Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC

Facility

$52,818.27

Service Code	MSDRG 026
Min. Negotiated Rate	$34,392.81
Max. Negotiated Rate	$52,818.27
Rate for Payer: EPIC Health Plan Medicare	$34,392.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,392.81
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,551.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,334.94
Rate for Payer: Molina Healthcare of CA Medicare	$43,334.94
Rate for Payer: Multiplan WC	$52,818.27

MS-DRG 42.00: CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC

Facility

$77,231.12

Service Code	MSDRG 025
Min. Negotiated Rate	$50,141.80
Max. Negotiated Rate	$77,231.12
Rate for Payer: EPIC Health Plan Medicare	$50,141.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$50,141.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$57,663.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$63,178.67
Rate for Payer: Molina Healthcare of CA Medicare	$63,178.67
Rate for Payer: Multiplan WC	$77,231.12

MS-DRG 42.00: CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC

Facility

$42,615.88

Service Code	MSDRG 027
Min. Negotiated Rate	$27,811.14
Max. Negotiated Rate	$42,615.88
Rate for Payer: EPIC Health Plan Medicare	$27,811.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,811.14
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,982.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,042.04
Rate for Payer: Molina Healthcare of CA Medicare	$35,042.04
Rate for Payer: Multiplan WC	$42,615.88

MS-DRG 42.00: CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$117,916.35

Service Code	MSDRG 955
Min. Negotiated Rate	$76,388.26
Max. Negotiated Rate	$117,916.35
Rate for Payer: EPIC Health Plan Medicare	$76,388.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$76,388.26
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$87,846.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$96,249.21
Rate for Payer: Molina Healthcare of CA Medicare	$96,249.21
Rate for Payer: Multiplan WC	$117,916.35

MS-DRG 42.00: CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR

Facility

$98,520.08

Service Code	MSDRG 023
Min. Negotiated Rate	$63,875.51
Max. Negotiated Rate	$98,520.08
Rate for Payer: EPIC Health Plan Medicare	$63,875.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$63,875.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$73,456.84
Rate for Payer: Molina Healthcare of CA Medi-Cal	$80,483.14
Rate for Payer: Molina Healthcare of CA Medicare	$80,483.14
Rate for Payer: Multiplan WC	$98,520.08

MS-DRG 42.00: CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC

Facility

$65,650.69

Service Code	MSDRG 024
Min. Negotiated Rate	$42,671.15
Max. Negotiated Rate	$65,650.69
Rate for Payer: EPIC Health Plan Medicare	$42,671.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$42,671.15
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$49,071.82
Rate for Payer: Molina Healthcare of CA Medi-Cal	$53,765.65
Rate for Payer: Molina Healthcare of CA Medicare	$53,765.65
Rate for Payer: Multiplan WC	$65,650.69

MS-DRG 42.00: D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC

Facility

$33,743.18

Service Code	MSDRG 744
Min. Negotiated Rate	$22,087.29
Max. Negotiated Rate	$33,743.18
Rate for Payer: EPIC Health Plan Medicare	$22,087.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,087.29
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,400.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,829.99
Rate for Payer: Molina Healthcare of CA Medicare	$27,829.99
Rate for Payer: Multiplan WC	$33,743.18

MS-DRG 42.00: D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC

Facility

$17,697.04

Service Code	MSDRG 745
Min. Negotiated Rate	$11,735.75
Max. Negotiated Rate	$17,697.04
Rate for Payer: EPIC Health Plan Medicare	$11,735.75
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,735.75
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,496.11
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,787.05
Rate for Payer: Molina Healthcare of CA Medicare	$14,787.05
Rate for Payer: Multiplan WC	$17,697.04

MS-DRG 42.00: DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC

Facility

$21,206.05

Service Code	MSDRG 294
Min. Negotiated Rate	$13,999.45
Max. Negotiated Rate	$21,206.05
Rate for Payer: EPIC Health Plan Medicare	$13,999.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,999.45
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,099.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,639.31
Rate for Payer: Molina Healthcare of CA Medicare	$17,639.31
Rate for Payer: Multiplan WC	$21,206.05

MS-DRG 42.00: DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC

Facility

$13,638.88

Service Code	MSDRG 295
Min. Negotiated Rate	$9,117.80
Max. Negotiated Rate	$13,638.88
Rate for Payer: EPIC Health Plan Medicare	$9,117.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,117.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,485.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,488.43
Rate for Payer: Molina Healthcare of CA Medicare	$11,488.43
Rate for Payer: Multiplan WC	$13,638.88

MS-DRG 42.00: DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC

Facility

$43,242.74

Service Code	MSDRG 056
Min. Negotiated Rate	$28,215.54
Max. Negotiated Rate	$43,242.74
Rate for Payer: EPIC Health Plan Medicare	$28,215.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,215.54
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,447.87
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,551.58
Rate for Payer: Molina Healthcare of CA Medicare	$35,551.58
Rate for Payer: Multiplan WC	$43,242.74

MS-DRG 42.00: DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC

Facility

$23,043.45

Service Code	MSDRG 057
Min. Negotiated Rate	$15,184.78
Max. Negotiated Rate	$23,043.45
Rate for Payer: EPIC Health Plan Medicare	$15,184.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,184.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,462.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,132.82
Rate for Payer: Molina Healthcare of CA Medicare	$19,132.82
Rate for Payer: Multiplan WC	$23,043.45

MS-DRG 42.00: DENTAL AND ORAL DISEASES WITH CC

Facility

$16,243.01

Service Code	MSDRG 158
Min. Negotiated Rate	$10,797.74
Max. Negotiated Rate	$16,243.01
Rate for Payer: EPIC Health Plan Medicare	$10,797.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,797.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,417.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,605.15
Rate for Payer: Molina Healthcare of CA Medicare	$13,605.15
Rate for Payer: Multiplan WC	$16,243.01

MS-DRG 42.00: DENTAL AND ORAL DISEASES WITH MCC

Facility

$28,277.62

Service Code	MSDRG 157
Min. Negotiated Rate	$18,561.38
Max. Negotiated Rate	$28,277.62
Rate for Payer: EPIC Health Plan Medicare	$18,561.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,561.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,345.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,387.34
Rate for Payer: Molina Healthcare of CA Medicare	$23,387.34
Rate for Payer: Multiplan WC	$28,277.62

MS-DRG 42.00: DENTAL AND ORAL DISEASES WITHOUT CC/MCC

Facility

$11,390.48

Service Code	MSDRG 159
Min. Negotiated Rate	$7,667.34
Max. Negotiated Rate	$11,390.48
Rate for Payer: EPIC Health Plan Medicare	$7,667.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,667.34
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,817.44
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,660.85
Rate for Payer: Molina Healthcare of CA Medicare	$9,660.85
Rate for Payer: Multiplan WC	$11,390.48

MS-DRG 42.00: DEPRESSIVE NEUROSES

Facility

$15,785.39

Service Code	MSDRG 881
Min. Negotiated Rate	$10,502.53
Max. Negotiated Rate	$15,785.39
Rate for Payer: EPIC Health Plan Medicare	$10,502.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,502.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,077.91
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,233.19
Rate for Payer: Molina Healthcare of CA Medicare	$13,233.19
Rate for Payer: Multiplan WC	$15,785.39

MS-DRG 42.00: DIABETES WITH CC

Facility

$15,838.92

Service Code	MSDRG 638
Min. Negotiated Rate	$10,537.06
Max. Negotiated Rate	$15,838.92
Rate for Payer: EPIC Health Plan Medicare	$10,537.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,537.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,117.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,276.70
Rate for Payer: Molina Healthcare of CA Medicare	$13,276.70
Rate for Payer: Multiplan WC	$15,838.92

MS-DRG 42.00: DIABETES WITH MCC

Facility

$25,148.51

Service Code	MSDRG 637
Min. Negotiated Rate	$16,542.78
Max. Negotiated Rate	$25,148.51
Rate for Payer: EPIC Health Plan Medicare	$16,542.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,542.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,024.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,843.90
Rate for Payer: Molina Healthcare of CA Medicare	$20,843.90
Rate for Payer: Multiplan WC	$25,148.51

MS-DRG 42.00: DIABETES WITHOUT CC/MCC

Facility

$10,820.61

Service Code	MSDRG 639
Min. Negotiated Rate	$7,299.71
Max. Negotiated Rate	$10,820.61
Rate for Payer: EPIC Health Plan Medicare	$7,299.71
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,299.71
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,394.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,197.63
Rate for Payer: Molina Healthcare of CA Medicare	$9,197.63
Rate for Payer: Multiplan WC	$10,820.61

MS-DRG 42.00: DIGESTIVE MALIGNANCY WITH CC

Facility

$21,218.14

Service Code	MSDRG 375
Min. Negotiated Rate	$14,007.27
Max. Negotiated Rate	$21,218.14
Rate for Payer: EPIC Health Plan Medicare	$14,007.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,007.27
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,108.36
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,649.16
Rate for Payer: Molina Healthcare of CA Medicare	$17,649.16
Rate for Payer: Multiplan WC	$21,218.14

MS-DRG 42.00: DIGESTIVE MALIGNANCY WITH MCC

Facility

$36,461.28

Service Code	MSDRG 374
Min. Negotiated Rate	$23,840.76
Max. Negotiated Rate	$36,461.28
Rate for Payer: EPIC Health Plan Medicare	$23,840.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,840.76
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,416.87
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,039.36
Rate for Payer: Molina Healthcare of CA Medicare	$30,039.36
Rate for Payer: Multiplan WC	$36,461.28

MS-DRG 42.00: DIGESTIVE MALIGNANCY WITHOUT CC/MCC

Facility

$15,248.33

Service Code	MSDRG 376
Min. Negotiated Rate	$10,156.07
Max. Negotiated Rate	$15,248.33
Rate for Payer: EPIC Health Plan Medicare	$10,156.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,156.07
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,679.48
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,796.65
Rate for Payer: Molina Healthcare of CA Medicare	$12,796.65
Rate for Payer: Multiplan WC	$15,248.33

MS-DRG 42.00: DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC

Facility

$16,685.09

Service Code	MSDRG 442
Min. Negotiated Rate	$11,082.94
Max. Negotiated Rate	$16,685.09
Rate for Payer: EPIC Health Plan Medicare	$11,082.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,082.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,745.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,964.50
Rate for Payer: Molina Healthcare of CA Medicare	$13,964.50
Rate for Payer: Multiplan WC	$16,685.09

MS-DRG 42.00: DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC

Facility

$32,644.89

Service Code	MSDRG 441
Min. Negotiated Rate	$21,378.76
Max. Negotiated Rate	$32,644.89
Rate for Payer: EPIC Health Plan Medicare	$21,378.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,378.76
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,585.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,937.24
Rate for Payer: Molina Healthcare of CA Medicare	$26,937.24
Rate for Payer: Multiplan WC	$32,644.89

MS-DRG 42.00: DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC

Facility

$12,134.76

Service Code	MSDRG 443
Min. Negotiated Rate	$8,147.47
Max. Negotiated Rate	$12,134.76
Rate for Payer: EPIC Health Plan Medicare	$8,147.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,147.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,369.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,265.81
Rate for Payer: Molina Healthcare of CA Medicare	$10,265.81
Rate for Payer: Multiplan WC	$12,134.76

Know your out-of-pocket cost for care.

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