Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC

Facility

$14,854.59

Service Code	MSDRG 439
Min. Negotiated Rate	$9,902.07
Max. Negotiated Rate	$14,854.59
Rate for Payer: EPIC Health Plan Medicare	$9,902.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,902.07
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,387.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,476.61
Rate for Payer: Molina Healthcare of CA Medicare	$12,476.61
Rate for Payer: Multiplan WC	$14,854.59

MS-DRG 42.00: DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC

Facility

$28,730.05

Service Code	MSDRG 438
Min. Negotiated Rate	$18,853.27
Max. Negotiated Rate	$28,730.05
Rate for Payer: EPIC Health Plan Medicare	$18,853.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,853.27
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,681.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,755.12
Rate for Payer: Molina Healthcare of CA Medicare	$23,755.12
Rate for Payer: Multiplan WC	$28,730.05

MS-DRG 42.00: DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC

Facility

$10,622.02

Service Code	MSDRG 440
Min. Negotiated Rate	$7,171.60
Max. Negotiated Rate	$10,622.02
Rate for Payer: EPIC Health Plan Medicare	$7,171.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,171.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,247.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,036.22
Rate for Payer: Molina Healthcare of CA Medicare	$9,036.22
Rate for Payer: Multiplan WC	$10,622.02

MS-DRG 42.00: DISORDERS OF PERSONALITY AND IMPULSE CONTROL

Facility

$32,014.58

Service Code	MSDRG 883
Min. Negotiated Rate	$20,972.16
Max. Negotiated Rate	$32,014.58
Rate for Payer: EPIC Health Plan Medicare	$20,972.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,972.16
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,117.98
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,424.92
Rate for Payer: Molina Healthcare of CA Medicare	$26,424.92
Rate for Payer: Multiplan WC	$32,014.58

MS-DRG 42.00: DISORDERS OF THE BILIARY TRACT WITH CC

Facility

$18,727.99

Service Code	MSDRG 445
Min. Negotiated Rate	$12,400.83
Max. Negotiated Rate	$18,727.99
Rate for Payer: EPIC Health Plan Medicare	$12,400.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,400.83
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,260.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,625.05
Rate for Payer: Molina Healthcare of CA Medicare	$15,625.05
Rate for Payer: Multiplan WC	$18,727.99

MS-DRG 42.00: DISORDERS OF THE BILIARY TRACT WITH MCC

Facility

$29,087.52

Service Code	MSDRG 444
Min. Negotiated Rate	$19,083.87
Max. Negotiated Rate	$29,087.52
Rate for Payer: EPIC Health Plan Medicare	$19,083.87
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,083.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,946.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,045.68
Rate for Payer: Molina Healthcare of CA Medicare	$24,045.68
Rate for Payer: Multiplan WC	$29,087.52

MS-DRG 42.00: DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC

Facility

$13,768.39

Service Code	MSDRG 446
Min. Negotiated Rate	$9,201.36
Max. Negotiated Rate	$13,768.39
Rate for Payer: EPIC Health Plan Medicare	$9,201.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,201.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,581.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,593.71
Rate for Payer: Molina Healthcare of CA Medicare	$11,593.71
Rate for Payer: Multiplan WC	$13,768.39

MS-DRG 42.00: DYSEQUILIBRIUM

Facility

$12,908.40

Service Code	MSDRG 149
Min. Negotiated Rate	$8,646.56
Max. Negotiated Rate	$12,908.40
Rate for Payer: EPIC Health Plan Medicare	$8,646.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,646.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,943.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,894.67
Rate for Payer: Molina Healthcare of CA Medicare	$10,894.67
Rate for Payer: Multiplan WC	$12,908.40

MS-DRG 42.00: EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC

Facility

$21,496.16

Service Code	MSDRG 147
Min. Negotiated Rate	$14,186.61
Max. Negotiated Rate	$21,496.16
Rate for Payer: EPIC Health Plan Medicare	$14,186.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,186.61
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,314.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,875.13
Rate for Payer: Molina Healthcare of CA Medicare	$17,875.13
Rate for Payer: Multiplan WC	$21,496.16

MS-DRG 42.00: EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC

Facility

$39,616.29

Service Code	MSDRG 146
Min. Negotiated Rate	$25,876.09
Max. Negotiated Rate	$39,616.29
Rate for Payer: EPIC Health Plan Medicare	$25,876.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,876.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,757.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,603.87
Rate for Payer: Molina Healthcare of CA Medicare	$32,603.87
Rate for Payer: Multiplan WC	$39,616.29

MS-DRG 42.00: EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC

Facility

$13,827.10

Service Code	MSDRG 148
Min. Negotiated Rate	$9,239.23
Max. Negotiated Rate	$13,827.10
Rate for Payer: EPIC Health Plan Medicare	$9,239.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,239.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,625.11
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,641.43
Rate for Payer: Molina Healthcare of CA Medicare	$11,641.43
Rate for Payer: Multiplan WC	$13,827.10

MS-DRG 42.00: ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES

Facility

$370,097.41

Service Code	MSDRG 003
Min. Negotiated Rate	$239,072.78
Max. Negotiated Rate	$370,097.41
Rate for Payer: EPIC Health Plan Medicare	$239,072.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$239,072.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$274,933.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$301,231.70
Rate for Payer: Molina Healthcare of CA Medicare	$301,231.70
Rate for Payer: Multiplan WC	$370,097.41

MS-DRG 42.00: ENDOCRINE DISORDERS WITH CC

Facility

$17,845.55

Service Code	MSDRG 644
Min. Negotiated Rate	$11,831.55
Max. Negotiated Rate	$17,845.55
Rate for Payer: EPIC Health Plan Medicare	$11,831.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,831.55
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,606.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,907.75
Rate for Payer: Molina Healthcare of CA Medicare	$14,907.75
Rate for Payer: Multiplan WC	$17,845.55

MS-DRG 42.00: ENDOCRINE DISORDERS WITH MCC

Facility

$28,619.54

Service Code	MSDRG 643
Min. Negotiated Rate	$18,781.97
Max. Negotiated Rate	$28,619.54
Rate for Payer: EPIC Health Plan Medicare	$18,781.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,781.97
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,599.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,665.28
Rate for Payer: Molina Healthcare of CA Medicare	$23,665.28
Rate for Payer: Multiplan WC	$28,619.54

MS-DRG 42.00: ENDOCRINE DISORDERS WITHOUT CC/MCC

Facility

$13,447.20

Service Code	MSDRG 645
Min. Negotiated Rate	$8,994.15
Max. Negotiated Rate	$13,447.20
Rate for Payer: EPIC Health Plan Medicare	$8,994.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,994.15
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,343.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,332.63
Rate for Payer: Molina Healthcare of CA Medicare	$11,332.63
Rate for Payer: Multiplan WC	$13,447.20

MS-DRG 42.00: ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC

Facility

$103,453.76

Service Code	MSDRG 266
Min. Negotiated Rate	$67,058.29
Max. Negotiated Rate	$103,453.76
Rate for Payer: EPIC Health Plan Medicare	$67,058.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$67,058.29
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$77,117.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$84,493.45
Rate for Payer: Molina Healthcare of CA Medicare	$84,493.45
Rate for Payer: Multiplan WC	$103,453.76

MS-DRG 42.00: ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC

Facility

$81,244.39

Service Code	MSDRG 267
Min. Negotiated Rate	$52,730.80
Max. Negotiated Rate	$81,244.39
Rate for Payer: EPIC Health Plan Medicare	$52,730.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$52,730.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$60,640.42
Rate for Payer: Molina Healthcare of CA Medi-Cal	$66,440.81
Rate for Payer: Molina Healthcare of CA Medicare	$66,440.81
Rate for Payer: Multiplan WC	$81,244.39

MS-DRG 42.00: EPISTAXIS WITH MCC

Facility

$23,868.90

Service Code	MSDRG 150
Min. Negotiated Rate	$15,717.29
Max. Negotiated Rate	$23,868.90
Rate for Payer: EPIC Health Plan Medicare	$15,717.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,717.29
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,074.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,803.79
Rate for Payer: Molina Healthcare of CA Medicare	$19,803.79
Rate for Payer: Multiplan WC	$23,868.90

MS-DRG 42.00: EPISTAXIS WITHOUT MCC

Facility

$13,089.73

Service Code	MSDRG 151
Min. Negotiated Rate	$8,763.54
Max. Negotiated Rate	$13,089.73
Rate for Payer: EPIC Health Plan Medicare	$8,763.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,763.54
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,078.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,042.06
Rate for Payer: Molina Healthcare of CA Medicare	$11,042.06
Rate for Payer: Multiplan WC	$13,089.73

MS-DRG 42.00: ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC

Facility

$22,181.74

Service Code	MSDRG 391
Min. Negotiated Rate	$14,628.88
Max. Negotiated Rate	$22,181.74
Rate for Payer: EPIC Health Plan Medicare	$14,628.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,628.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,823.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,432.39
Rate for Payer: Molina Healthcare of CA Medicare	$18,432.39
Rate for Payer: Multiplan WC	$22,181.74

MS-DRG 42.00: ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC

Facility

$13,474.82

Service Code	MSDRG 392
Min. Negotiated Rate	$9,011.97
Max. Negotiated Rate	$13,474.82
Rate for Payer: EPIC Health Plan Medicare	$9,011.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,011.97
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,363.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,355.08
Rate for Payer: Molina Healthcare of CA Medicare	$11,355.08
Rate for Payer: Multiplan WC	$13,474.82

MS-DRG 42.00: EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT

Facility

$74,720.25

Service Code	MSDRG 933
Min. Negotiated Rate	$48,521.99
Max. Negotiated Rate	$74,720.25
Rate for Payer: EPIC Health Plan Medicare	$48,521.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$48,521.99
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$55,800.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$61,137.71
Rate for Payer: Molina Healthcare of CA Medicare	$61,137.71
Rate for Payer: Multiplan WC	$74,720.25

MS-DRG 42.00: EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT

Facility

$409,663.63

Service Code	MSDRG 927
Min. Negotiated Rate	$264,597.36
Max. Negotiated Rate	$409,663.63
Rate for Payer: EPIC Health Plan Medicare	$264,597.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$264,597.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$304,286.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$333,392.67
Rate for Payer: Molina Healthcare of CA Medicare	$333,392.67
Rate for Payer: Multiplan WC	$409,663.63

MS-DRG 42.00: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC

Facility

$42,279.13

Service Code	MSDRG 982
Min. Negotiated Rate	$27,593.91
Max. Negotiated Rate	$42,279.13
Rate for Payer: EPIC Health Plan Medicare	$27,593.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,593.91
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,733.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,768.33
Rate for Payer: Molina Healthcare of CA Medicare	$34,768.33
Rate for Payer: Multiplan WC	$42,279.13

MS-DRG 42.00: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC

Facility

$82,094.01

Service Code	MSDRG 981
Min. Negotiated Rate	$53,278.89
Max. Negotiated Rate	$82,094.01
Rate for Payer: EPIC Health Plan Medicare	$53,278.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$53,278.89
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$61,270.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$67,131.40
Rate for Payer: Molina Healthcare of CA Medicare	$67,131.40
Rate for Payer: Multiplan WC	$82,094.01

Know your out-of-pocket cost for care.

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