Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

INPATIENT MS-DRG 835: ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC

Facility

$67,771.42

Service Code	MSDRG 835
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$67,771.42
Rate for Payer: Aetna of CA HMO/PPO	$67,771.42
Rate for Payer: EPIC Health Plan Commercial	$52,241.77
Rate for Payer: EPIC Health Plan Medicare/Senior	$38,697.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$38,697.61
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$38,697.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$48,758.99
Rate for Payer: Molina Healthcare of CA Medicare	$51,854.80
Rate for Payer: Multiplan WC	$43,067.04
Rate for Payer: Prime Health Services WC	$42,627.58
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 836: ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC

Facility

$39,913.45

Service Code	MSDRG 836
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$39,913.45
Rate for Payer: Aetna of CA HMO/PPO	$36,297.35
Rate for Payer: EPIC Health Plan Commercial	$39,913.45
Rate for Payer: EPIC Health Plan Medicare/Senior	$29,565.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,565.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,565.52
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,252.56
Rate for Payer: Molina Healthcare of CA Medicare	$39,617.80
Rate for Payer: Multiplan WC	$32,217.63
Rate for Payer: Prime Health Services WC	$31,888.88
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 837: CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC

Facility

$144,201.09

Service Code	MSDRG 837
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$144,201.09
Rate for Payer: Aetna of CA HMO/PPO	$144,201.09
Rate for Payer: EPIC Health Plan Commercial	$91,288.00
Rate for Payer: EPIC Health Plan Medicare/Senior	$67,620.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$67,620.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$67,620.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$85,202.13
Rate for Payer: Molina Healthcare of CA Medicare	$90,611.79
Rate for Payer: Multiplan WC	$110,531.43
Rate for Payer: Prime Health Services WC	$109,403.55
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 838: CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT

Facility

$59,188.96

Service Code	MSDRG 838
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$59,188.96
Rate for Payer: Aetna of CA HMO/PPO	$59,188.96
Rate for Payer: EPIC Health Plan Commercial	$48,742.07
Rate for Payer: EPIC Health Plan Medicare/Senior	$36,105.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,105.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,105.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$45,492.60
Rate for Payer: Molina Healthcare of CA Medicare	$48,381.02
Rate for Payer: Multiplan WC	$45,675.17
Rate for Payer: Prime Health Services WC	$45,209.10
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 839: CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC

Facility

$39,504.78

Service Code	MSDRG 839
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$39,504.78
Rate for Payer: Aetna of CA HMO/PPO	$39,504.78
Rate for Payer: EPIC Health Plan Commercial	$38,284.85
Rate for Payer: EPIC Health Plan Medicare/Senior	$28,359.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,359.15
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,359.15
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,732.53
Rate for Payer: Molina Healthcare of CA Medicare	$38,001.26
Rate for Payer: Multiplan WC	$28,231.50
Rate for Payer: Prime Health Services WC	$27,943.42
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 840: LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC

Facility

$94,743.56

Service Code	MSDRG 840
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$94,743.56
Rate for Payer: Aetna of CA HMO/PPO	$94,743.56
Rate for Payer: EPIC Health Plan Commercial	$65,559.56
Rate for Payer: EPIC Health Plan Medicare/Senior	$48,562.64
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$48,562.64
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$48,562.64
Rate for Payer: Molina Healthcare of CA Medi-Cal	$61,188.93
Rate for Payer: Molina Healthcare of CA Medicare	$65,073.94
Rate for Payer: Multiplan WC	$63,806.83
Rate for Payer: Prime Health Services WC	$63,155.74
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 841: LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC

Facility

$47,702.23

Service Code	MSDRG 841
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$47,702.23
Rate for Payer: Aetna of CA HMO/PPO	$47,702.23
Rate for Payer: EPIC Health Plan Commercial	$42,332.42
Rate for Payer: EPIC Health Plan Medicare/Senior	$31,357.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,357.35
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,357.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$39,510.26
Rate for Payer: Molina Healthcare of CA Medicare	$42,018.85
Rate for Payer: Multiplan WC	$32,751.57
Rate for Payer: Prime Health Services WC	$32,417.37
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 842: LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC

Facility

$34,741.74

Service Code	MSDRG 842
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$34,741.74
Rate for Payer: Aetna of CA HMO/PPO	$32,328.98
Rate for Payer: EPIC Health Plan Commercial	$34,741.74
Rate for Payer: EPIC Health Plan Medicare/Senior	$25,734.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,734.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,734.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,425.62
Rate for Payer: Molina Healthcare of CA Medicare	$34,484.39
Rate for Payer: Multiplan WC	$22,666.11
Rate for Payer: Prime Health Services WC	$22,434.82
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 843: OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC

Facility

$56,405.95

Service Code	MSDRG 843
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$56,405.95
Rate for Payer: Aetna of CA HMO/PPO	$56,405.95
Rate for Payer: EPIC Health Plan Commercial	$46,629.97
Rate for Payer: EPIC Health Plan Medicare/Senior	$34,540.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,540.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,540.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,521.31
Rate for Payer: Molina Healthcare of CA Medicare	$46,284.56
Rate for Payer: Multiplan WC	$39,787.37
Rate for Payer: Prime Health Services WC	$39,381.38
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 844: OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC

Facility

$36,100.89

Service Code	MSDRG 844
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$36,100.89
Rate for Payer: Aetna of CA HMO/PPO	$35,081.68
Rate for Payer: EPIC Health Plan Commercial	$36,100.89
Rate for Payer: EPIC Health Plan Medicare/Senior	$26,741.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,741.40
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,741.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$33,694.16
Rate for Payer: Molina Healthcare of CA Medicare	$35,833.48
Rate for Payer: Multiplan WC	$23,423.90
Rate for Payer: Prime Health Services WC	$23,184.88
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 845: OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC

Facility

$31,725.50

Service Code	MSDRG 845
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$31,725.50
Rate for Payer: Aetna of CA HMO/PPO	$26,220.31
Rate for Payer: EPIC Health Plan Commercial	$31,725.50
Rate for Payer: EPIC Health Plan Medicare/Senior	$23,500.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,500.37
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,500.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,610.47
Rate for Payer: Molina Healthcare of CA Medicare	$31,490.50
Rate for Payer: Multiplan WC	$17,363.59
Rate for Payer: Prime Health Services WC	$17,186.41
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 846: CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC

Facility

$74,092.30

Service Code	MSDRG 846
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$74,092.30
Rate for Payer: Aetna of CA HMO/PPO	$74,092.30
Rate for Payer: EPIC Health Plan Commercial	$55,362.81
Rate for Payer: EPIC Health Plan Medicare/Senior	$41,009.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$41,009.49
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$41,009.49
Rate for Payer: Molina Healthcare of CA Medi-Cal	$51,671.96
Rate for Payer: Molina Healthcare of CA Medicare	$54,952.72
Rate for Payer: Multiplan WC	$49,472.37
Rate for Payer: Prime Health Services WC	$48,967.55
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 847: CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC

Facility

$36,930.15

Service Code	MSDRG 847
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$36,930.15
Rate for Payer: Aetna of CA HMO/PPO	$36,761.18
Rate for Payer: EPIC Health Plan Commercial	$36,930.15
Rate for Payer: EPIC Health Plan Medicare/Senior	$27,355.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,355.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,355.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,468.14
Rate for Payer: Molina Healthcare of CA Medicare	$36,656.60
Rate for Payer: Multiplan WC	$25,015.48
Rate for Payer: Prime Health Services WC	$24,760.22
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 848: CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC

Facility

$31,295.89

Service Code	MSDRG 848
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$31,295.89
Rate for Payer: Aetna of CA HMO/PPO	$23,025.00
Rate for Payer: EPIC Health Plan Commercial	$31,295.89
Rate for Payer: EPIC Health Plan Medicare/Senior	$23,182.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,182.14
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,182.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,209.50
Rate for Payer: Molina Healthcare of CA Medicare	$31,064.07
Rate for Payer: Multiplan WC	$19,080.44
Rate for Payer: Prime Health Services WC	$18,885.74
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 849: RADIOTHERAPY

Facility

$81,592.48

Service Code	MSDRG 849
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$81,592.48
Rate for Payer: Aetna of CA HMO/PPO	$81,592.48
Rate for Payer: EPIC Health Plan Commercial	$59,066.08
Rate for Payer: EPIC Health Plan Medicare/Senior	$43,752.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$43,752.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$43,752.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$55,128.34
Rate for Payer: Molina Healthcare of CA Medicare	$58,628.55
Rate for Payer: Multiplan WC	$48,032.76
Rate for Payer: Prime Health Services WC	$47,542.63
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 853: INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC

Facility

$151,558.78

Service Code	MSDRG 853
Min. Negotiated Rate	$7,235.00
Max. Negotiated Rate	$151,558.78
Rate for Payer: Aetna of CA HMO/PPO	$151,558.78
Rate for Payer: EPIC Health Plan Commercial	$93,612.64
Rate for Payer: EPIC Health Plan Medicare/Senior	$69,342.70
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$69,342.70
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$69,342.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$87,371.80
Rate for Payer: Molina Healthcare of CA Medicare	$92,919.22
Rate for Payer: Multiplan WC	$100,649.27
Rate for Payer: Prime Health Services WC	$99,622.24
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 854: INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC

Facility

$61,790.07

Service Code	MSDRG 854
Min. Negotiated Rate	$7,235.00
Max. Negotiated Rate	$61,790.07
Rate for Payer: Aetna of CA HMO/PPO	$61,790.07
Rate for Payer: EPIC Health Plan Commercial	$49,288.43
Rate for Payer: EPIC Health Plan Medicare/Senior	$36,509.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,509.95
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,509.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,002.54
Rate for Payer: Molina Healthcare of CA Medicare	$48,923.33
Rate for Payer: Multiplan WC	$42,214.78
Rate for Payer: Prime Health Services WC	$41,784.02
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 855: INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$51,591.77

Service Code	MSDRG 855
Min. Negotiated Rate	$7,235.00
Max. Negotiated Rate	$51,591.77
Rate for Payer: Aetna of CA HMO/PPO	$51,591.77
Rate for Payer: EPIC Health Plan Commercial	$44,252.92
Rate for Payer: EPIC Health Plan Medicare/Senior	$32,779.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,779.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,779.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$41,302.72
Rate for Payer: Molina Healthcare of CA Medicare	$43,925.12
Rate for Payer: Multiplan WC	$31,373.57
Rate for Payer: Prime Health Services WC	$31,053.43
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 856: POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC

Facility

$134,251.37

Service Code	MSDRG 856
Min. Negotiated Rate	$7,235.00
Max. Negotiated Rate	$134,251.37
Rate for Payer: Aetna of CA HMO/PPO	$134,251.37
Rate for Payer: EPIC Health Plan Commercial	$85,066.94
Rate for Payer: EPIC Health Plan Medicare/Senior	$63,012.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$63,012.55
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$63,012.55
Rate for Payer: Molina Healthcare of CA Medi-Cal	$79,395.81
Rate for Payer: Molina Healthcare of CA Medicare	$84,436.82
Rate for Payer: Multiplan WC	$90,621.31
Rate for Payer: Prime Health Services WC	$89,696.60
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 857: POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC

Facility

$64,745.88

Service Code	MSDRG 857
Min. Negotiated Rate	$7,235.00
Max. Negotiated Rate	$64,745.88
Rate for Payer: Aetna of CA HMO/PPO	$64,745.88
Rate for Payer: EPIC Health Plan Commercial	$50,747.90
Rate for Payer: EPIC Health Plan Medicare/Senior	$37,591.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,591.04
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,591.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$47,364.71
Rate for Payer: Molina Healthcare of CA Medicare	$50,371.99
Rate for Payer: Multiplan WC	$43,311.43
Rate for Payer: Prime Health Services WC	$42,869.48
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 858: POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$38,907.55

Service Code	MSDRG 858
Min. Negotiated Rate	$7,235.00
Max. Negotiated Rate	$38,907.55
Rate for Payer: Aetna of CA HMO/PPO	$38,907.55
Rate for Payer: EPIC Health Plan Commercial	$37,989.94
Rate for Payer: EPIC Health Plan Medicare/Senior	$28,140.70
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,140.70
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,140.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,457.28
Rate for Payer: Molina Healthcare of CA Medicare	$37,708.54
Rate for Payer: Multiplan WC	$29,050.89
Rate for Payer: Prime Health Services WC	$28,754.46
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 862: POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC

Facility

$55,842.07

Service Code	MSDRG 862
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$55,842.07
Rate for Payer: Aetna of CA HMO/PPO	$55,842.07
Rate for Payer: EPIC Health Plan Commercial	$46,351.55
Rate for Payer: EPIC Health Plan Medicare/Senior	$34,334.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,334.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,334.48
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,261.44
Rate for Payer: Molina Healthcare of CA Medicare	$46,008.20
Rate for Payer: Multiplan WC	$37,563.27
Rate for Payer: Prime Health Services WC	$37,179.97
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 863: POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC

Facility

$33,830.12

Service Code	MSDRG 863
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$33,830.12
Rate for Payer: Aetna of CA HMO/PPO	$30,482.74
Rate for Payer: EPIC Health Plan Commercial	$33,830.12
Rate for Payer: EPIC Health Plan Medicare/Senior	$25,059.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,059.35
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,059.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,574.78
Rate for Payer: Molina Healthcare of CA Medicare	$33,579.53
Rate for Payer: Multiplan WC	$20,657.65
Rate for Payer: Prime Health Services WC	$20,446.85
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 864: FEVER AND INFLAMMATORY CONDITIONS

Facility

$31,993.45

Service Code	MSDRG 864
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$31,993.45
Rate for Payer: Aetna of CA HMO/PPO	$26,762.96
Rate for Payer: EPIC Health Plan Commercial	$31,993.45
Rate for Payer: EPIC Health Plan Medicare/Senior	$23,698.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,698.85
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,698.85
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,860.55
Rate for Payer: Molina Healthcare of CA Medicare	$31,756.46
Rate for Payer: Multiplan WC	$17,419.04
Rate for Payer: Prime Health Services WC	$17,241.29
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 865: VIRAL ILLNESS WITH MCC

Facility

$49,715.21

Service Code	MSDRG 865
Min. Negotiated Rate	$6,486.00
Max. Negotiated Rate	$49,715.21
Rate for Payer: Aetna of CA HMO/PPO	$49,715.21
Rate for Payer: EPIC Health Plan Commercial	$43,326.35
Rate for Payer: EPIC Health Plan Medicare/Senior	$32,093.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,093.59
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,093.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$40,437.92
Rate for Payer: Molina Healthcare of CA Medicare	$43,005.41
Rate for Payer: Multiplan WC	$34,353.42
Rate for Payer: Prime Health Services WC	$34,002.87
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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