Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

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	$8,147.51
Max. Negotiated Rate	$12,134.76
Rate for Payer: EPIC Health Plan Medicare	$8,147.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,147.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,369.64
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,265.86
Rate for Payer: Molina Healthcare of CA Medicare	$10,265.86
Rate for Payer: Multiplan WC	$12,134.76

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

Facility

$14,854.59

Service Code	MSDRG 439
Min. Negotiated Rate	$9,902.11
Max. Negotiated Rate	$14,854.59
Rate for Payer: EPIC Health Plan Medicare	$9,902.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,902.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,387.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,476.66
Rate for Payer: Molina Healthcare of CA Medicare	$12,476.66
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	$18,853.31
Max. Negotiated Rate	$28,730.05
Rate for Payer: EPIC Health Plan Medicare	$18,853.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,853.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,681.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,755.17
Rate for Payer: Molina Healthcare of CA Medicare	$23,755.17
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	$7,171.64
Max. Negotiated Rate	$10,622.02
Rate for Payer: EPIC Health Plan Medicare	$7,171.64
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,171.64
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,247.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,036.27
Rate for Payer: Molina Healthcare of CA Medicare	$9,036.27
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	$20,972.20
Max. Negotiated Rate	$32,014.58
Rate for Payer: EPIC Health Plan Medicare	$20,972.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,972.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,118.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,424.97
Rate for Payer: Molina Healthcare of CA Medicare	$26,424.97
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	$12,400.87
Max. Negotiated Rate	$18,727.99
Rate for Payer: EPIC Health Plan Medicare	$12,400.87
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,400.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,261.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,625.10
Rate for Payer: Molina Healthcare of CA Medicare	$15,625.10
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	$19,083.91
Max. Negotiated Rate	$29,087.52
Rate for Payer: EPIC Health Plan Medicare	$19,083.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,083.91
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,946.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,045.73
Rate for Payer: Molina Healthcare of CA Medicare	$24,045.73
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	$9,201.40
Max. Negotiated Rate	$13,768.39
Rate for Payer: EPIC Health Plan Medicare	$9,201.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,201.40
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,581.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,593.76
Rate for Payer: Molina Healthcare of CA Medicare	$11,593.76
Rate for Payer: Multiplan WC	$13,768.39

MS-DRG 42.00: DYSEQUILIBRIUM

Facility

$12,908.40

Service Code	MSDRG 149
Min. Negotiated Rate	$8,646.60
Max. Negotiated Rate	$12,908.40
Rate for Payer: EPIC Health Plan Medicare	$8,646.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,646.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,943.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,894.72
Rate for Payer: Molina Healthcare of CA Medicare	$10,894.72
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	$14,186.65
Max. Negotiated Rate	$21,496.16
Rate for Payer: EPIC Health Plan Medicare	$14,186.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,186.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,314.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,875.18
Rate for Payer: Molina Healthcare of CA Medicare	$17,875.18
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	$25,876.13
Max. Negotiated Rate	$39,616.29
Rate for Payer: EPIC Health Plan Medicare	$25,876.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,876.13
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,757.55
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,603.92
Rate for Payer: Molina Healthcare of CA Medicare	$32,603.92
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	$9,239.27
Max. Negotiated Rate	$13,827.10
Rate for Payer: EPIC Health Plan Medicare	$9,239.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,239.27
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,625.16
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,641.48
Rate for Payer: Molina Healthcare of CA Medicare	$11,641.48
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	$239,072.82
Max. Negotiated Rate	$370,097.41
Rate for Payer: EPIC Health Plan Medicare	$239,072.82
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$239,072.82
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$274,933.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$301,231.75
Rate for Payer: Molina Healthcare of CA Medicare	$301,231.75
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	$11,831.59
Max. Negotiated Rate	$17,845.55
Rate for Payer: EPIC Health Plan Medicare	$11,831.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,831.59
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,606.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,907.80
Rate for Payer: Molina Healthcare of CA Medicare	$14,907.80
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	$18,782.01
Max. Negotiated Rate	$28,619.54
Rate for Payer: EPIC Health Plan Medicare	$18,782.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,782.01
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,599.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,665.33
Rate for Payer: Molina Healthcare of CA Medicare	$23,665.33
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	$8,994.19
Max. Negotiated Rate	$13,447.20
Rate for Payer: EPIC Health Plan Medicare	$8,994.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,994.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,343.32
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,332.68
Rate for Payer: Molina Healthcare of CA Medicare	$11,332.68
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	$67,058.33
Max. Negotiated Rate	$103,453.76
Rate for Payer: EPIC Health Plan Medicare	$67,058.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$67,058.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$77,117.08
Rate for Payer: Molina Healthcare of CA Medi-Cal	$84,493.50
Rate for Payer: Molina Healthcare of CA Medicare	$84,493.50
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	$52,730.84
Max. Negotiated Rate	$81,244.39
Rate for Payer: EPIC Health Plan Medicare	$52,730.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$52,730.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$60,640.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$66,440.86
Rate for Payer: Molina Healthcare of CA Medicare	$66,440.86
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	$15,717.33
Max. Negotiated Rate	$23,868.90
Rate for Payer: EPIC Health Plan Medicare	$15,717.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,717.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,074.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,803.84
Rate for Payer: Molina Healthcare of CA Medicare	$19,803.84
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	$8,763.58
Max. Negotiated Rate	$13,089.73
Rate for Payer: EPIC Health Plan Medicare	$8,763.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,763.58
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,078.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,042.11
Rate for Payer: Molina Healthcare of CA Medicare	$11,042.11
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	$14,628.92
Max. Negotiated Rate	$22,181.74
Rate for Payer: EPIC Health Plan Medicare	$14,628.92
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,628.92
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,823.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,432.44
Rate for Payer: Molina Healthcare of CA Medicare	$18,432.44
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	$9,012.01
Max. Negotiated Rate	$13,474.82
Rate for Payer: EPIC Health Plan Medicare	$9,012.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,012.01
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,363.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,355.13
Rate for Payer: Molina Healthcare of CA Medicare	$11,355.13
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	$48,522.03
Max. Negotiated Rate	$74,720.25
Rate for Payer: EPIC Health Plan Medicare	$48,522.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$48,522.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$55,800.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$61,137.76
Rate for Payer: Molina Healthcare of CA Medicare	$61,137.76
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	$264,597.40
Max. Negotiated Rate	$409,663.63
Rate for Payer: EPIC Health Plan Medicare	$264,597.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$264,597.40
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$304,287.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$333,392.72
Rate for Payer: Molina Healthcare of CA Medicare	$333,392.72
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	$27,593.95
Max. Negotiated Rate	$42,279.13
Rate for Payer: EPIC Health Plan Medicare	$27,593.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,593.95
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,733.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,768.38
Rate for Payer: Molina Healthcare of CA Medicare	$34,768.38
Rate for Payer: Multiplan WC	$42,279.13

Know your out-of-pocket cost for care.

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