Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: COMPLICATED PEPTIC ULCER WITH CC

Facility

$18,807.42

Service Code	MSDRG 381
Min. Negotiated Rate	$12,452.07
Max. Negotiated Rate	$18,807.42
Rate for Payer: EPIC Health Plan Medicare	$12,452.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,452.07
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,319.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,689.61
Rate for Payer: Molina Healthcare of CA Medicare	$15,689.61
Rate for Payer: Multiplan WC	$18,807.42

MS-DRG 42.00: COMPLICATED PEPTIC ULCER WITH MCC

Facility

$33,230.30

Service Code	MSDRG 380
Min. Negotiated Rate	$21,756.42
Max. Negotiated Rate	$33,230.30
Rate for Payer: EPIC Health Plan Medicare	$21,756.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,756.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,019.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,413.09
Rate for Payer: Molina Healthcare of CA Medicare	$27,413.09
Rate for Payer: Multiplan WC	$33,230.30

MS-DRG 42.00: COMPLICATED PEPTIC ULCER WITHOUT CC/MCC

Facility

$12,939.49

Service Code	MSDRG 382
Min. Negotiated Rate	$8,666.62
Max. Negotiated Rate	$12,939.49
Rate for Payer: EPIC Health Plan Medicare	$8,666.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,666.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,966.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,919.94
Rate for Payer: Molina Healthcare of CA Medicare	$10,919.94
Rate for Payer: Multiplan WC	$12,939.49

MS-DRG 42.00: COMPLICATIONS OF TREATMENT WITH CC

Facility

$17,543.34

Service Code	MSDRG 920
Min. Negotiated Rate	$11,636.62
Max. Negotiated Rate	$17,543.34
Rate for Payer: EPIC Health Plan Medicare	$11,636.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,636.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,382.11
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,662.14
Rate for Payer: Molina Healthcare of CA Medicare	$14,662.14
Rate for Payer: Multiplan WC	$17,543.34

MS-DRG 42.00: COMPLICATIONS OF TREATMENT WITH MCC

Facility

$31,491.33

Service Code	MSDRG 919
Min. Negotiated Rate	$20,634.58
Max. Negotiated Rate	$31,491.33
Rate for Payer: EPIC Health Plan Medicare	$20,634.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,634.58
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,729.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,999.57
Rate for Payer: Molina Healthcare of CA Medicare	$25,999.57
Rate for Payer: Multiplan WC	$31,491.33

MS-DRG 42.00: COMPLICATIONS OF TREATMENT WITHOUT CC/MCC

Facility

$11,875.74

Service Code	MSDRG 921
Min. Negotiated Rate	$7,980.36
Max. Negotiated Rate	$11,875.74
Rate for Payer: EPIC Health Plan Medicare	$7,980.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,980.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,177.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,055.25
Rate for Payer: Molina Healthcare of CA Medicare	$10,055.25
Rate for Payer: Multiplan WC	$11,875.74

MS-DRG 42.00: CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES

Facility

$188,124.28

Service Code	MSDRG 212
Min. Negotiated Rate	$121,680.09
Max. Negotiated Rate	$188,124.28
Rate for Payer: EPIC Health Plan Medicare	$121,680.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$121,680.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$139,932.10
Rate for Payer: Molina Healthcare of CA Medi-Cal	$153,316.91
Rate for Payer: Molina Healthcare of CA Medicare	$153,316.91
Rate for Payer: Multiplan WC	$188,124.28

MS-DRG 42.00: CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION

Facility

$106,831.53

Service Code	MSDRG 317
Min. Negotiated Rate	$69,237.32
Max. Negotiated Rate	$106,831.53
Rate for Payer: EPIC Health Plan Medicare	$69,237.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$69,237.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$79,622.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$87,239.02
Rate for Payer: Molina Healthcare of CA Medicare	$87,239.02
Rate for Payer: Multiplan WC	$106,831.53

MS-DRG 42.00: CONCUSSION WITH CC

Facility

$18,513.85

Service Code	MSDRG 089
Min. Negotiated Rate	$12,262.69
Max. Negotiated Rate	$18,513.85
Rate for Payer: EPIC Health Plan Medicare	$12,262.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,262.69
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,102.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,450.99
Rate for Payer: Molina Healthcare of CA Medicare	$15,450.99
Rate for Payer: Multiplan WC	$18,513.85

MS-DRG 42.00: CONCUSSION WITH MCC

Facility

$24,361.06

Service Code	MSDRG 088
Min. Negotiated Rate	$16,034.78
Max. Negotiated Rate	$24,361.06
Rate for Payer: EPIC Health Plan Medicare	$16,034.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,034.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,440.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,203.82
Rate for Payer: Molina Healthcare of CA Medicare	$20,203.82
Rate for Payer: Multiplan WC	$24,361.06

MS-DRG 42.00: CONCUSSION WITHOUT CC/MCC

Facility

$14,804.52

Service Code	MSDRG 090
Min. Negotiated Rate	$9,869.76
Max. Negotiated Rate	$14,804.52
Rate for Payer: EPIC Health Plan Medicare	$9,869.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,869.76
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,350.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,435.90
Rate for Payer: Molina Healthcare of CA Medicare	$12,435.90
Rate for Payer: Multiplan WC	$14,804.52

MS-DRG 42.00: CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$19,992.06

Service Code	MSDRG 546
Min. Negotiated Rate	$13,216.31
Max. Negotiated Rate	$19,992.06
Rate for Payer: EPIC Health Plan Medicare	$13,216.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,216.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,198.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,652.55
Rate for Payer: Molina Healthcare of CA Medicare	$16,652.55
Rate for Payer: Multiplan WC	$19,992.06

MS-DRG 42.00: CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$43,636.46

Service Code	MSDRG 545
Min. Negotiated Rate	$28,469.54
Max. Negotiated Rate	$43,636.46
Rate for Payer: EPIC Health Plan Medicare	$28,469.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,469.54
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,739.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,871.62
Rate for Payer: Molina Healthcare of CA Medicare	$35,871.62
Rate for Payer: Multiplan WC	$43,636.46

MS-DRG 42.00: CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$12,885.96

Service Code	MSDRG 547
Min. Negotiated Rate	$8,632.07
Max. Negotiated Rate	$12,885.96
Rate for Payer: EPIC Health Plan Medicare	$8,632.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,632.07
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,926.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,876.41
Rate for Payer: Molina Healthcare of CA Medicare	$10,876.41
Rate for Payer: Multiplan WC	$12,885.96

MS-DRG 42.00: CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC

Facility

$134,979.63

Service Code	MSDRG 233
Min. Negotiated Rate	$23,752.00
Max. Negotiated Rate	$134,979.63
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: EPIC Health Plan Medicare	$87,395.94
Rate for Payer: Heritage Provider Network Commercial	$26,116.00
Rate for Payer: Heritage Provider Network Senior	$23,752.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$87,395.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$100,505.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$110,118.88
Rate for Payer: Molina Healthcare of CA Medicare	$110,118.88
Rate for Payer: Multiplan WC	$134,979.63

MS-DRG 42.00: CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC

Facility

$91,873.32

Service Code	MSDRG 234
Min. Negotiated Rate	$23,752.00
Max. Negotiated Rate	$91,873.32
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: EPIC Health Plan Medicare	$59,587.62
Rate for Payer: Heritage Provider Network Commercial	$26,116.00
Rate for Payer: Heritage Provider Network Senior	$23,752.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$59,587.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$68,525.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$75,080.40
Rate for Payer: Molina Healthcare of CA Medicare	$75,080.40
Rate for Payer: Multiplan WC	$91,873.32

MS-DRG 42.00: CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$101,612.91

Service Code	MSDRG 235
Min. Negotiated Rate	$23,752.00
Max. Negotiated Rate	$101,612.91
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: EPIC Health Plan Medicare	$65,870.73
Rate for Payer: Heritage Provider Network Commercial	$26,116.00
Rate for Payer: Heritage Provider Network Senior	$23,752.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$65,870.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$75,751.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$82,997.12
Rate for Payer: Molina Healthcare of CA Medicare	$82,997.12
Rate for Payer: Multiplan WC	$101,612.91

MS-DRG 42.00: CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC

Facility

$86,939.00

Service Code	MSDRG 236
Min. Negotiated Rate	$23,752.00
Max. Negotiated Rate	$86,939.00
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: EPIC Health Plan Medicare	$46,129.08
Rate for Payer: Heritage Provider Network Commercial	$26,116.00
Rate for Payer: Heritage Provider Network Senior	$23,752.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$46,129.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$53,048.44
Rate for Payer: Molina Healthcare of CA Medi-Cal	$58,122.64
Rate for Payer: Molina Healthcare of CA Medicare	$58,122.64
Rate for Payer: Multiplan WC	$71,010.92

MS-DRG 42.00: CORONARY BYPASS WITH PTCA WITH MCC

Facility

$146,333.85

Service Code	MSDRG 231
Min. Negotiated Rate	$23,752.00
Max. Negotiated Rate	$146,333.85
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: EPIC Health Plan Medicare	$94,720.65
Rate for Payer: Heritage Provider Network Commercial	$26,116.00
Rate for Payer: Heritage Provider Network Senior	$23,752.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$94,720.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$108,928.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$119,348.02
Rate for Payer: Molina Healthcare of CA Medicare	$119,348.02
Rate for Payer: Multiplan WC	$146,333.85

MS-DRG 42.00: CORONARY BYPASS WITH PTCA WITHOUT MCC

Facility

$105,489.75

Service Code	MSDRG 232
Min. Negotiated Rate	$23,752.00
Max. Negotiated Rate	$105,489.75
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: EPIC Health Plan Medicare	$68,371.72
Rate for Payer: Heritage Provider Network Commercial	$26,116.00
Rate for Payer: Heritage Provider Network Senior	$23,752.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$68,371.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$78,627.48
Rate for Payer: Molina Healthcare of CA Medi-Cal	$86,148.37
Rate for Payer: Molina Healthcare of CA Medicare	$86,148.37
Rate for Payer: Multiplan WC	$105,489.75

MS-DRG 42.00: CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC

Facility

$73,554.61

Service Code	MSDRG 323
Min. Negotiated Rate	$47,770.03
Max. Negotiated Rate	$73,554.61
Rate for Payer: EPIC Health Plan Medicare	$47,770.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$47,770.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$54,935.53
Rate for Payer: Molina Healthcare of CA Medi-Cal	$60,190.24
Rate for Payer: Molina Healthcare of CA Medicare	$60,190.24
Rate for Payer: Multiplan WC	$73,554.61

MS-DRG 42.00: CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC

Facility

$55,175.45

Service Code	MSDRG 324
Min. Negotiated Rate	$35,913.46
Max. Negotiated Rate	$55,175.45
Rate for Payer: EPIC Health Plan Medicare	$35,913.46
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,913.46
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$41,300.48
Rate for Payer: Molina Healthcare of CA Medi-Cal	$45,250.96
Rate for Payer: Molina Healthcare of CA Medicare	$45,250.96
Rate for Payer: Multiplan WC	$55,175.45

MS-DRG 42.00: CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE

Facility

$49,424.96

Service Code	MSDRG 325
Min. Negotiated Rate	$32,203.77
Max. Negotiated Rate	$49,424.96
Rate for Payer: EPIC Health Plan Medicare	$32,203.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,203.77
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,034.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$40,576.75
Rate for Payer: Molina Healthcare of CA Medicare	$40,576.75
Rate for Payer: Multiplan WC	$49,424.96

MS-DRG 42.00: CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC

Facility

$26,690.61

Service Code	MSDRG 073
Min. Negotiated Rate	$17,537.60
Max. Negotiated Rate	$26,690.61
Rate for Payer: EPIC Health Plan Medicare	$17,537.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,537.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,168.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,097.38
Rate for Payer: Molina Healthcare of CA Medicare	$22,097.38
Rate for Payer: Multiplan WC	$26,690.61

MS-DRG 42.00: CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC

Facility

$18,000.96

Service Code	MSDRG 074
Min. Negotiated Rate	$11,931.82
Max. Negotiated Rate	$18,000.96
Rate for Payer: EPIC Health Plan Medicare	$11,931.82
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,931.82
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,721.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,034.09
Rate for Payer: Molina Healthcare of CA Medicare	$15,034.09
Rate for Payer: Multiplan WC	$18,000.96

Know your out-of-pocket cost for care.

All Charges