Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC

Facility

$105,973.27

Service Code	MSDRG 461
Min. Negotiated Rate	$9,944.00
Max. Negotiated Rate	$105,973.27
Rate for Payer: EPIC Health Plan Medicare	$68,683.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$68,683.65
Rate for Payer: Kaiser Permanente of CA Commercial	$9,944.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$78,986.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$86,541.40
Rate for Payer: Molina Healthcare of CA Medicare	$86,541.40
Rate for Payer: Multiplan WC	$105,973.27

MS-DRG 42.00: BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC

Facility

$49,454.31

Service Code	MSDRG 462
Min. Negotiated Rate	$9,944.00
Max. Negotiated Rate	$49,454.31
Rate for Payer: EPIC Health Plan Medicare	$32,222.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,222.69
Rate for Payer: Kaiser Permanente of CA Commercial	$9,944.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,056.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$40,600.59
Rate for Payer: Molina Healthcare of CA Medicare	$40,600.59
Rate for Payer: Multiplan WC	$49,454.31

MS-DRG 42.00: BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC

Facility

$36,203.98

Service Code	MSDRG 409
Min. Negotiated Rate	$23,674.77
Max. Negotiated Rate	$36,203.98
Rate for Payer: EPIC Health Plan Medicare	$23,674.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,674.77
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,225.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,830.21
Rate for Payer: Molina Healthcare of CA Medicare	$29,830.21
Rate for Payer: Multiplan WC	$36,203.98

MS-DRG 42.00: BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC

Facility

$60,463.15

Service Code	MSDRG 408
Min. Negotiated Rate	$39,324.61
Max. Negotiated Rate	$60,463.15
Rate for Payer: EPIC Health Plan Medicare	$39,324.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,324.61
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$45,223.30
Rate for Payer: Molina Healthcare of CA Medi-Cal	$49,549.01
Rate for Payer: Molina Healthcare of CA Medicare	$49,549.01
Rate for Payer: Multiplan WC	$60,463.15

MS-DRG 42.00: BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$26,785.60

Service Code	MSDRG 410
Min. Negotiated Rate	$17,598.89
Max. Negotiated Rate	$26,785.60
Rate for Payer: EPIC Health Plan Medicare	$17,598.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,598.89
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,238.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,174.60
Rate for Payer: Molina Healthcare of CA Medicare	$22,174.60
Rate for Payer: Multiplan WC	$26,785.60

MS-DRG 42.00: BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC

Facility

$40,384.75

Service Code	MSDRG 478
Min. Negotiated Rate	$26,371.82
Max. Negotiated Rate	$40,384.75
Rate for Payer: EPIC Health Plan Medicare	$26,371.82
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,371.82
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,327.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$33,228.49
Rate for Payer: Molina Healthcare of CA Medicare	$33,228.49
Rate for Payer: Multiplan WC	$40,384.75

MS-DRG 42.00: BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$59,387.30

Service Code	MSDRG 477
Min. Negotiated Rate	$38,630.59
Max. Negotiated Rate	$59,387.30
Rate for Payer: EPIC Health Plan Medicare	$38,630.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$38,630.59
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$44,425.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$48,674.54
Rate for Payer: Molina Healthcare of CA Medicare	$48,674.54
Rate for Payer: Multiplan WC	$59,387.30

MS-DRG 42.00: BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC

Facility

$30,665.89

Service Code	MSDRG 479
Min. Negotiated Rate	$20,102.08
Max. Negotiated Rate	$30,665.89
Rate for Payer: EPIC Health Plan Medicare	$20,102.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,102.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,117.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,328.62
Rate for Payer: Molina Healthcare of CA Medicare	$25,328.62
Rate for Payer: Multiplan WC	$30,665.89

MS-DRG 42.00: BONE DISEASES AND ARTHROPATHIES WITH MCC

Facility

$22,553.01

Service Code	MSDRG 553
Min. Negotiated Rate	$14,868.40
Max. Negotiated Rate	$22,553.01
Rate for Payer: EPIC Health Plan Medicare	$14,868.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,868.40
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,098.66
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,734.18
Rate for Payer: Molina Healthcare of CA Medicare	$18,734.18
Rate for Payer: Multiplan WC	$22,553.01

MS-DRG 42.00: BONE DISEASES AND ARTHROPATHIES WITHOUT MCC

Facility

$14,412.52

Service Code	MSDRG 554
Min. Negotiated Rate	$9,616.88
Max. Negotiated Rate	$14,412.52
Rate for Payer: EPIC Health Plan Medicare	$9,616.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,616.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,059.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,117.27
Rate for Payer: Molina Healthcare of CA Medicare	$12,117.27
Rate for Payer: Multiplan WC	$14,412.52

MS-DRG 42.00: BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC

Facility

$35,356.09

Service Code	MSDRG 584
Min. Negotiated Rate	$23,127.79
Max. Negotiated Rate	$35,356.09
Rate for Payer: EPIC Health Plan Medicare	$23,127.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,127.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,596.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,141.02
Rate for Payer: Molina Healthcare of CA Medicare	$29,141.02
Rate for Payer: Multiplan WC	$35,356.09

MS-DRG 42.00: BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC

Facility

$34,280.24

Service Code	MSDRG 585
Min. Negotiated Rate	$22,433.75
Max. Negotiated Rate	$34,280.24
Rate for Payer: EPIC Health Plan Medicare	$22,433.75
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,433.75
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,798.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,266.53
Rate for Payer: Molina Healthcare of CA Medicare	$28,266.53
Rate for Payer: Multiplan WC	$34,280.24

MS-DRG 42.00: BRONCHITIS AND ASTHMA WITH CC/MCC

Facility

$16,693.72

Service Code	MSDRG 202
Min. Negotiated Rate	$11,088.50
Max. Negotiated Rate	$16,693.72
Rate for Payer: EPIC Health Plan Medicare	$11,088.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,088.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,751.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,971.51
Rate for Payer: Molina Healthcare of CA Medicare	$13,971.51
Rate for Payer: Multiplan WC	$16,693.72

MS-DRG 42.00: BRONCHITIS AND ASTHMA WITHOUT CC/MCC

Facility

$12,029.43

Service Code	MSDRG 203
Min. Negotiated Rate	$8,079.52
Max. Negotiated Rate	$12,029.43
Rate for Payer: EPIC Health Plan Medicare	$8,079.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,079.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,291.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,180.20
Rate for Payer: Molina Healthcare of CA Medicare	$10,180.20
Rate for Payer: Multiplan WC	$12,029.43

MS-DRG 42.00: CARDIAC ARREST, UNEXPLAINED WITH CC

Facility

$12,164.12

Service Code	MSDRG 297
Min. Negotiated Rate	$8,166.42
Max. Negotiated Rate	$12,164.12
Rate for Payer: EPIC Health Plan Medicare	$8,166.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,166.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,391.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,289.69
Rate for Payer: Molina Healthcare of CA Medicare	$10,289.69
Rate for Payer: Multiplan WC	$12,164.12

MS-DRG 42.00: CARDIAC ARREST, UNEXPLAINED WITH MCC

Facility

$28,293.16

Service Code	MSDRG 296
Min. Negotiated Rate	$18,571.42
Max. Negotiated Rate	$28,293.16
Rate for Payer: EPIC Health Plan Medicare	$18,571.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,571.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,357.13
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,399.99
Rate for Payer: Molina Healthcare of CA Medicare	$23,399.99
Rate for Payer: Multiplan WC	$28,293.16

MS-DRG 42.00: CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC

Facility

$7,627.61

Service Code	MSDRG 298
Min. Negotiated Rate	$5,239.86
Max. Negotiated Rate	$7,627.61
Rate for Payer: EPIC Health Plan Medicare	$5,239.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$5,239.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$6,025.84
Rate for Payer: Molina Healthcare of CA Medi-Cal	$6,602.22
Rate for Payer: Molina Healthcare of CA Medicare	$6,602.22
Rate for Payer: Multiplan WC	$7,627.61

MS-DRG 42.00: CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC

Facility

$12,766.80

Service Code	MSDRG 309
Min. Negotiated Rate	$8,555.22
Max. Negotiated Rate	$12,766.80
Rate for Payer: EPIC Health Plan Medicare	$8,555.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,555.22
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,838.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,779.58
Rate for Payer: Molina Healthcare of CA Medicare	$10,779.58
Rate for Payer: Multiplan WC	$12,766.80

MS-DRG 42.00: CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC

Facility

$20,824.41

Service Code	MSDRG 308
Min. Negotiated Rate	$13,753.25
Max. Negotiated Rate	$20,824.41
Rate for Payer: EPIC Health Plan Medicare	$13,753.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,753.25
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,816.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,329.10
Rate for Payer: Molina Healthcare of CA Medicare	$17,329.10
Rate for Payer: Multiplan WC	$20,824.41

MS-DRG 42.00: CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC

Facility

$9,661.88

Service Code	MSDRG 310
Min. Negotiated Rate	$6,552.19
Max. Negotiated Rate	$9,661.88
Rate for Payer: EPIC Health Plan Medicare	$6,552.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$6,552.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$7,535.02
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,255.76
Rate for Payer: Molina Healthcare of CA Medicare	$8,255.76
Rate for Payer: Multiplan WC	$9,661.88

MS-DRG 42.00: CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC

Facility

$25,858.26

Service Code	MSDRG 306
Min. Negotiated Rate	$17,000.64
Max. Negotiated Rate	$25,858.26
Rate for Payer: EPIC Health Plan Medicare	$17,000.64
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,000.64
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,550.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,420.81
Rate for Payer: Molina Healthcare of CA Medicare	$21,420.81
Rate for Payer: Multiplan WC	$25,858.26

MS-DRG 42.00: CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC

Facility

$15,997.79

Service Code	MSDRG 307
Min. Negotiated Rate	$10,639.56
Max. Negotiated Rate	$15,997.79
Rate for Payer: EPIC Health Plan Medicare	$10,639.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,639.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,235.49
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,405.85
Rate for Payer: Molina Healthcare of CA Medicare	$13,405.85
Rate for Payer: Multiplan WC	$15,997.79

MS-DRG 42.00: CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC

Facility

$122,038.41

Service Code	MSDRG 275
Min. Negotiated Rate	$79,047.43
Max. Negotiated Rate	$122,038.41
Rate for Payer: EPIC Health Plan Medicare	$79,047.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$79,047.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$90,904.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$99,599.76
Rate for Payer: Molina Healthcare of CA Medicare	$99,599.76
Rate for Payer: Multiplan WC	$122,038.41

MS-DRG 42.00: CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR

Facility

$106,969.69

Service Code	MSDRG 276
Min. Negotiated Rate	$69,326.43
Max. Negotiated Rate	$106,969.69
Rate for Payer: EPIC Health Plan Medicare	$69,326.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$69,326.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$79,725.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$87,351.30
Rate for Payer: Molina Healthcare of CA Medicare	$87,351.30
Rate for Payer: Multiplan WC	$106,969.69

MS-DRG 42.00: CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC

Facility

$80,332.60

Service Code	MSDRG 277
Min. Negotiated Rate	$52,142.58
Max. Negotiated Rate	$80,332.60
Rate for Payer: EPIC Health Plan Medicare	$52,142.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$52,142.58
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$59,963.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$65,699.65
Rate for Payer: Molina Healthcare of CA Medicare	$65,699.65
Rate for Payer: Multiplan WC	$80,332.60

Know your out-of-pocket cost for care.

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