Prime Health Services WC	$17,664.10
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 559: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$56,099.76

Service Code	MSDRG 559
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$56,099.76
Rate for Payer: Aetna of CA HMO/PPO	$56,099.76
Rate for Payer: EPIC Health Plan Commercial	$46,478.79
Rate for Payer: EPIC Health Plan Medicare/Senior	$34,428.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,428.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,428.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,380.20
Rate for Payer: Molina Healthcare of CA Medicare	$46,134.50
Rate for Payer: Multiplan WC	$36,657.61
Rate for Payer: Prime Health Services WC	$36,283.55
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 560: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC

Facility

$35,725.17

Service Code	MSDRG 560
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$35,725.17
Rate for Payer: Aetna of CA HMO/PPO	$34,320.74
Rate for Payer: EPIC Health Plan Commercial	$35,725.17
Rate for Payer: EPIC Health Plan Medicare/Senior	$26,463.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,463.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,463.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$33,343.49
Rate for Payer: Molina Healthcare of CA Medicare	$35,460.54
Rate for Payer: Multiplan WC	$22,499.76
Rate for Payer: Prime Health Services WC	$22,270.17
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 561: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC

Facility

$30,457.65

Service Code	MSDRG 561
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$30,457.65
Rate for Payer: Aetna of CA HMO/PPO	$23,652.54
Rate for Payer: EPIC Health Plan Commercial	$30,457.65
Rate for Payer: EPIC Health Plan Medicare/Senior	$22,561.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,561.22
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,561.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,427.14
Rate for Payer: Molina Healthcare of CA Medicare	$30,232.03
Rate for Payer: Multiplan WC	$16,227.93
Rate for Payer: Prime Health Services WC	$16,062.34
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 562: FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC

Facility

$46,101.54

Service Code	MSDRG 562
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$46,101.54
Rate for Payer: Aetna of CA HMO/PPO	$46,101.54
Rate for Payer: EPIC Health Plan Commercial	$41,542.08
Rate for Payer: EPIC Health Plan Medicare/Senior	$30,771.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,771.91
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,771.91
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,772.61
Rate for Payer: Molina Healthcare of CA Medicare	$41,234.36
Rate for Payer: Multiplan WC	$30,040.75
Rate for Payer: Prime Health Services WC	$29,734.22
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 563: FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC

Facility

$32,185.04

Service Code	MSDRG 563
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$32,185.04
Rate for Payer: Aetna of CA HMO/PPO	$27,151.01
Rate for Payer: EPIC Health Plan Commercial	$32,185.04
Rate for Payer: EPIC Health Plan Medicare/Senior	$23,840.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,840.77
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,840.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,039.37
Rate for Payer: Molina Healthcare of CA Medicare	$31,946.63
Rate for Payer: Multiplan WC	$17,686.01
Rate for Payer: Prime Health Services WC	$17,505.54
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 564: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC

Facility

$47,350.56

Service Code	MSDRG 564
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$47,350.56
Rate for Payer: Aetna of CA HMO/PPO	$47,350.56
Rate for Payer: EPIC Health Plan Commercial	$42,158.77
Rate for Payer: EPIC Health Plan Medicare/Senior	$31,228.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,228.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,228.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$39,348.19
Rate for Payer: Molina Healthcare of CA Medicare	$41,846.48
Rate for Payer: Multiplan WC	$31,899.30
Rate for Payer: Prime Health Services WC	$31,573.80
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 565: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC

Facility

$33,738.82

Service Code	MSDRG 565
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$33,738.82
Rate for Payer: Aetna of CA HMO/PPO	$30,297.81
Rate for Payer: EPIC Health Plan Commercial	$33,738.82
Rate for Payer: EPIC Health Plan Medicare/Senior	$24,991.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,991.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,991.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,489.57
Rate for Payer: Molina Healthcare of CA Medicare	$33,488.90
Rate for Payer: Multiplan WC	$20,277.72
Rate for Payer: Prime Health Services WC	$20,070.80
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 566: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC

Facility

$30,013.09

Service Code	MSDRG 566
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$30,013.09
Rate for Payer: Aetna of CA HMO/PPO	$22,752.16
Rate for Payer: EPIC Health Plan Commercial	$30,013.09
Rate for Payer: EPIC Health Plan Medicare/Senior	$22,231.92
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,231.92
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,231.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,012.22
Rate for Payer: Molina Healthcare of CA Medicare	$29,790.77
Rate for Payer: Multiplan WC	$15,252.45
Rate for Payer: Prime Health Services WC	$15,096.81
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 570: SKIN DEBRIDEMENT WITH MCC

Facility

$88,589.42

Service Code	MSDRG 570
Min. Negotiated Rate	$7,235.00
Max. Negotiated Rate	$88,589.42
Rate for Payer: Aetna of CA HMO/PPO	$88,589.42
Rate for Payer: EPIC Health Plan Commercial	$62,520.88
Rate for Payer: EPIC Health Plan Medicare/Senior	$46,311.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$46,311.76
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$46,311.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$58,352.82
Rate for Payer: Molina Healthcare of CA Medicare	$62,057.76
Rate for Payer: Multiplan WC	$59,906.96
Rate for Payer: Prime Health Services WC	$59,295.66
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 571: SKIN DEBRIDEMENT WITH CC

Facility

$51,291.64

Service Code	MSDRG 571
Min. Negotiated Rate	$7,235.00
Max. Negotiated Rate	$51,291.64
Rate for Payer: Aetna of CA HMO/PPO	$51,291.64
Rate for Payer: EPIC Health Plan Commercial	$44,104.73
Rate for Payer: EPIC Health Plan Medicare/Senior	$32,670.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,670.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,670.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$41,164.41
Rate for Payer: Molina Healthcare of CA Medicare	$43,778.03
Rate for Payer: Multiplan WC	$33,856.43
Rate for Payer: Prime Health Services WC	$33,510.96
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 572: SKIN DEBRIDEMENT WITHOUT CC/MCC

Facility

$35,837.44

Service Code	MSDRG 572
Min. Negotiated Rate	$7,235.00
Max. Negotiated Rate	$35,837.44
Rate for Payer: Aetna of CA HMO/PPO	$34,548.11
Rate for Payer: EPIC Health Plan Commercial	$35,837.44
Rate for Payer: EPIC Health Plan Medicare/Senior	$26,546.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,546.25
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,546.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$33,448.28
Rate for Payer: Molina Healthcare of CA Medicare	$35,571.98
Rate for Payer: Multiplan WC	$24,717.71
Rate for Payer: Prime Health Services WC	$24,465.49
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

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