Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC

Facility

$86,468.19

Service Code	MSDRG 837
Min. Negotiated Rate	$56,100.72
Max. Negotiated Rate	$86,468.19
Rate for Payer: EPIC Health Plan Medicare	$56,100.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$56,100.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$64,515.83
Rate for Payer: Molina Healthcare of CA Medi-Cal	$70,686.91
Rate for Payer: Molina Healthcare of CA Medicare	$70,686.91
Rate for Payer: Multiplan WC	$86,468.19

MS-DRG 42.00: CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT

Facility

$35,024.52

Service Code	MSDRG 838
Min. Negotiated Rate	$22,913.90
Max. Negotiated Rate	$35,024.52
Rate for Payer: EPIC Health Plan Medicare	$22,913.90
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,913.90
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,350.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,871.51
Rate for Payer: Molina Healthcare of CA Medicare	$28,871.51
Rate for Payer: Multiplan WC	$35,024.52

MS-DRG 42.00: CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC

Facility

$23,665.13

Service Code	MSDRG 839
Min. Negotiated Rate	$15,585.84
Max. Negotiated Rate	$23,665.13
Rate for Payer: EPIC Health Plan Medicare	$15,585.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,585.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,923.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,638.16
Rate for Payer: Molina Healthcare of CA Medicare	$19,638.16
Rate for Payer: Multiplan WC	$23,665.13

MS-DRG 42.00: CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC

Facility

$21,943.42

Service Code	MSDRG 847
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: CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC

Facility

$44,100.99

Service Code	MSDRG 846
Min. Negotiated Rate	$28,769.22
Max. Negotiated Rate	$44,100.99
Rate for Payer: EPIC Health Plan Medicare	$28,769.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,769.22
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,084.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$36,249.22
Rate for Payer: Molina Healthcare of CA Medicare	$36,249.22
Rate for Payer: Multiplan WC	$44,100.99

MS-DRG 42.00: CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC

Facility

$14,141.40

Service Code	MSDRG 848
Min. Negotiated Rate	$9,441.97
Max. Negotiated Rate	$14,141.40
Rate for Payer: EPIC Health Plan Medicare	$9,441.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,441.97
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,858.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,896.88
Rate for Payer: Molina Healthcare of CA Medicare	$11,896.88
Rate for Payer: Multiplan WC	$14,141.40

MS-DRG 42.00: CHEST PAIN

Facility

$12,319.54

Service Code	MSDRG 313
Min. Negotiated Rate	$8,266.68
Max. Negotiated Rate	$12,319.54
Rate for Payer: EPIC Health Plan Medicare	$8,266.68
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,266.68
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,506.68
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,416.02
Rate for Payer: Molina Healthcare of CA Medicare	$10,416.02
Rate for Payer: Multiplan WC	$12,319.54

MS-DRG 42.00: CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES

Facility

$651,253.75

Service Code	MSDRG 018
Min. Negotiated Rate	$420,449.57
Max. Negotiated Rate	$651,253.75
Rate for Payer: EPIC Health Plan Medicare	$420,449.57
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$420,449.57
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$483,517.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$529,766.46
Rate for Payer: Molina Healthcare of CA Medicare	$529,766.46
Rate for Payer: Multiplan WC	$651,253.75

MS-DRG 42.00: CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC

Facility

$34,159.36

Service Code	MSDRG 415
Min. Negotiated Rate	$22,355.76
Max. Negotiated Rate	$34,159.36
Rate for Payer: EPIC Health Plan Medicare	$22,355.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,355.76
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,709.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,168.26
Rate for Payer: Molina Healthcare of CA Medicare	$28,168.26
Rate for Payer: Multiplan WC	$34,159.36

MS-DRG 42.00: CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC

Facility

$60,506.33

Service Code	MSDRG 414
Min. Negotiated Rate	$39,352.46
Max. Negotiated Rate	$60,506.33
Rate for Payer: EPIC Health Plan Medicare	$39,352.46
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,352.46
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$45,255.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$49,584.10
Rate for Payer: Molina Healthcare of CA Medicare	$49,584.10
Rate for Payer: Multiplan WC	$60,506.33

MS-DRG 42.00: CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$23,661.67

Service Code	MSDRG 416
Min. Negotiated Rate	$15,583.60
Max. Negotiated Rate	$23,661.67
Rate for Payer: EPIC Health Plan Medicare	$15,583.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,583.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,921.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,635.34
Rate for Payer: Molina Healthcare of CA Medicare	$19,635.34
Rate for Payer: Multiplan WC	$23,661.67

MS-DRG 42.00: CHOLECYSTECTOMY WITH C.D.E. WITH CC

Facility

$36,810.11

Service Code	MSDRG 412
Min. Negotiated Rate	$24,065.80
Max. Negotiated Rate	$36,810.11
Rate for Payer: EPIC Health Plan Medicare	$24,065.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,065.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,675.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,322.91
Rate for Payer: Molina Healthcare of CA Medicare	$30,322.91
Rate for Payer: Multiplan WC	$36,810.11

MS-DRG 42.00: CHOLECYSTECTOMY WITH C.D.E. WITH MCC

Facility

$47,254.27

Service Code	MSDRG 411
Min. Negotiated Rate	$30,803.41
Max. Negotiated Rate	$47,254.27
Rate for Payer: EPIC Health Plan Medicare	$30,803.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,803.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,423.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,812.30
Rate for Payer: Molina Healthcare of CA Medicare	$38,812.30
Rate for Payer: Multiplan WC	$47,254.27

MS-DRG 42.00: CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC

Facility

$28,709.34

Service Code	MSDRG 413
Min. Negotiated Rate	$18,839.90
Max. Negotiated Rate	$28,709.34
Rate for Payer: EPIC Health Plan Medicare	$18,839.90
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,839.90
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,665.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,738.27
Rate for Payer: Molina Healthcare of CA Medicare	$23,738.27
Rate for Payer: Multiplan WC	$28,709.34

MS-DRG 42.00: CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC

Facility

$14,835.60

Service Code	MSDRG 191
Min. Negotiated Rate	$9,889.81
Max. Negotiated Rate	$14,835.60
Rate for Payer: EPIC Health Plan Medicare	$9,889.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,889.81
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,373.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,461.16
Rate for Payer: Molina Healthcare of CA Medicare	$12,461.16
Rate for Payer: Multiplan WC	$14,835.60

MS-DRG 42.00: CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC

Facility

$19,392.83

Service Code	MSDRG 190
Min. Negotiated Rate	$12,829.73
Max. Negotiated Rate	$19,392.83
Rate for Payer: EPIC Health Plan Medicare	$12,829.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,829.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,754.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,165.46
Rate for Payer: Molina Healthcare of CA Medicare	$16,165.46
Rate for Payer: Multiplan WC	$19,392.83

MS-DRG 42.00: CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC

Facility

$11,176.35

Service Code	MSDRG 192
Min. Negotiated Rate	$7,529.21
Max. Negotiated Rate	$11,176.35
Rate for Payer: EPIC Health Plan Medicare	$7,529.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,529.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,658.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,486.80
Rate for Payer: Molina Healthcare of CA Medicare	$9,486.80
Rate for Payer: Multiplan WC	$11,176.35

MS-DRG 42.00: CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC

Facility

$38,220.97

Service Code	MSDRG 286
Min. Negotiated Rate	$8,633.00
Max. Negotiated Rate	$38,220.97
Rate for Payer: Aetna of CA Gatekeeper	$10,558.00
Rate for Payer: EPIC Health Plan Medicare	$24,975.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,975.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,722.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,469.68
Rate for Payer: Molina Healthcare of CA Medicare	$31,469.68
Rate for Payer: Multiplan WC	$38,220.97

MS-DRG 42.00: CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC

Facility

$18,817.78

Service Code	MSDRG 287
Min. Negotiated Rate	$8,633.00
Max. Negotiated Rate	$18,817.78
Rate for Payer: Aetna of CA Gatekeeper	$10,558.00
Rate for Payer: EPIC Health Plan Medicare	$12,458.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,458.77
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,327.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,698.05
Rate for Payer: Molina Healthcare of CA Medicare	$15,698.05
Rate for Payer: Multiplan WC	$18,817.78

MS-DRG 42.00: CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC

Facility

$18,474.14

Service Code	MSDRG 433
Min. Negotiated Rate	$12,237.06
Max. Negotiated Rate	$18,474.14
Rate for Payer: EPIC Health Plan Medicare	$12,237.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,237.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,072.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,418.70
Rate for Payer: Molina Healthcare of CA Medicare	$15,418.70
Rate for Payer: Multiplan WC	$18,474.14

MS-DRG 42.00: CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC

Facility

$33,831.26

Service Code	MSDRG 432
Min. Negotiated Rate	$22,144.10
Max. Negotiated Rate	$33,831.26
Rate for Payer: EPIC Health Plan Medicare	$22,144.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,144.10
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,465.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,901.57
Rate for Payer: Molina Healthcare of CA Medicare	$27,901.57
Rate for Payer: Multiplan WC	$33,831.26

MS-DRG 42.00: CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC

Facility

$12,027.70

Service Code	MSDRG 434
Min. Negotiated Rate	$8,078.43
Max. Negotiated Rate	$12,027.70
Rate for Payer: EPIC Health Plan Medicare	$8,078.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,078.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,290.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,178.82
Rate for Payer: Molina Healthcare of CA Medicare	$10,178.82
Rate for Payer: Multiplan WC	$12,027.70

MS-DRG 42.00: COAGULATION DISORDERS

Facility

$26,732.06

Service Code	MSDRG 813
Min. Negotiated Rate	$17,564.35
Max. Negotiated Rate	$26,732.06
Rate for Payer: EPIC Health Plan Medicare	$17,564.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,564.35
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,199.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,131.08
Rate for Payer: Molina Healthcare of CA Medicare	$22,131.08
Rate for Payer: Multiplan WC	$26,732.06

MS-DRG 42.00: COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC

Facility

$144,031.92

Service Code	MSDRG 429
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$144,031.92
Rate for Payer: EPIC Health Plan Medicare	$93,235.66
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	$93,235.66
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$107,221.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$117,476.93
Rate for Payer: Molina Healthcare of CA Medicare	$117,476.93
Rate for Payer: Multiplan WC	$144,031.92

MS-DRG 42.00: COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC

Facility

$94,468.82

Service Code	MSDRG 430
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$94,468.82
Rate for Payer: EPIC Health Plan Medicare	$61,262.01
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	$61,262.01
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$70,451.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$77,190.13
Rate for Payer: Molina Healthcare of CA Medicare	$77,190.13
Rate for Payer: Multiplan WC	$94,468.82

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