Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC

Facility

$30,320.76

Service Code	MSDRG 470
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$30,320.76
Rate for Payer: EPIC Health Plan Medicare	$22,627.43
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,627.43
Rate for Payer: Kaiser Foundation Hospitals Commercial	$9,944.00
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$26,021.54
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$30,320.76

MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES

Facility

$43,265.41

Service Code	MSDRG 483
Min. Negotiated Rate	$32,287.62
Max. Negotiated Rate	$43,265.41
Rate for Payer: EPIC Health Plan Medicare	$32,287.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,287.62
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$37,130.76
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$43,265.41

MAJOR MALE PELVIC PROCEDURES WITH CC/MCC

Facility

$31,417.13

Service Code	MSDRG 707
Min. Negotiated Rate	$16,674.00
Max. Negotiated Rate	$31,417.13
Rate for Payer: EPIC Health Plan Medicare	$23,445.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,445.62
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$26,962.46
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$31,417.13
Rate for Payer: United Healthcare All Other HMO/non HMO	$19,873.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$16,674.00

MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC

Facility

$24,259.95

Service Code	MSDRG 708
Min. Negotiated Rate	$16,674.00
Max. Negotiated Rate	$24,259.95
Rate for Payer: EPIC Health Plan Medicare	$18,104.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,104.44
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$20,820.11
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$24,259.95
Rate for Payer: United Healthcare All Other HMO/non HMO	$19,873.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$16,674.00

MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC

Facility

$28,439.70

Service Code	MSDRG 507
Min. Negotiated Rate	$21,223.66
Max. Negotiated Rate	$28,439.70
Rate for Payer: EPIC Health Plan Medicare	$21,223.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,223.66
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$24,407.21
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$28,439.70

MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC

Facility

$23,955.92

Service Code	MSDRG 508
Min. Negotiated Rate	$17,877.55
Max. Negotiated Rate	$23,955.92
Rate for Payer: EPIC Health Plan Medicare	$17,877.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,877.55
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$20,559.18
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$23,955.92

MAJOR SKIN DISORDERS WITH MCC

Facility

$33,265.93

Service Code	MSDRG 595
Min. Negotiated Rate	$24,825.32
Max. Negotiated Rate	$33,265.93
Rate for Payer: EPIC Health Plan Medicare	$24,825.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,825.32
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$28,549.12
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$33,265.93

MAJOR SKIN DISORDERS WITHOUT MCC

Facility

$17,323.90

Service Code	MSDRG 596
Min. Negotiated Rate	$12,928.28
Max. Negotiated Rate	$17,323.90
Rate for Payer: EPIC Health Plan Medicare	$12,928.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,928.28
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$14,867.52
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$17,323.90

MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC

Facility

$37,511.72

Service Code	MSDRG 330
Min. Negotiated Rate	$27,993.82
Max. Negotiated Rate	$37,511.72
Rate for Payer: EPIC Health Plan Medicare	$27,993.82
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,993.82
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$32,192.89
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$37,511.72

MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC

Facility

$71,282.98

Service Code	MSDRG 329
Min. Negotiated Rate	$53,196.25
Max. Negotiated Rate	$71,282.98
Rate for Payer: EPIC Health Plan Medicare	$53,196.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$53,196.25
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$61,175.69
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$71,282.98

MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC

Facility

$26,543.30

Service Code	MSDRG 331
Min. Negotiated Rate	$19,808.43
Max. Negotiated Rate	$26,543.30
Rate for Payer: EPIC Health Plan Medicare	$19,808.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,808.43
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$22,779.69
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$26,543.30

MAJOR THUMB OR JOINT PROCEDURES

Facility

$21,419.19

Service Code	MSDRG 506
Min. Negotiated Rate	$15,984.47
Max. Negotiated Rate	$21,419.19
Rate for Payer: EPIC Health Plan Medicare	$15,984.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,984.47
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$18,382.14
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$21,419.19

MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC

Facility

$17,405.27

Service Code	MSDRG 755
Min. Negotiated Rate	$12,989.01
Max. Negotiated Rate	$17,405.27
Rate for Payer: EPIC Health Plan Medicare	$12,989.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,989.01
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$14,937.36
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$17,405.27

MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$28,981.79

Service Code	MSDRG 754
Min. Negotiated Rate	$21,628.20
Max. Negotiated Rate	$28,981.79
Rate for Payer: EPIC Health Plan Medicare	$21,628.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,628.20
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$24,872.43
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$28,981.79

MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility

$15,450.52

Service Code	MSDRG 756
Min. Negotiated Rate	$11,530.24
Max. Negotiated Rate	$15,450.52
Rate for Payer: EPIC Health Plan Medicare	$11,530.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,530.24
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$13,259.78
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$15,450.52

MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC

Facility

$18,248.28

Service Code	MSDRG 723
Min. Negotiated Rate	$13,618.12
Max. Negotiated Rate	$18,248.28
Rate for Payer: EPIC Health Plan Medicare	$13,618.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,618.12
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$15,660.84
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$18,248.28

MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$28,490.38

Service Code	MSDRG 722
Min. Negotiated Rate	$21,261.48
Max. Negotiated Rate	$28,490.38
Rate for Payer: EPIC Health Plan Medicare	$21,261.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,261.48
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$24,450.70
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$28,490.38

MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility

$10,770.17

Service Code	MSDRG 724
Min. Negotiated Rate	$8,037.44
Max. Negotiated Rate	$10,770.17
Rate for Payer: EPIC Health Plan Medicare	$8,037.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,037.44
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$9,243.06
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$10,770.17

MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC

Facility

$18,070.17

Service Code	MSDRG 436
Min. Negotiated Rate	$13,485.20
Max. Negotiated Rate	$18,070.17
Rate for Payer: EPIC Health Plan Medicare	$13,485.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,485.20
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$15,507.98
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$18,070.17

MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC

Facility

$28,904.99

Service Code	MSDRG 435
Min. Negotiated Rate	$21,570.89
Max. Negotiated Rate	$28,904.99
Rate for Payer: EPIC Health Plan Medicare	$21,570.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,570.89
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$24,806.52
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$28,904.99

MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC

Facility

$13,804.41

Service Code	MSDRG 437
Min. Negotiated Rate	$10,301.80
Max. Negotiated Rate	$13,804.41
Rate for Payer: EPIC Health Plan Medicare	$10,301.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,301.80
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$11,847.07
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$13,804.41

MALIGNANT BREAST DISORDERS WITH CC

Facility

$18,073.25

Service Code	MSDRG 598
Min. Negotiated Rate	$13,487.50
Max. Negotiated Rate	$18,073.25
Rate for Payer: EPIC Health Plan Medicare	$13,487.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,487.50
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$15,510.62
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$18,073.25

MALIGNANT BREAST DISORDERS WITH MCC

Facility

$26,300.68

Service Code	MSDRG 597
Min. Negotiated Rate	$19,627.37
Max. Negotiated Rate	$26,300.68
Rate for Payer: EPIC Health Plan Medicare	$19,627.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,627.37
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$22,571.48
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$26,300.68

MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility

$12,516.10

Service Code	MSDRG 599
Min. Negotiated Rate	$9,340.37
Max. Negotiated Rate	$12,516.10
Rate for Payer: EPIC Health Plan Medicare	$9,340.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,340.37
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$10,741.43
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$12,516.10

MANGO FLAVOR LIQUID [213757]

Facility

$2.86

Service Code	NDC 7857300081
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.15
Rate for Payer: Adventist Health Commercial	$0.57
Rate for Payer: Aetna of CA Non-Gatekeeper	$1.84
Rate for Payer: Cash Price	$1.29
Rate for Payer: EPIC Health Plan Commercial	$1.54
Rate for Payer: Heritage Provider Network Commercial	$1.94
Rate for Payer: Heritage Provider Network Senior	$1.94
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$0.52
Rate for Payer: LLUH Dept of Risk Management WC	$0.72
Rate for Payer: Multiplan Commercial	$2.15

Know your out-of-pocket cost for care.

All Charges