Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

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	$21,837.80
Max. Negotiated Rate	$33,356.36
Rate for Payer: EPIC Health Plan Medicare	$21,837.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,837.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,113.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,515.63
Rate for Payer: Molina Healthcare of CA Medicare	$27,515.63
Rate for Payer: Multiplan WC	$33,356.36

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

Facility

$66,743.80

Service Code	MSDRG 616
Min. Negotiated Rate	$43,376.35
Max. Negotiated Rate	$66,743.80
Rate for Payer: EPIC Health Plan Medicare	$43,376.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$43,376.35
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$49,882.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$54,654.20
Rate for Payer: Molina Healthcare of CA Medicare	$54,654.20
Rate for Payer: Multiplan WC	$66,743.80

MS-DRG 42.00: AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC

Facility

$21,501.35

Service Code	MSDRG 618
Min. Negotiated Rate	$14,190.02
Max. Negotiated Rate	$21,501.35
Rate for Payer: EPIC Health Plan Medicare	$14,190.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,190.02
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,318.52
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,879.43
Rate for Payer: Molina Healthcare of CA Medicare	$17,879.43
Rate for Payer: Multiplan WC	$21,501.35

MS-DRG 42.00: ANAL AND STOMAL PROCEDURES WITH CC

Facility

$21,739.65

Service Code	MSDRG 348
Min. Negotiated Rate	$14,343.74
Max. Negotiated Rate	$21,739.65
Rate for Payer: EPIC Health Plan Medicare	$14,343.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,343.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,495.30
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,073.11
Rate for Payer: Molina Healthcare of CA Medicare	$18,073.11
Rate for Payer: Multiplan WC	$21,739.65

MS-DRG 42.00: ANAL AND STOMAL PROCEDURES WITH MCC

Facility

$40,871.73

Service Code	MSDRG 347
Min. Negotiated Rate	$26,686.02
Max. Negotiated Rate	$40,871.73
Rate for Payer: EPIC Health Plan Medicare	$26,686.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,686.02
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,688.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$33,624.39
Rate for Payer: Molina Healthcare of CA Medicare	$33,624.39
Rate for Payer: Multiplan WC	$40,871.73

MS-DRG 42.00: ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC

Facility

$15,212.06

Service Code	MSDRG 349
Min. Negotiated Rate	$10,132.72
Max. Negotiated Rate	$15,212.06
Rate for Payer: EPIC Health Plan Medicare	$10,132.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,132.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,652.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,767.23
Rate for Payer: Molina Healthcare of CA Medicare	$12,767.23
Rate for Payer: Multiplan WC	$15,212.06

MS-DRG 42.00: ANGINA PECTORIS

Facility

$12,058.78

Service Code	MSDRG 311
Min. Negotiated Rate	$8,098.51
Max. Negotiated Rate	$12,058.78
Rate for Payer: EPIC Health Plan Medicare	$8,098.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,098.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,313.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,204.12
Rate for Payer: Molina Healthcare of CA Medicare	$10,204.12
Rate for Payer: Multiplan WC	$12,058.78

MS-DRG 42.00: AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC

Facility

$115,141.27

Service Code	MSDRG 268
Min. Negotiated Rate	$74,598.05
Max. Negotiated Rate	$115,141.27
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: EPIC Health Plan Medicare	$74,598.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$74,598.05
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$85,787.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$93,993.54
Rate for Payer: Molina Healthcare of CA Medicare	$93,993.54
Rate for Payer: Multiplan WC	$115,141.27

MS-DRG 42.00: AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC

Facility

$86,939.00

Service Code	MSDRG 269
Min. Negotiated Rate	$46,670.54
Max. Negotiated Rate	$86,939.00
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: EPIC Health Plan Medicare	$46,670.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$46,670.54
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$53,671.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$58,804.88
Rate for Payer: Molina Healthcare of CA Medicare	$58,804.88
Rate for Payer: Multiplan WC	$71,850.18

MS-DRG 42.00: APPENDIX PROCEDURES WITH CC

Facility

$26,131.10

Service Code	MSDRG 398
Min. Negotiated Rate	$17,176.69
Max. Negotiated Rate	$26,131.10
Rate for Payer: EPIC Health Plan Medicare	$17,176.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,176.69
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,753.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,642.63
Rate for Payer: Molina Healthcare of CA Medicare	$21,642.63
Rate for Payer: Multiplan WC	$26,131.10

MS-DRG 42.00: APPENDIX PROCEDURES WITH MCC

Facility

$42,788.56

Service Code	MSDRG 397
Min. Negotiated Rate	$27,922.57
Max. Negotiated Rate	$42,788.56
Rate for Payer: EPIC Health Plan Medicare	$27,922.57
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,922.57
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,110.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,182.44
Rate for Payer: Molina Healthcare of CA Medicare	$35,182.44
Rate for Payer: Multiplan WC	$42,788.56

MS-DRG 42.00: APPENDIX PROCEDURES WITHOUT CC/MCC

Facility

$19,406.65

Service Code	MSDRG 399
Min. Negotiated Rate	$12,838.70
Max. Negotiated Rate	$19,406.65
Rate for Payer: EPIC Health Plan Medicare	$12,838.70
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,838.70
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,764.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,176.76
Rate for Payer: Molina Healthcare of CA Medicare	$16,176.76
Rate for Payer: Multiplan WC	$19,406.65

MS-DRG 42.00: ARTHROSCOPY

Facility

$30,336.06

Service Code	MSDRG 509
Min. Negotiated Rate	$19,889.36
Max. Negotiated Rate	$30,336.06
Rate for Payer: EPIC Health Plan Medicare	$19,889.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,889.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,872.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,060.59
Rate for Payer: Molina Healthcare of CA Medicare	$25,060.59
Rate for Payer: Multiplan WC	$30,336.06

MS-DRG 42.00: ATHEROSCLEROSIS WITH MCC

Facility

$20,088.77

Service Code	MSDRG 302
Min. Negotiated Rate	$13,278.73
Max. Negotiated Rate	$20,088.77
Rate for Payer: EPIC Health Plan Medicare	$13,278.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,278.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,270.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,731.20
Rate for Payer: Molina Healthcare of CA Medicare	$16,731.20
Rate for Payer: Multiplan WC	$20,088.77

MS-DRG 42.00: ATHEROSCLEROSIS WITHOUT MCC

Facility

$11,611.52

Service Code	MSDRG 303
Min. Negotiated Rate	$7,809.96
Max. Negotiated Rate	$11,611.52
Rate for Payer: EPIC Health Plan Medicare	$7,809.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,809.96
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,981.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,840.55
Rate for Payer: Molina Healthcare of CA Medicare	$9,840.55
Rate for Payer: Multiplan WC	$11,611.52

MS-DRG 42.00: AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC

Facility

$104,232.58

Service Code	MSDRG 016
Min. Negotiated Rate	$67,560.74
Max. Negotiated Rate	$104,232.58
Rate for Payer: EPIC Health Plan Medicare	$67,560.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$67,560.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$77,694.85
Rate for Payer: Molina Healthcare of CA Medi-Cal	$85,126.53
Rate for Payer: Molina Healthcare of CA Medicare	$85,126.53
Rate for Payer: Multiplan WC	$104,232.58

MS-DRG 42.00: AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC

Facility

$104,232.58

Service Code	MSDRG 017
Min. Negotiated Rate	$67,560.74
Max. Negotiated Rate	$104,232.58
Rate for Payer: EPIC Health Plan Medicare	$67,560.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$67,560.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$77,694.85
Rate for Payer: Molina Healthcare of CA Medi-Cal	$85,126.53
Rate for Payer: Molina Healthcare of CA Medicare	$85,126.53
Rate for Payer: Multiplan WC	$104,232.58

MS-DRG 42.00: BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC

Facility

$34,052.30

Service Code	MSDRG 519
Min. Negotiated Rate	$22,286.74
Max. Negotiated Rate	$34,052.30
Rate for Payer: EPIC Health Plan Medicare	$22,286.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,286.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,629.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,081.29
Rate for Payer: Molina Healthcare of CA Medicare	$28,081.29
Rate for Payer: Multiplan WC	$34,052.30

MS-DRG 42.00: BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR

Facility

$61,891.28

Service Code	MSDRG 518
Min. Negotiated Rate	$40,245.95
Max. Negotiated Rate	$61,891.28
Rate for Payer: EPIC Health Plan Medicare	$40,245.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$40,245.95
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$46,282.84
Rate for Payer: Molina Healthcare of CA Medi-Cal	$50,709.90
Rate for Payer: Molina Healthcare of CA Medicare	$50,709.90
Rate for Payer: Multiplan WC	$61,891.28

MS-DRG 42.00: BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC

Facility

$24,749.61

Service Code	MSDRG 520
Min. Negotiated Rate	$16,285.48
Max. Negotiated Rate	$24,749.61
Rate for Payer: EPIC Health Plan Medicare	$16,285.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,285.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,728.30
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,519.70
Rate for Payer: Molina Healthcare of CA Medicare	$20,519.70
Rate for Payer: Multiplan WC	$24,749.61

MS-DRG 42.00: BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC

Facility

$41,396.70

Service Code	MSDRG 095
Min. Negotiated Rate	$27,024.70
Max. Negotiated Rate	$41,396.70
Rate for Payer: EPIC Health Plan Medicare	$27,024.70
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,024.70
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,078.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,051.12
Rate for Payer: Molina Healthcare of CA Medicare	$34,051.12
Rate for Payer: Multiplan WC	$41,396.70

MS-DRG 42.00: BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC

Facility

$63,008.57

Service Code	MSDRG 094
Min. Negotiated Rate	$40,966.72
Max. Negotiated Rate	$63,008.57
Rate for Payer: EPIC Health Plan Medicare	$40,966.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$40,966.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$47,111.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$51,618.07
Rate for Payer: Molina Healthcare of CA Medicare	$51,618.07
Rate for Payer: Multiplan WC	$63,008.57

MS-DRG 42.00: BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility

$41,396.70

Service Code	MSDRG 096
Min. Negotiated Rate	$27,024.70
Max. Negotiated Rate	$41,396.70
Rate for Payer: EPIC Health Plan Medicare	$27,024.70
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,024.70
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,078.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,051.12
Rate for Payer: Molina Healthcare of CA Medicare	$34,051.12
Rate for Payer: Multiplan WC	$41,396.70

MS-DRG 42.00: BEHAVIORAL AND DEVELOPMENTAL DISORDERS

Facility

$31,023.35

Service Code	MSDRG 886
Min. Negotiated Rate	$20,332.72
Max. Negotiated Rate	$31,023.35
Rate for Payer: EPIC Health Plan Medicare	$20,332.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,332.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,382.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,619.23
Rate for Payer: Molina Healthcare of CA Medicare	$25,619.23
Rate for Payer: Multiplan WC	$31,023.35

MS-DRG 42.00: BENIGN PROSTATIC HYPERTROPHY WITH MCC

Facility

$21,803.55

Service Code	MSDRG 725
Min. Negotiated Rate	$14,384.94
Max. Negotiated Rate	$21,803.55
Rate for Payer: EPIC Health Plan Medicare	$14,384.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,384.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,542.68
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,125.02
Rate for Payer: Molina Healthcare of CA Medicare	$18,125.02
Rate for Payer: Multiplan WC	$21,803.55

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