Loma Linda University Medical Center

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Type

Price

INPATIENT MS-DRG 497: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC

Facility IP

$24,834.94

Service Code	MS-DRG 497
Min. Negotiated Rate	$16,277.54
Max. Negotiated Rate	$24,834.94
Rate for Payer: EPIC Health Plan Medicare	$16,277.54
Rate for Payer: Humana Medicare	$16,277.54
Rate for Payer: IEHP Medicare Advantage	$16,277.54
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,207.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,509.70
Rate for Payer: Molina Healthcare of CA Medicare	$20,509.70
Rate for Payer: Multiplan WC	$24,834.94

INPATIENT MS-DRG 498: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC

Facility IP

$41,831.14

Service Code	MS-DRG 498
Min. Negotiated Rate	$29,605.41
Max. Negotiated Rate	$41,831.14
Rate for Payer: EPIC Health Plan Medicare	$29,605.41
Rate for Payer: Humana Medicare	$29,605.41
Rate for Payer: IEHP Medicare Advantage	$29,605.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,934.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,302.82
Rate for Payer: Molina Healthcare of CA Medicare	$37,302.82
Rate for Payer: Multiplan WC	$41,831.14

INPATIENT MS-DRG 499: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC

Facility IP

$21,521.88

Service Code	MS-DRG 499
Min. Negotiated Rate	$14,728.11
Max. Negotiated Rate	$21,521.88
Rate for Payer: EPIC Health Plan Medicare	$14,728.11
Rate for Payer: Humana Medicare	$14,728.11
Rate for Payer: IEHP Medicare Advantage	$14,728.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,379.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,557.42
Rate for Payer: Molina Healthcare of CA Medicare	$18,557.42
Rate for Payer: Multiplan WC	$21,521.88

INPATIENT MS-DRG 500: SOFT TISSUE PROCEDURES WITH MCC

Facility IP

$52,299.13

Service Code	MS-DRG 500
Min. Negotiated Rate	$36,719.78
Max. Negotiated Rate	$52,299.13
Rate for Payer: EPIC Health Plan Medicare	$36,719.78
Rate for Payer: Humana Medicare	$36,719.78
Rate for Payer: IEHP Medicare Advantage	$36,719.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$43,329.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,266.92
Rate for Payer: Molina Healthcare of CA Medicare	$46,266.92
Rate for Payer: Multiplan WC	$52,299.13

INPATIENT MS-DRG 501: SOFT TISSUE PROCEDURES WITH CC

Facility IP

$28,688.23

Service Code	MS-DRG 501
Min. Negotiated Rate	$19,749.14
Max. Negotiated Rate	$28,688.23
Rate for Payer: EPIC Health Plan Medicare	$19,749.14
Rate for Payer: Humana Medicare	$19,749.14
Rate for Payer: IEHP Medicare Advantage	$19,749.14
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,303.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,883.92
Rate for Payer: Molina Healthcare of CA Medicare	$24,883.92
Rate for Payer: Multiplan WC	$28,688.23

INPATIENT MS-DRG 502: SOFT TISSUE PROCEDURES WITHOUT CC/MCC

Facility IP

$22,432.56

Service Code	MS-DRG 502
Min. Negotiated Rate	$15,774.20
Max. Negotiated Rate	$22,432.56
Rate for Payer: EPIC Health Plan Medicare	$15,774.20
Rate for Payer: Humana Medicare	$15,774.20
Rate for Payer: IEHP Medicare Advantage	$15,774.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,613.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,875.49
Rate for Payer: Molina Healthcare of CA Medicare	$19,875.49
Rate for Payer: Multiplan WC	$22,432.56

INPATIENT MS-DRG 503: FOOT PROCEDURES WITH MCC

Facility IP

$41,344.79

Service Code	MS-DRG 503
Min. Negotiated Rate	$30,403.78
Max. Negotiated Rate	$41,344.79
Rate for Payer: EPIC Health Plan Medicare	$30,403.78
Rate for Payer: Humana Medicare	$30,403.78
Rate for Payer: IEHP Medicare Advantage	$30,403.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,876.46
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,308.76
Rate for Payer: Molina Healthcare of CA Medicare	$38,308.76
Rate for Payer: Multiplan WC	$41,344.79

INPATIENT MS-DRG 504: FOOT PROCEDURES WITH CC

Facility IP

$28,965.67

Service Code	MS-DRG 504
Min. Negotiated Rate	$19,652.29
Max. Negotiated Rate	$28,965.67
Rate for Payer: EPIC Health Plan Medicare	$19,652.29
Rate for Payer: Humana Medicare	$19,652.29
Rate for Payer: IEHP Medicare Advantage	$19,652.29
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,189.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,761.89
Rate for Payer: Molina Healthcare of CA Medicare	$24,761.89
Rate for Payer: Multiplan WC	$28,965.67

INPATIENT MS-DRG 505: FOOT PROCEDURES WITHOUT CC/MCC

Facility IP

$28,835.11

Service Code	MS-DRG 505
Min. Negotiated Rate	$19,411.33
Max. Negotiated Rate	$28,835.11
Rate for Payer: EPIC Health Plan Medicare	$19,411.33
Rate for Payer: Humana Medicare	$19,411.33
Rate for Payer: IEHP Medicare Advantage	$19,411.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,905.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,458.28
Rate for Payer: Molina Healthcare of CA Medicare	$24,458.28
Rate for Payer: Multiplan WC	$28,835.11

INPATIENT MS-DRG 506: MAJOR THUMB OR JOINT PROCEDURES

Facility IP

$23,008.68

Service Code	MS-DRG 506
Min. Negotiated Rate	$16,673.91
Max. Negotiated Rate	$23,008.68
Rate for Payer: EPIC Health Plan Medicare	$16,673.91
Rate for Payer: Humana Medicare	$16,673.91
Rate for Payer: IEHP Medicare Advantage	$16,673.91
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,675.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,009.13
Rate for Payer: Molina Healthcare of CA Medicare	$21,009.13
Rate for Payer: Multiplan WC	$23,008.68

INPATIENT MS-DRG 507: MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC

Facility IP

$30,502.43

Service Code	MS-DRG 507
Min. Negotiated Rate	$24,208.28
Max. Negotiated Rate	$30,502.43
Rate for Payer: EPIC Health Plan Medicare	$24,208.28
Rate for Payer: Humana Medicare	$24,208.28
Rate for Payer: IEHP Medicare Advantage	$24,208.28
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,565.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,502.43
Rate for Payer: Molina Healthcare of CA Medicare	$30,502.43
Rate for Payer: Multiplan WC	$30,271.32

INPATIENT MS-DRG 508: MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC

Facility IP

$23,635.39

Service Code	MS-DRG 508
Min. Negotiated Rate	$16,351.87
Max. Negotiated Rate	$23,635.39
Rate for Payer: EPIC Health Plan Medicare	$16,351.87
Rate for Payer: Humana Medicare	$16,351.87
Rate for Payer: IEHP Medicare Advantage	$16,351.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,295.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,603.36
Rate for Payer: Molina Healthcare of CA Medicare	$20,603.36
Rate for Payer: Multiplan WC	$23,635.39

INPATIENT MS-DRG 509: ARTHROSCOPY

Facility IP

$24,772.93

Service Code	MS-DRG 509
Min. Negotiated Rate	$15,587.28
Max. Negotiated Rate	$24,772.93
Rate for Payer: EPIC Health Plan Medicare	$15,587.28
Rate for Payer: Humana Medicare	$15,587.28
Rate for Payer: IEHP Medicare Advantage	$15,587.28
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,392.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,639.97
Rate for Payer: Molina Healthcare of CA Medicare	$19,639.97
Rate for Payer: Multiplan WC	$24,772.93

INPATIENT MS-DRG 510: SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC

Facility IP

$47,135.31

Service Code	MS-DRG 510
Min. Negotiated Rate	$30,839.57
Max. Negotiated Rate	$47,135.31
Rate for Payer: EPIC Health Plan Medicare	$30,839.57
Rate for Payer: Humana Medicare	$30,839.57
Rate for Payer: IEHP Medicare Advantage	$30,839.57
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,390.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,857.86
Rate for Payer: Molina Healthcare of CA Medicare	$38,857.86
Rate for Payer: Multiplan WC	$47,135.31

INPATIENT MS-DRG 511: SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC

Facility IP

$32,298.32

Service Code	MS-DRG 511
Min. Negotiated Rate	$22,655.47
Max. Negotiated Rate	$32,298.32
Rate for Payer: EPIC Health Plan Medicare	$22,655.47
Rate for Payer: Humana Medicare	$22,655.47
Rate for Payer: IEHP Medicare Advantage	$22,655.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,733.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,545.89
Rate for Payer: Molina Healthcare of CA Medicare	$28,545.89
Rate for Payer: Multiplan WC	$32,298.32

INPATIENT MS-DRG 512: SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC

Facility IP

$26,218.93

Service Code	MS-DRG 512
Min. Negotiated Rate	$18,376.50
Max. Negotiated Rate	$26,218.93
Rate for Payer: EPIC Health Plan Medicare	$18,376.50
Rate for Payer: Humana Medicare	$18,376.50
Rate for Payer: IEHP Medicare Advantage	$18,376.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,684.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,154.39
Rate for Payer: Molina Healthcare of CA Medicare	$23,154.39
Rate for Payer: Multiplan WC	$26,218.93

INPATIENT MS-DRG 513: HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC

Facility IP

$26,014.92

Service Code	MS-DRG 513
Min. Negotiated Rate	$18,457.57
Max. Negotiated Rate	$26,014.92
Rate for Payer: EPIC Health Plan Medicare	$18,457.57
Rate for Payer: Humana Medicare	$18,457.57
Rate for Payer: IEHP Medicare Advantage	$18,457.57
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,779.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,256.54
Rate for Payer: Molina Healthcare of CA Medicare	$23,256.54
Rate for Payer: Multiplan WC	$26,014.92

INPATIENT MS-DRG 514: HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC

Facility IP

$16,854.21

Service Code	MS-DRG 514
Min. Negotiated Rate	$11,932.14
Max. Negotiated Rate	$16,854.21
Rate for Payer: EPIC Health Plan Medicare	$11,932.14
Rate for Payer: Humana Medicare	$11,932.14
Rate for Payer: IEHP Medicare Advantage	$11,932.14
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,079.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,034.50
Rate for Payer: Molina Healthcare of CA Medicare	$15,034.50
Rate for Payer: Multiplan WC	$16,854.21

INPATIENT MS-DRG 515: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC

Facility IP

$50,884.14

Service Code	MS-DRG 515
Min. Negotiated Rate	$13,500.00
Max. Negotiated Rate	$50,884.14
Rate for Payer: Cigna of CA HMO/PPO	$13,500.00
Rate for Payer: EPIC Health Plan Commercial	$27,318.00
Rate for Payer: EPIC Health Plan Medicare	$35,804.28
Rate for Payer: Humana Medicare	$35,804.28
Rate for Payer: IEHP Medicare Advantage	$35,804.28
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,249.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$45,113.39
Rate for Payer: Molina Healthcare of CA Medicare	$45,113.39
Rate for Payer: Multiplan WC	$50,884.14

INPATIENT MS-DRG 516: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC

Facility IP

$33,192.69

Service Code	MS-DRG 516
Min. Negotiated Rate	$23,184.73
Max. Negotiated Rate	$33,192.69
Rate for Payer: EPIC Health Plan Commercial	$27,318.00
Rate for Payer: EPIC Health Plan Medicare	$23,184.73
Rate for Payer: Humana Medicare	$23,184.73
Rate for Payer: IEHP Medicare Advantage	$23,184.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,357.98
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,212.76
Rate for Payer: Molina Healthcare of CA Medicare	$29,212.76
Rate for Payer: Multiplan WC	$33,192.69

INPATIENT MS-DRG 517: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC

Facility IP

$27,318.00

Service Code	MS-DRG 517
Min. Negotiated Rate	$17,031.99
Max. Negotiated Rate	$27,318.00
Rate for Payer: EPIC Health Plan Commercial	$27,318.00
Rate for Payer: EPIC Health Plan Medicare	$17,031.99
Rate for Payer: Humana Medicare	$17,031.99
Rate for Payer: IEHP Medicare Advantage	$17,031.99
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,097.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,460.31
Rate for Payer: Molina Healthcare of CA Medicare	$21,460.31
Rate for Payer: Multiplan WC	$24,642.36

INPATIENT MS-DRG 518: BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR

Facility IP

$60,838.03

Service Code	MS-DRG 518
Min. Negotiated Rate	$41,325.29
Max. Negotiated Rate	$60,838.03
Rate for Payer: EPIC Health Plan Medicare	$41,325.29
Rate for Payer: Humana Medicare	$41,325.29
Rate for Payer: IEHP Medicare Advantage	$41,325.29
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$48,763.84
Rate for Payer: Molina Healthcare of CA Medi-Cal	$52,069.87
Rate for Payer: Molina Healthcare of CA Medicare	$52,069.87
Rate for Payer: Multiplan WC	$60,838.03

INPATIENT MS-DRG 519: BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC

Facility IP

$32,629.63

Service Code	MS-DRG 519
Min. Negotiated Rate	$22,371.71
Max. Negotiated Rate	$32,629.63
Rate for Payer: EPIC Health Plan Medicare	$22,371.71
Rate for Payer: Humana Medicare	$22,371.71
Rate for Payer: IEHP Medicare Advantage	$22,371.71
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,398.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,188.35
Rate for Payer: Molina Healthcare of CA Medicare	$28,188.35
Rate for Payer: Multiplan WC	$32,629.63

INPATIENT MS-DRG 520: BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC

Facility IP

$24,151.12

Service Code	MS-DRG 520
Min. Negotiated Rate	$16,323.72
Max. Negotiated Rate	$24,151.12
Rate for Payer: EPIC Health Plan Medicare	$16,323.72
Rate for Payer: Humana Medicare	$16,323.72
Rate for Payer: IEHP Medicare Advantage	$16,323.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,261.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,567.89
Rate for Payer: Molina Healthcare of CA Medicare	$20,567.89
Rate for Payer: Multiplan WC	$24,151.12

INPATIENT MS-DRG 521: HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC

Facility IP

$49,274.94

Service Code	MS-DRG 521
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$49,274.94
Rate for Payer: EPIC Health Plan Medicare	$33,920.42
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	$33,920.42
Rate for Payer: IEHP Medicare Advantage	$33,920.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,026.10
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,739.73
Rate for Payer: Molina Healthcare of CA Medicare	$42,739.73
Rate for Payer: Multiplan WC	$49,274.94

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