Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

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

Facility

$33,767.36

Service Code	MSDRG 283
Min. Negotiated Rate	$22,102.88
Max. Negotiated Rate	$33,767.36
Rate for Payer: EPIC Health Plan Medicare	$22,102.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,102.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,418.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,849.63
Rate for Payer: Molina Healthcare of CA Medicare	$27,849.63
Rate for Payer: Multiplan WC	$33,767.36

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

Facility

$9,694.69

Service Code	MSDRG 285
Min. Negotiated Rate	$6,573.36
Max. Negotiated Rate	$9,694.69
Rate for Payer: EPIC Health Plan Medicare	$6,573.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$6,573.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$7,559.36
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,282.43
Rate for Payer: Molina Healthcare of CA Medicare	$8,282.43
Rate for Payer: Multiplan WC	$9,694.69

MS-DRG 42.00: ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC

Facility

$39,355.54

Service Code	MSDRG 614
Min. Negotiated Rate	$25,707.87
Max. Negotiated Rate	$39,355.54
Rate for Payer: EPIC Health Plan Medicare	$25,707.87
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,707.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,564.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,391.92
Rate for Payer: Molina Healthcare of CA Medicare	$32,391.92
Rate for Payer: Multiplan WC	$39,355.54

MS-DRG 42.00: ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC

Facility

$24,746.15

Service Code	MSDRG 615
Min. Negotiated Rate	$16,283.21
Max. Negotiated Rate	$24,746.15
Rate for Payer: EPIC Health Plan Medicare	$16,283.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,283.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,725.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,516.84
Rate for Payer: Molina Healthcare of CA Medicare	$20,516.84
Rate for Payer: Multiplan WC	$24,746.15

MS-DRG 42.00: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC

Facility

$19,663.95

Service Code	MSDRG 560
Min. Negotiated Rate	$13,004.63
Max. Negotiated Rate	$19,663.95
Rate for Payer: EPIC Health Plan Medicare	$13,004.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,004.63
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,955.32
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,385.83
Rate for Payer: Molina Healthcare of CA Medicare	$16,385.83
Rate for Payer: Multiplan WC	$19,663.95

MS-DRG 42.00: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$32,056.03

Service Code	MSDRG 559
Min. Negotiated Rate	$20,998.87
Max. Negotiated Rate	$32,056.03
Rate for Payer: EPIC Health Plan Medicare	$20,998.87
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,998.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,148.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,458.58
Rate for Payer: Molina Healthcare of CA Medicare	$26,458.58
Rate for Payer: Multiplan WC	$32,056.03

MS-DRG 42.00: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC

Facility

$14,118.95

Service Code	MSDRG 561
Min. Negotiated Rate	$9,427.48
Max. Negotiated Rate	$14,118.95
Rate for Payer: EPIC Health Plan Medicare	$9,427.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,427.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,841.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,878.62
Rate for Payer: Molina Healthcare of CA Medicare	$11,878.62
Rate for Payer: Multiplan WC	$14,118.95

MS-DRG 42.00: AFTERCARE WITH CC/MCC

Facility

$18,633.00

Service Code	MSDRG 949
Min. Negotiated Rate	$12,339.57
Max. Negotiated Rate	$18,633.00
Rate for Payer: EPIC Health Plan Medicare	$12,339.57
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,339.57
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,190.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,547.86
Rate for Payer: Molina Healthcare of CA Medicare	$15,547.86
Rate for Payer: Multiplan WC	$18,633.00

MS-DRG 42.00: AFTERCARE WITHOUT CC/MCC

Facility

$10,121.22

Service Code	MSDRG 950
Min. Negotiated Rate	$6,848.51
Max. Negotiated Rate	$10,121.22
Rate for Payer: EPIC Health Plan Medicare	$6,848.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$6,848.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$7,875.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,629.12
Rate for Payer: Molina Healthcare of CA Medicare	$8,629.12
Rate for Payer: Multiplan WC	$10,121.22

MS-DRG 42.00: AICD GENERATOR PROCEDURES

Facility

$84,389.03

Service Code	MSDRG 245
Min. Negotiated Rate	$10,312.00
Max. Negotiated Rate	$84,389.03
Rate for Payer: EPIC Health Plan Medicare	$54,759.44
Rate for Payer: Heritage Provider Network Commercial	$11,338.00
Rate for Payer: Heritage Provider Network Senior	$10,312.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$54,759.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$62,973.36
Rate for Payer: Molina Healthcare of CA Medi-Cal	$68,996.89
Rate for Payer: Molina Healthcare of CA Medicare	$68,996.89
Rate for Payer: Multiplan WC	$84,389.03

MS-DRG 42.00: AICD LEAD PROCEDURES

Facility

$61,601.16

Service Code	MSDRG 265
Min. Negotiated Rate	$10,312.00
Max. Negotiated Rate	$61,601.16
Rate for Payer: EPIC Health Plan Medicare	$40,058.77
Rate for Payer: Heritage Provider Network Commercial	$11,338.00
Rate for Payer: Heritage Provider Network Senior	$10,312.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$40,058.77
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$46,067.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$50,474.05
Rate for Payer: Molina Healthcare of CA Medicare	$50,474.05
Rate for Payer: Multiplan WC	$61,601.16

MS-DRG 42.00: ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA

Facility

$10,777.44

Service Code	MSDRG 894
Min. Negotiated Rate	$7,271.86
Max. Negotiated Rate	$10,777.44
Rate for Payer: EPIC Health Plan Medicare	$7,271.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,271.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,362.64
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,162.54
Rate for Payer: Molina Healthcare of CA Medicare	$9,162.54
Rate for Payer: Multiplan WC	$10,777.44

MS-DRG 42.00: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC

Facility

$30,752.23

Service Code	MSDRG 896
Min. Negotiated Rate	$20,157.79
Max. Negotiated Rate	$30,752.23
Rate for Payer: EPIC Health Plan Medicare	$20,157.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,157.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,181.46
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,398.82
Rate for Payer: Molina Healthcare of CA Medicare	$25,398.82
Rate for Payer: Multiplan WC	$30,752.23

MS-DRG 42.00: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC

Facility

$15,234.51

Service Code	MSDRG 897
Min. Negotiated Rate	$10,147.15
Max. Negotiated Rate	$15,234.51
Rate for Payer: EPIC Health Plan Medicare	$10,147.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,147.15
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,669.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,785.41
Rate for Payer: Molina Healthcare of CA Medicare	$12,785.41
Rate for Payer: Multiplan WC	$15,234.51

MS-DRG 42.00: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY

Facility

$25,003.46

Service Code	MSDRG 895
Min. Negotiated Rate	$16,449.19
Max. Negotiated Rate	$25,003.46
Rate for Payer: EPIC Health Plan Medicare	$16,449.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,449.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,916.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,725.98
Rate for Payer: Molina Healthcare of CA Medicare	$20,725.98
Rate for Payer: Multiplan WC	$25,003.46

MS-DRG 42.00: ALLERGIC REACTIONS WITH MCC

Facility

$30,011.40

Service Code	MSDRG 915
Min. Negotiated Rate	$19,679.87
Max. Negotiated Rate	$30,011.40
Rate for Payer: EPIC Health Plan Medicare	$19,679.87
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,679.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,631.85
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,796.64
Rate for Payer: Molina Healthcare of CA Medicare	$24,796.64
Rate for Payer: Multiplan WC	$30,011.40

MS-DRG 42.00: ALLERGIC REACTIONS WITHOUT MCC

Facility

$11,468.20

Service Code	MSDRG 916
Min. Negotiated Rate	$7,717.47
Max. Negotiated Rate	$11,468.20
Rate for Payer: EPIC Health Plan Medicare	$7,717.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,717.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,875.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,724.01
Rate for Payer: Molina Healthcare of CA Medicare	$9,724.01
Rate for Payer: Multiplan WC	$11,468.20

MS-DRG 42.00: ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$226,252.00

Service Code	MSDRG 014
Min. Negotiated Rate	$146,276.66
Max. Negotiated Rate	$226,252.00
Rate for Payer: EPIC Health Plan Medicare	$146,276.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$146,276.66
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$168,218.16
Rate for Payer: Molina Healthcare of CA Medi-Cal	$184,308.59
Rate for Payer: Molina Healthcare of CA Medicare	$184,308.59
Rate for Payer: Multiplan WC	$226,252.00

MS-DRG 42.00: AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC

Facility

$50,290.12

Service Code	MSDRG 240
Min. Negotiated Rate	$32,761.88
Max. Negotiated Rate	$50,290.12
Rate for Payer: EPIC Health Plan Medicare	$32,761.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,761.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,676.16
Rate for Payer: Molina Healthcare of CA Medi-Cal	$41,279.97
Rate for Payer: Molina Healthcare of CA Medicare	$41,279.97
Rate for Payer: Multiplan WC	$50,290.12

MS-DRG 42.00: AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC

Facility

$86,981.08

Service Code	MSDRG 239
Min. Negotiated Rate	$56,431.59
Max. Negotiated Rate	$86,981.08
Rate for Payer: EPIC Health Plan Medicare	$56,431.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$56,431.59
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$64,896.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$71,103.80
Rate for Payer: Molina Healthcare of CA Medicare	$71,103.80
Rate for Payer: Multiplan WC	$86,981.08

MS-DRG 42.00: AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC

Facility

$26,074.12

Service Code	MSDRG 241
Min. Negotiated Rate	$17,139.90
Max. Negotiated Rate	$26,074.12
Rate for Payer: EPIC Health Plan Medicare	$17,139.90
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,139.90
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,710.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,596.27
Rate for Payer: Molina Healthcare of CA Medicare	$21,596.27
Rate for Payer: Multiplan WC	$26,074.12

MS-DRG 42.00: AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$37,253.93

Service Code	MSDRG 475
Min. Negotiated Rate	$24,352.10
Max. Negotiated Rate	$37,253.93
Rate for Payer: EPIC Health Plan Medicare	$24,352.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,352.10
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,004.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,683.65
Rate for Payer: Molina Healthcare of CA Medicare	$30,683.65
Rate for Payer: Multiplan WC	$37,253.93

MS-DRG 42.00: AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$77,445.26

Service Code	MSDRG 474
Min. Negotiated Rate	$50,279.95
Max. Negotiated Rate	$77,445.26
Rate for Payer: EPIC Health Plan Medicare	$50,279.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$50,279.95
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$57,821.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$63,352.74
Rate for Payer: Molina Healthcare of CA Medicare	$63,352.74
Rate for Payer: Multiplan WC	$77,445.26

MS-DRG 42.00: AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$20,085.31

Service Code	MSDRG 476
Min. Negotiated Rate	$13,276.46
Max. Negotiated Rate	$20,085.31
Rate for Payer: EPIC Health Plan Medicare	$13,276.46
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,276.46
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,267.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,728.34
Rate for Payer: Molina Healthcare of CA Medicare	$16,728.34
Rate for Payer: Multiplan WC	$20,085.31

MS-DRG 42.00: AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC

Facility

$33,356.36

Service Code	MSDRG 617
Min. Negotiated Rate	$21,837.76
Max. Negotiated Rate	$33,356.36
Rate for Payer: EPIC Health Plan Medicare	$21,837.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,837.76
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,113.42
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,515.58
Rate for Payer: Molina Healthcare of CA Medicare	$27,515.58
Rate for Payer: Multiplan WC	$33,356.36

Know your out-of-pocket cost for care.

All Charges