Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 33.00: REVISION OF HIP OR KNEE REPLACEMENT W CC

Facility

$59,149.00

Service Code	MSDRG 467
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$59,149.00
Rate for Payer: EPIC Health Plan Commercial	$24,040.00

MS-DRG 33.00: REVISION OF HIP OR KNEE REPLACEMENT W MCC

Facility

$87,977.49

Service Code	MSDRG 466
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$87,977.49
Rate for Payer: EPIC Health Plan Commercial	$24,040.00

MS-DRG 33.00: REVISION OF HIP OR KNEE REPLACEMENT W/O CC/MCC

Facility

$45,301.17

Service Code	MSDRG 468
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$45,301.17
Rate for Payer: EPIC Health Plan Commercial	$24,040.00

MS-DRG 33.00: SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W CC

Facility

$99,112.39

Service Code	MSDRG 457
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$99,112.39
Rate for Payer: EPIC Health Plan Commercial	$28,410.00

MS-DRG 33.00: SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W MCC

Facility

$146,252.68

Service Code	MSDRG 456
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$146,252.68
Rate for Payer: EPIC Health Plan Commercial	$28,410.00

MS-DRG 33.00: SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W/O CC/MCC

Facility

$74,566.55

Service Code	MSDRG 458
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$74,566.55
Rate for Payer: EPIC Health Plan Commercial	$28,410.00

MS-DRG 33.00: SPINAL FUSION EXCEPT CERVICAL W MCC

Facility

$28,410.00

Service Code	MSDRG 459
Min. Negotiated Rate	$21,600.00
Max. Negotiated Rate	$28,410.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00

MS-DRG 33.00: SPINAL FUSION EXCEPT CERVICAL W/O MCC

Facility

$28,410.00

Service Code	MSDRG 460
Min. Negotiated Rate	$21,600.00
Max. Negotiated Rate	$28,410.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00

MS-DRG 33.00: TRANSIENT ISCHEMIA

Facility

$18,576.00

Service Code	MSDRG 069
Min. Negotiated Rate	$9,232.55
Max. Negotiated Rate	$18,576.00
Rate for Payer: EPIC Health Plan Commercial	$18,576.00

MS-DRG 42.00: ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$18,581.20

Service Code	MSDRG 770
Min. Negotiated Rate	$12,306.13
Max. Negotiated Rate	$18,581.20
Rate for Payer: EPIC Health Plan Medicare	$12,306.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,306.13
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,152.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,505.72
Rate for Payer: Molina Healthcare of CA Medicare	$15,505.72
Rate for Payer: Multiplan WC	$18,581.20

MS-DRG 42.00: ABORTION WITHOUT D&C

Facility

$16,142.84

Service Code	MSDRG 779
Min. Negotiated Rate	$10,733.13
Max. Negotiated Rate	$16,142.84
Rate for Payer: EPIC Health Plan Medicare	$10,733.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,733.13
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,343.10
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,523.74
Rate for Payer: Molina Healthcare of CA Medicare	$13,523.74
Rate for Payer: Multiplan WC	$16,142.84

MS-DRG 42.00: ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION

Facility

$16,553.85

Service Code	MSDRG 880
Min. Negotiated Rate	$10,998.27
Max. Negotiated Rate	$16,553.85
Rate for Payer: EPIC Health Plan Medicare	$10,998.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,998.27
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,648.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,857.82
Rate for Payer: Molina Healthcare of CA Medicare	$13,857.82
Rate for Payer: Multiplan WC	$16,553.85

MS-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS WITH CC

Facility

$27,227.67

Service Code	MSDRG 289
Min. Negotiated Rate	$17,884.06
Max. Negotiated Rate	$27,227.67
Rate for Payer: EPIC Health Plan Medicare	$17,884.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,884.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,566.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,533.92
Rate for Payer: Molina Healthcare of CA Medicare	$22,533.92
Rate for Payer: Multiplan WC	$27,227.67

MS-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC

Facility

$47,169.65

Service Code	MSDRG 288
Min. Negotiated Rate	$30,748.84
Max. Negotiated Rate	$47,169.65
Rate for Payer: EPIC Health Plan Medicare	$30,748.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,748.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,361.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,743.54
Rate for Payer: Molina Healthcare of CA Medicare	$38,743.54
Rate for Payer: Multiplan WC	$47,169.65

MS-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC

Facility

$16,906.13

Service Code	MSDRG 290
Min. Negotiated Rate	$11,225.53
Max. Negotiated Rate	$16,906.13
Rate for Payer: EPIC Health Plan Medicare	$11,225.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,225.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,909.36
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,144.17
Rate for Payer: Molina Healthcare of CA Medicare	$14,144.17
Rate for Payer: Multiplan WC	$16,906.13

MS-DRG 42.00: ACUTE LEUKEMIA WITH CC

Facility

$36,884.37

Service Code	MSDRG 835
Min. Negotiated Rate	$24,113.71
Max. Negotiated Rate	$36,884.37
Rate for Payer: EPIC Health Plan Medicare	$24,113.71
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,113.71
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,730.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,383.27
Rate for Payer: Molina Healthcare of CA Medicare	$30,383.27
Rate for Payer: Multiplan WC	$36,884.37

MS-DRG 42.00: ACUTE LEUKEMIA WITH MCC

Facility

$95,449.69

Service Code	MSDRG 834
Min. Negotiated Rate	$61,894.78
Max. Negotiated Rate	$95,449.69
Rate for Payer: EPIC Health Plan Medicare	$61,894.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$61,894.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$71,179.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$77,987.42
Rate for Payer: Molina Healthcare of CA Medicare	$77,987.42
Rate for Payer: Multiplan WC	$95,449.69

MS-DRG 42.00: ACUTE LEUKEMIA WITH OTHER PROCEDURES

Facility

$159,078.21

Service Code	MSDRG 850
Min. Negotiated Rate	$102,942.17
Max. Negotiated Rate	$159,078.21
Rate for Payer: EPIC Health Plan Medicare	$102,942.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$102,942.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$118,383.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$129,707.13
Rate for Payer: Molina Healthcare of CA Medicare	$129,707.13
Rate for Payer: Multiplan WC	$159,078.21

MS-DRG 42.00: ACUTE LEUKEMIA WITHOUT CC/MCC

Facility

$21,943.42

Service Code	MSDRG 836
Min. Negotiated Rate	$14,475.15
Max. Negotiated Rate	$21,943.42
Rate for Payer: EPIC Health Plan Medicare	$14,475.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,475.15
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,646.42
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,238.69
Rate for Payer: Molina Healthcare of CA Medicare	$18,238.69
Rate for Payer: Multiplan WC	$21,943.42

MS-DRG 42.00: ACUTE MAJOR EYE INFECTIONS WITH CC/MCC

Facility

$20,087.04

Service Code	MSDRG 121
Min. Negotiated Rate	$13,277.56
Max. Negotiated Rate	$20,087.04
Rate for Payer: EPIC Health Plan Medicare	$13,277.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,277.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,269.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,729.73
Rate for Payer: Molina Healthcare of CA Medicare	$16,729.73
Rate for Payer: Multiplan WC	$20,087.04

MS-DRG 42.00: ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC

Facility

$11,713.41

Service Code	MSDRG 122
Min. Negotiated Rate	$7,875.66
Max. Negotiated Rate	$11,713.41
Rate for Payer: EPIC Health Plan Medicare	$7,875.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,875.66
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,057.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,923.33
Rate for Payer: Molina Healthcare of CA Medicare	$9,923.33
Rate for Payer: Multiplan WC	$11,713.41

MS-DRG 42.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC

Facility

$15,918.36

Service Code	MSDRG 281
Min. Negotiated Rate	$10,588.32
Max. Negotiated Rate	$15,918.36
Rate for Payer: EPIC Health Plan Medicare	$10,588.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,588.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,176.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,341.28
Rate for Payer: Molina Healthcare of CA Medicare	$13,341.28
Rate for Payer: Multiplan WC	$15,918.36

MS-DRG 42.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC

Facility

$28,344.96

Service Code	MSDRG 280
Min. Negotiated Rate	$18,604.85
Max. Negotiated Rate	$28,344.96
Rate for Payer: EPIC Health Plan Medicare	$18,604.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,604.85
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,395.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,442.11
Rate for Payer: Molina Healthcare of CA Medicare	$23,442.11
Rate for Payer: Multiplan WC	$28,344.96

MS-DRG 42.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC

Facility

$12,521.59

Service Code	MSDRG 282
Min. Negotiated Rate	$8,397.02
Max. Negotiated Rate	$12,521.59
Rate for Payer: EPIC Health Plan Medicare	$8,397.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,397.02
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,656.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,580.25
Rate for Payer: Molina Healthcare of CA Medicare	$10,580.25
Rate for Payer: Multiplan WC	$12,521.59

MS-DRG 42.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC

Facility

$12,796.16

Service Code	MSDRG 284
Min. Negotiated Rate	$8,574.13
Max. Negotiated Rate	$12,796.16
Rate for Payer: EPIC Health Plan Medicare	$8,574.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,574.13
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,860.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,803.40
Rate for Payer: Molina Healthcare of CA Medicare	$10,803.40
Rate for Payer: Multiplan WC	$12,796.16

Know your out-of-pocket cost for care.

All Charges