Loma Linda University Medical Center

All Charges

Charge

Type

Price

INPATIENT MS-DRG 469: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT

Facility IP

$52,738.15

Service Code	MS-DRG 469
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$52,738.15
Rate for Payer: Cigna of CA HMO/PPO	$17,300.00
Rate for Payer: EPIC Health Plan Commercial	$24,040.00
Rate for Payer: EPIC Health Plan Medicare	$37,699.43
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$37,699.43
Rate for Payer: IEHP Medicare Advantage	$37,699.43
Rate for Payer: Kaiser Permanente of CA Commercial	$9,561.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$44,485.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$47,501.28
Rate for Payer: Molina Healthcare of CA Medicare	$47,501.28
Rate for Payer: Multiplan WC	$52,738.15

INPATIENT MS-DRG 470: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC

Facility IP

$31,203.22

Service Code	MS-DRG 470
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$31,203.22
Rate for Payer: Cigna of CA HMO/PPO	$17,300.00
Rate for Payer: EPIC Health Plan Commercial	$24,040.00
Rate for Payer: EPIC Health Plan Medicare	$21,393.16
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$21,393.16
Rate for Payer: IEHP Medicare Advantage	$21,393.16
Rate for Payer: Kaiser Permanente of CA Commercial	$9,561.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,243.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,955.38
Rate for Payer: Molina Healthcare of CA Medicare	$26,955.38
Rate for Payer: Multiplan WC	$31,203.22

INPATIENT MS-DRG 471: CERVICAL SPINAL FUSION WITH MCC

Facility IP

$82,206.50

Service Code	MS-DRG 471
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$82,206.50
Rate for Payer: Cigna of CA HMO/PPO	$21,600.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$55,594.55
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$55,594.55
Rate for Payer: IEHP Medicare Advantage	$55,594.55
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$65,601.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$70,049.13
Rate for Payer: Molina Healthcare of CA Medicare	$70,049.13
Rate for Payer: Multiplan WC	$82,206.50

INPATIENT MS-DRG 472: CERVICAL SPINAL FUSION WITH CC

Facility IP

$50,120.35

Service Code	MS-DRG 472
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$50,120.35
Rate for Payer: Cigna of CA HMO/PPO	$21,600.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$33,483.51
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$33,483.51
Rate for Payer: IEHP Medicare Advantage	$33,483.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,510.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,189.22
Rate for Payer: Molina Healthcare of CA Medicare	$42,189.22
Rate for Payer: Multiplan WC	$50,120.35

INPATIENT MS-DRG 473: CERVICAL SPINAL FUSION WITHOUT CC/MCC

Facility IP

$41,374.17

Service Code	MS-DRG 473
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$41,374.17
Rate for Payer: Cigna of CA HMO/PPO	$21,600.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$27,911.84
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$27,911.84
Rate for Payer: IEHP Medicare Advantage	$27,911.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,935.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,168.92
Rate for Payer: Molina Healthcare of CA Medicare	$35,168.92
Rate for Payer: Multiplan WC	$41,374.17

INPATIENT MS-DRG 474: AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC

Facility IP

$66,863.57

Service Code	MS-DRG 474
Min. Negotiated Rate	$48,655.86
Max. Negotiated Rate	$66,863.57
Rate for Payer: EPIC Health Plan Medicare	$48,655.86
Rate for Payer: Humana Medicare	$48,655.86
Rate for Payer: IEHP Medicare Advantage	$48,655.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$57,413.91
Rate for Payer: Molina Healthcare of CA Medi-Cal	$61,306.38
Rate for Payer: Molina Healthcare of CA Medicare	$61,306.38
Rate for Payer: Multiplan WC	$66,863.57

INPATIENT MS-DRG 475: AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC

Facility IP

$36,251.16

Service Code	MS-DRG 475
Min. Negotiated Rate	$24,354.66
Max. Negotiated Rate	$36,251.16
Rate for Payer: EPIC Health Plan Medicare	$24,354.66
Rate for Payer: Humana Medicare	$24,354.66
Rate for Payer: IEHP Medicare Advantage	$24,354.66
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,738.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,686.87
Rate for Payer: Molina Healthcare of CA Medicare	$30,686.87
Rate for Payer: Multiplan WC	$36,251.16

INPATIENT MS-DRG 476: AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility IP

$20,033.44

Service Code	MS-DRG 476
Min. Negotiated Rate	$13,456.80
Max. Negotiated Rate	$20,033.44
Rate for Payer: EPIC Health Plan Medicare	$13,456.80
Rate for Payer: Humana Medicare	$13,456.80
Rate for Payer: IEHP Medicare Advantage	$13,456.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,879.02
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,955.57
Rate for Payer: Molina Healthcare of CA Medicare	$16,955.57
Rate for Payer: Multiplan WC	$20,033.44

INPATIENT MS-DRG 477: BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility IP

$55,535.49

Service Code	MS-DRG 477
Min. Negotiated Rate	$38,140.84
Max. Negotiated Rate	$55,535.49
Rate for Payer: EPIC Health Plan Medicare	$38,140.84
Rate for Payer: Humana Medicare	$38,140.84
Rate for Payer: IEHP Medicare Advantage	$38,140.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$45,006.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$48,057.46
Rate for Payer: Molina Healthcare of CA Medicare	$48,057.46
Rate for Payer: Multiplan WC	$55,535.49

INPATIENT MS-DRG 478: BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC

Facility IP

$38,335.29

Service Code	MS-DRG 478
Min. Negotiated Rate	$27,045.91
Max. Negotiated Rate	$38,335.29
Rate for Payer: EPIC Health Plan Medicare	$27,045.91
Rate for Payer: Humana Medicare	$27,045.91
Rate for Payer: IEHP Medicare Advantage	$27,045.91
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,914.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,077.85
Rate for Payer: Molina Healthcare of CA Medicare	$34,077.85
Rate for Payer: Multiplan WC	$38,335.29

INPATIENT MS-DRG 479: BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC

Facility IP

$28,861.23

Service Code	MS-DRG 479
Min. Negotiated Rate	$21,193.86
Max. Negotiated Rate	$28,861.23
Rate for Payer: EPIC Health Plan Medicare	$21,193.86
Rate for Payer: Humana Medicare	$21,193.86
Rate for Payer: IEHP Medicare Advantage	$21,193.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,008.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,704.26
Rate for Payer: Molina Healthcare of CA Medicare	$26,704.26
Rate for Payer: Multiplan WC	$28,861.23

INPATIENT MS-DRG 480: HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC

Facility IP

$48,406.69

Service Code	MS-DRG 480
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$48,406.69
Rate for Payer: EPIC Health Plan Medicare	$33,410.32
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$33,410.32
Rate for Payer: IEHP Medicare Advantage	$33,410.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,424.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,097.00
Rate for Payer: Molina Healthcare of CA Medicare	$42,097.00
Rate for Payer: Multiplan WC	$48,406.69

INPATIENT MS-DRG 481: HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC

Facility IP

$34,475.48

Service Code	MS-DRG 481
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$34,475.48
Rate for Payer: EPIC Health Plan Medicare	$23,568.70
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$23,568.70
Rate for Payer: IEHP Medicare Advantage	$23,568.70
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,811.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,696.56
Rate for Payer: Molina Healthcare of CA Medicare	$29,696.56
Rate for Payer: Multiplan WC	$34,475.48

INPATIENT MS-DRG 482: HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC

Facility IP

$26,865.22

Service Code	MS-DRG 482
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$26,865.22
Rate for Payer: EPIC Health Plan Medicare	$18,090.48
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$18,090.48
Rate for Payer: IEHP Medicare Advantage	$18,090.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,346.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,794.00
Rate for Payer: Molina Healthcare of CA Medicare	$22,794.00
Rate for Payer: Multiplan WC	$26,865.22

INPATIENT MS-DRG 483: MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES

Facility IP

$38,477.28

Service Code	MS-DRG 483
Min. Negotiated Rate	$28,177.60
Max. Negotiated Rate	$38,477.28
Rate for Payer: EPIC Health Plan Medicare	$28,177.60
Rate for Payer: Humana Medicare	$28,177.60
Rate for Payer: IEHP Medicare Advantage	$28,177.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,249.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,503.78
Rate for Payer: Molina Healthcare of CA Medicare	$35,503.78
Rate for Payer: Multiplan WC	$38,477.28

INPATIENT MS-DRG 485: KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC

Facility IP

$53,058.03

Service Code	MS-DRG 485
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$53,058.03
Rate for Payer: EPIC Health Plan Medicare	$37,296.31
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$37,296.31
Rate for Payer: IEHP Medicare Advantage	$37,296.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$44,009.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,993.35
Rate for Payer: Molina Healthcare of CA Medicare	$46,993.35
Rate for Payer: Multiplan WC	$53,058.03

INPATIENT MS-DRG 486: KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC

Facility IP

$34,044.62

Service Code	MS-DRG 486
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$34,044.62
Rate for Payer: EPIC Health Plan Medicare	$22,818.75
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$22,818.75
Rate for Payer: IEHP Medicare Advantage	$22,818.75
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,926.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,751.62
Rate for Payer: Molina Healthcare of CA Medicare	$28,751.62
Rate for Payer: Multiplan WC	$34,044.62

INPATIENT MS-DRG 487: KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility IP

$26,178.12

Service Code	MS-DRG 487
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$26,178.12
Rate for Payer: EPIC Health Plan Medicare	$17,600.66
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$17,600.66
Rate for Payer: IEHP Medicare Advantage	$17,600.66
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,768.78
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,176.83
Rate for Payer: Molina Healthcare of CA Medicare	$22,176.83
Rate for Payer: Multiplan WC	$26,178.12

INPATIENT MS-DRG 488: KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC

Facility IP

$37,034.54

Service Code	MS-DRG 488
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$37,034.54
Rate for Payer: EPIC Health Plan Medicare	$23,925.65
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$23,925.65
Rate for Payer: IEHP Medicare Advantage	$23,925.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,232.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,146.32
Rate for Payer: Molina Healthcare of CA Medicare	$30,146.32
Rate for Payer: Multiplan WC	$37,034.54

INPATIENT MS-DRG 489: KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility IP

$21,698.14

Service Code	MS-DRG 489
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$21,698.14
Rate for Payer: EPIC Health Plan Medicare	$14,141.43
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$14,141.43
Rate for Payer: IEHP Medicare Advantage	$14,141.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,686.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,818.20
Rate for Payer: Molina Healthcare of CA Medicare	$17,818.20
Rate for Payer: Multiplan WC	$21,698.14

INPATIENT MS-DRG 492: LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC

Facility IP

$56,891.72

Service Code	MS-DRG 492
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$56,891.72
Rate for Payer: EPIC Health Plan Medicare	$39,189.20
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$39,189.20
Rate for Payer: IEHP Medicare Advantage	$39,189.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$46,243.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$49,378.39
Rate for Payer: Molina Healthcare of CA Medicare	$49,378.39
Rate for Payer: Multiplan WC	$56,891.72

INPATIENT MS-DRG 493: LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC

Facility IP

$38,774.31

Service Code	MS-DRG 493
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$38,774.31
Rate for Payer: EPIC Health Plan Medicare	$27,248.60
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$27,248.60
Rate for Payer: IEHP Medicare Advantage	$27,248.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,153.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,333.24
Rate for Payer: Molina Healthcare of CA Medicare	$34,333.24
Rate for Payer: Multiplan WC	$38,774.31

INPATIENT MS-DRG 494: LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC

Facility IP

$30,826.21

Service Code	MS-DRG 494
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$30,826.21
Rate for Payer: EPIC Health Plan Medicare	$21,252.42
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$21,252.42
Rate for Payer: IEHP Medicare Advantage	$21,252.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,077.86
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,778.05
Rate for Payer: Molina Healthcare of CA Medicare	$26,778.05
Rate for Payer: Multiplan WC	$30,826.21

INPATIENT MS-DRG 495: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC

Facility IP

$60,620.97

Service Code	MS-DRG 495
Min. Negotiated Rate	$40,530.30
Max. Negotiated Rate	$60,620.97
Rate for Payer: EPIC Health Plan Medicare	$40,530.30
Rate for Payer: Humana Medicare	$40,530.30
Rate for Payer: IEHP Medicare Advantage	$40,530.30
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$47,825.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$51,068.18
Rate for Payer: Molina Healthcare of CA Medicare	$51,068.18
Rate for Payer: Multiplan WC	$60,620.97

INPATIENT MS-DRG 496: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC

Facility IP

$34,268.21

Service Code	MS-DRG 496
Min. Negotiated Rate	$22,584.52
Max. Negotiated Rate	$34,268.21
Rate for Payer: EPIC Health Plan Medicare	$22,584.52
Rate for Payer: Humana Medicare	$22,584.52
Rate for Payer: IEHP Medicare Advantage	$22,584.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,649.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,456.50
Rate for Payer: Molina Healthcare of CA Medicare	$28,456.50
Rate for Payer: Multiplan WC	$34,268.21

Price Transparency.

All Charges