Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC

Facility

$28,807.77

Service Code	MSDRG 983
Min. Negotiated Rate	$18,903.40
Max. Negotiated Rate	$28,807.77
Rate for Payer: EPIC Health Plan Medicare	$18,903.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,903.40
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,738.91
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,818.28
Rate for Payer: Molina Healthcare of CA Medicare	$23,818.28
Rate for Payer: Multiplan WC	$28,807.77

MS-DRG 42.00: EXTRACRANIAL PROCEDURES WITH CC

Facility

$27,825.17

Service Code	MSDRG 038
Min. Negotiated Rate	$18,269.52
Max. Negotiated Rate	$27,825.17
Rate for Payer: EPIC Health Plan Medicare	$18,269.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,269.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,009.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,019.60
Rate for Payer: Molina Healthcare of CA Medicare	$23,019.60
Rate for Payer: Multiplan WC	$27,825.17

MS-DRG 42.00: EXTRACRANIAL PROCEDURES WITH MCC

Facility

$57,347.87

Service Code	MSDRG 037
Min. Negotiated Rate	$37,314.90
Max. Negotiated Rate	$57,347.87
Rate for Payer: EPIC Health Plan Medicare	$37,314.90
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,314.90
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,912.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$47,016.77
Rate for Payer: Molina Healthcare of CA Medicare	$47,016.77
Rate for Payer: Multiplan WC	$57,347.87

MS-DRG 42.00: EXTRACRANIAL PROCEDURES WITHOUT CC/MCC

Facility

$19,655.32

Service Code	MSDRG 039
Min. Negotiated Rate	$12,999.06
Max. Negotiated Rate	$19,655.32
Rate for Payer: EPIC Health Plan Medicare	$12,999.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,999.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,948.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,378.82
Rate for Payer: Molina Healthcare of CA Medicare	$16,378.82
Rate for Payer: Multiplan WC	$19,655.32

MS-DRG 42.00: EXTRAOCULAR PROCEDURES EXCEPT ORBIT

Facility

$26,438.49

Service Code	MSDRG 115
Min. Negotiated Rate	$17,374.96
Max. Negotiated Rate	$26,438.49
Rate for Payer: EPIC Health Plan Medicare	$17,374.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,374.96
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,981.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,892.45
Rate for Payer: Molina Healthcare of CA Medicare	$21,892.45
Rate for Payer: Multiplan WC	$26,438.49

MS-DRG 42.00: EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE

Facility

$102,659.40

Service Code	MSDRG 790
Min. Negotiated Rate	$5,206.00
Max. Negotiated Rate	$102,659.40
Rate for Payer: EPIC Health Plan Medicare	$66,545.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$66,545.81
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$76,527.68
Rate for Payer: Molina Healthcare of CA Medi-Cal	$83,847.72
Rate for Payer: Molina Healthcare of CA Medicare	$83,847.72
Rate for Payer: Multiplan WC	$102,659.40
Rate for Payer: United Healthcare All Other HMO/non HMO	$6,182.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$5,206.00

MS-DRG 42.00: FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

Facility

$23,525.25

Service Code	MSDRG 748
Min. Negotiated Rate	$15,495.59
Max. Negotiated Rate	$23,525.25
Rate for Payer: EPIC Health Plan Medicare	$15,495.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,495.59
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,819.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,524.44
Rate for Payer: Molina Healthcare of CA Medicare	$19,524.44
Rate for Payer: Multiplan WC	$23,525.25

MS-DRG 42.00: FEVER AND INFLAMMATORY CONDITIONS

Facility

$15,507.35

Service Code	MSDRG 864
Min. Negotiated Rate	$10,323.17
Max. Negotiated Rate	$15,507.35
Rate for Payer: EPIC Health Plan Medicare	$10,323.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,323.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,871.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,007.19
Rate for Payer: Molina Healthcare of CA Medicare	$13,007.19
Rate for Payer: Multiplan WC	$15,507.35

MS-DRG 42.00: FOOT PROCEDURES WITH CC

Facility

$30,306.70

Service Code	MSDRG 504
Min. Negotiated Rate	$19,870.38
Max. Negotiated Rate	$30,306.70
Rate for Payer: EPIC Health Plan Medicare	$19,870.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,870.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,850.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,036.68
Rate for Payer: Molina Healthcare of CA Medicare	$25,036.68
Rate for Payer: Multiplan WC	$30,306.70

MS-DRG 42.00: FOOT PROCEDURES WITH MCC

Facility

$45,703.53

Service Code	MSDRG 503
Min. Negotiated Rate	$29,803.02
Max. Negotiated Rate	$45,703.53
Rate for Payer: EPIC Health Plan Medicare	$29,803.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,803.02
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,273.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,551.81
Rate for Payer: Molina Healthcare of CA Medicare	$37,551.81
Rate for Payer: Multiplan WC	$45,703.53

MS-DRG 42.00: FOOT PROCEDURES WITHOUT CC/MCC

Facility

$30,306.70

Service Code	MSDRG 505
Min. Negotiated Rate	$19,870.38
Max. Negotiated Rate	$30,306.70
Rate for Payer: EPIC Health Plan Medicare	$19,870.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,870.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,850.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,036.68
Rate for Payer: Molina Healthcare of CA Medicare	$25,036.68
Rate for Payer: Multiplan WC	$30,306.70

MS-DRG 42.00: FRACTURES OF FEMUR WITH MCC

Facility

$26,333.15

Service Code	MSDRG 533
Min. Negotiated Rate	$17,307.01
Max. Negotiated Rate	$26,333.15
Rate for Payer: EPIC Health Plan Medicare	$17,307.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,307.01
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,903.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,806.83
Rate for Payer: Molina Healthcare of CA Medicare	$21,806.83
Rate for Payer: Multiplan WC	$26,333.15

MS-DRG 42.00: FRACTURES OF FEMUR WITHOUT MCC

Facility

$14,056.78

Service Code	MSDRG 534
Min. Negotiated Rate	$9,387.39
Max. Negotiated Rate	$14,056.78
Rate for Payer: EPIC Health Plan Medicare	$9,387.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,387.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,795.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,828.11
Rate for Payer: Molina Healthcare of CA Medicare	$11,828.11
Rate for Payer: Multiplan WC	$14,056.78

MS-DRG 42.00: FRACTURES OF HIP AND PELVIS WITH MCC

Facility

$22,965.74

Service Code	MSDRG 535
Min. Negotiated Rate	$15,134.66
Max. Negotiated Rate	$22,965.74
Rate for Payer: EPIC Health Plan Medicare	$15,134.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,134.66
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,404.86
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,069.67
Rate for Payer: Molina Healthcare of CA Medicare	$19,069.67
Rate for Payer: Multiplan WC	$22,965.74

MS-DRG 42.00: FRACTURES OF HIP AND PELVIS WITHOUT MCC

Facility

$14,003.25

Service Code	MSDRG 536
Min. Negotiated Rate	$9,352.87
Max. Negotiated Rate	$14,003.25
Rate for Payer: EPIC Health Plan Medicare	$9,352.87
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,352.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,755.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,784.62
Rate for Payer: Molina Healthcare of CA Medicare	$11,784.62
Rate for Payer: Multiplan WC	$14,003.25

MS-DRG 42.00: FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC

Facility

$25,272.85

Service Code	MSDRG 562
Min. Negotiated Rate	$16,623.00
Max. Negotiated Rate	$25,272.85
Rate for Payer: EPIC Health Plan Medicare	$16,623.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,623.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,116.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,944.98
Rate for Payer: Molina Healthcare of CA Medicare	$20,944.98
Rate for Payer: Multiplan WC	$25,272.85

MS-DRG 42.00: FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC

Facility

$15,434.82

Service Code	MSDRG 563
Min. Negotiated Rate	$10,276.39
Max. Negotiated Rate	$15,434.82
Rate for Payer: EPIC Health Plan Medicare	$10,276.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,276.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,817.85
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,948.25
Rate for Payer: Molina Healthcare of CA Medicare	$12,948.25
Rate for Payer: Multiplan WC	$15,434.82

MS-DRG 42.00: FULL TERM NEONATE WITH MAJOR PROBLEMS

Facility

$72,019.42

Service Code	MSDRG 793
Min. Negotiated Rate	$4,780.00
Max. Negotiated Rate	$72,019.42
Rate for Payer: EPIC Health Plan Medicare	$46,779.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$46,779.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$53,796.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$58,942.38
Rate for Payer: Molina Healthcare of CA Medicare	$58,942.38
Rate for Payer: Multiplan WC	$72,019.42
Rate for Payer: United Healthcare All Other HMO/non HMO	$5,681.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$4,780.00

MS-DRG 42.00: FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY

Facility

$37,055.33

Service Code	MSDRG 934
Min. Negotiated Rate	$24,223.97
Max. Negotiated Rate	$37,055.33
Rate for Payer: EPIC Health Plan Medicare	$24,223.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,223.97
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,857.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,522.20
Rate for Payer: Molina Healthcare of CA Medicare	$30,522.20
Rate for Payer: Multiplan WC	$37,055.33

MS-DRG 42.00: FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC

Facility

$115,336.41

Service Code	MSDRG 928
Min. Negotiated Rate	$74,723.90
Max. Negotiated Rate	$115,336.41
Rate for Payer: EPIC Health Plan Medicare	$74,723.90
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$74,723.90
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$85,932.49
Rate for Payer: Molina Healthcare of CA Medi-Cal	$94,152.11
Rate for Payer: Molina Healthcare of CA Medicare	$94,152.11
Rate for Payer: Multiplan WC	$115,336.41

MS-DRG 42.00: FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC

Facility

$54,921.60

Service Code	MSDRG 929
Min. Negotiated Rate	$35,749.69
Max. Negotiated Rate	$54,921.60
Rate for Payer: EPIC Health Plan Medicare	$35,749.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,749.69
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$41,112.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$45,044.61
Rate for Payer: Molina Healthcare of CA Medicare	$45,044.61
Rate for Payer: Multiplan WC	$54,921.60

MS-DRG 42.00: GASTROINTESTINAL HEMORRHAGE WITH CC

Facility

$17,025.29

Service Code	MSDRG 378
Min. Negotiated Rate	$11,302.41
Max. Negotiated Rate	$17,025.29
Rate for Payer: EPIC Health Plan Medicare	$11,302.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,302.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,997.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,241.04
Rate for Payer: Molina Healthcare of CA Medicare	$14,241.04
Rate for Payer: Multiplan WC	$17,025.29

MS-DRG 42.00: GASTROINTESTINAL HEMORRHAGE WITH MCC

Facility

$31,398.08

Service Code	MSDRG 377
Min. Negotiated Rate	$20,574.44
Max. Negotiated Rate	$31,398.08
Rate for Payer: EPIC Health Plan Medicare	$20,574.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,574.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,660.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,923.79
Rate for Payer: Molina Healthcare of CA Medicare	$25,923.79
Rate for Payer: Multiplan WC	$31,398.08

MS-DRG 42.00: GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC

Facility

$10,995.03

Service Code	MSDRG 379
Min. Negotiated Rate	$7,412.23
Max. Negotiated Rate	$10,995.03
Rate for Payer: EPIC Health Plan Medicare	$7,412.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,412.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,524.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,339.41
Rate for Payer: Molina Healthcare of CA Medicare	$9,339.41
Rate for Payer: Multiplan WC	$10,995.03

MS-DRG 42.00: GASTROINTESTINAL OBSTRUCTION WITH CC

Facility

$13,842.65

Service Code	MSDRG 389
Min. Negotiated Rate	$9,249.26
Max. Negotiated Rate	$13,842.65
Rate for Payer: EPIC Health Plan Medicare	$9,249.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,249.26
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,636.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,654.07
Rate for Payer: Molina Healthcare of CA Medicare	$11,654.07
Rate for Payer: Multiplan WC	$13,842.65

Know your out-of-pocket cost for care.

All Charges