Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC

Facility

$19,475.72

Service Code	MSDRG 695
Min. Negotiated Rate	$12,883.24
Max. Negotiated Rate	$19,475.72
Rate for Payer: EPIC Health Plan Medicare	$12,883.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,883.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,815.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,232.88
Rate for Payer: Molina Healthcare of CA Medicare	$16,232.88
Rate for Payer: Multiplan WC	$19,475.72

MS-DRG 42.00: KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC

Facility

$11,946.53

Service Code	MSDRG 696
Min. Negotiated Rate	$8,026.09
Max. Negotiated Rate	$11,946.53
Rate for Payer: EPIC Health Plan Medicare	$8,026.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,026.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,230.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,112.87
Rate for Payer: Molina Healthcare of CA Medicare	$10,112.87
Rate for Payer: Multiplan WC	$11,946.53

MS-DRG 42.00: KIDNEY TRANSPLANT

Facility

$53,039.31

Service Code	MSDRG 652
Min. Negotiated Rate	$34,535.46
Max. Negotiated Rate	$53,039.31
Rate for Payer: EPIC Health Plan Medicare	$34,535.46
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,535.46
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,715.78
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,514.68
Rate for Payer: Molina Healthcare of CA Medicare	$43,514.68
Rate for Payer: Multiplan WC	$53,039.31

MS-DRG 42.00: KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC

Facility

$79,562.42

Service Code	MSDRG 650
Min. Negotiated Rate	$51,645.77
Max. Negotiated Rate	$79,562.42
Rate for Payer: EPIC Health Plan Medicare	$51,645.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$51,645.77
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$59,392.64
Rate for Payer: Molina Healthcare of CA Medi-Cal	$65,073.67
Rate for Payer: Molina Healthcare of CA Medicare	$65,073.67
Rate for Payer: Multiplan WC	$79,562.42

MS-DRG 42.00: KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC

Facility

$59,965.81

Service Code	MSDRG 651
Min. Negotiated Rate	$39,003.80
Max. Negotiated Rate	$59,965.81
Rate for Payer: EPIC Health Plan Medicare	$39,003.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,003.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$44,854.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$49,144.79
Rate for Payer: Molina Healthcare of CA Medicare	$49,144.79
Rate for Payer: Multiplan WC	$59,965.81

MS-DRG 42.00: KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC

Facility

$33,940.05

Service Code	MSDRG 488
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$33,940.05
Rate for Payer: EPIC Health Plan Medicare	$22,214.31
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,214.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,546.46
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,990.03
Rate for Payer: Molina Healthcare of CA Medicare	$27,990.03
Rate for Payer: Multiplan WC	$33,940.05

MS-DRG 42.00: KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

$21,385.65

Service Code	MSDRG 489
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$21,385.65
Rate for Payer: EPIC Health Plan Medicare	$14,115.37
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,115.37
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,232.68
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,785.37
Rate for Payer: Molina Healthcare of CA Medicare	$17,785.37
Rate for Payer: Multiplan WC	$21,385.65

MS-DRG 42.00: KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC

Facility

$36,625.33

Service Code	MSDRG 486
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$36,625.33
Rate for Payer: EPIC Health Plan Medicare	$23,946.65
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,946.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,538.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,172.78
Rate for Payer: Molina Healthcare of CA Medicare	$30,172.78
Rate for Payer: Multiplan WC	$36,625.33

MS-DRG 42.00: KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC

Facility

$55,593.36

Service Code	MSDRG 485
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$55,593.36
Rate for Payer: EPIC Health Plan Medicare	$36,183.09
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,183.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$41,610.55
Rate for Payer: Molina Healthcare of CA Medi-Cal	$45,590.69
Rate for Payer: Molina Healthcare of CA Medicare	$45,590.69
Rate for Payer: Multiplan WC	$55,593.36

MS-DRG 42.00: KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

$27,288.11

Service Code	MSDRG 487
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$27,288.11
Rate for Payer: EPIC Health Plan Medicare	$17,923.11
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,923.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,611.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,583.12
Rate for Payer: Molina Healthcare of CA Medicare	$22,583.12
Rate for Payer: Multiplan WC	$27,288.11

MS-DRG 42.00: LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC

Facility

$28,638.53

Service Code	MSDRG 418
Min. Negotiated Rate	$14,580.00
Max. Negotiated Rate	$28,638.53
Rate for Payer: EPIC Health Plan Medicare	$18,794.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,794.25
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,613.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,680.76
Rate for Payer: Molina Healthcare of CA Medicare	$23,680.76
Rate for Payer: Multiplan WC	$28,638.53

MS-DRG 42.00: LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC

Facility

$41,039.23

Service Code	MSDRG 417
Min. Negotiated Rate	$14,580.00
Max. Negotiated Rate	$41,039.23
Rate for Payer: EPIC Health Plan Medicare	$26,794.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,794.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,813.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$33,760.55
Rate for Payer: Molina Healthcare of CA Medicare	$33,760.55
Rate for Payer: Multiplan WC	$41,039.23

MS-DRG 42.00: LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$22,753.34

Service Code	MSDRG 419
Min. Negotiated Rate	$14,580.00
Max. Negotiated Rate	$22,753.34
Rate for Payer: EPIC Health Plan Medicare	$14,997.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,997.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,247.32
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,897.06
Rate for Payer: Molina Healthcare of CA Medicare	$18,897.06
Rate for Payer: Multiplan WC	$22,753.34

MS-DRG 42.00: LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$66,008.15

Service Code	MSDRG 956
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$66,008.15
Rate for Payer: EPIC Health Plan Medicare	$42,901.79
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$42,901.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$49,337.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$54,056.26
Rate for Payer: Molina Healthcare of CA Medicare	$54,056.26
Rate for Payer: Multiplan WC	$66,008.15

MS-DRG 42.00: LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT

Facility

$183,902.06

Service Code	MSDRG 005
Min. Negotiated Rate	$118,956.33
Max. Negotiated Rate	$183,902.06
Rate for Payer: EPIC Health Plan Medicare	$118,956.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$118,956.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$136,799.78
Rate for Payer: Molina Healthcare of CA Medi-Cal	$149,884.98
Rate for Payer: Molina Healthcare of CA Medicare	$149,884.98
Rate for Payer: Multiplan WC	$183,902.06

MS-DRG 42.00: LIVER TRANSPLANT WITHOUT MCC

Facility

$83,739.73

Service Code	MSDRG 006
Min. Negotiated Rate	$54,340.61
Max. Negotiated Rate	$83,739.73
Rate for Payer: EPIC Health Plan Medicare	$54,340.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$54,340.61
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$62,491.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$68,469.17
Rate for Payer: Molina Healthcare of CA Medicare	$68,469.17
Rate for Payer: Multiplan WC	$83,739.73

MS-DRG 42.00: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC

Facility

$34,071.29

Service Code	MSDRG 496
Min. Negotiated Rate	$22,298.99
Max. Negotiated Rate	$34,071.29
Rate for Payer: EPIC Health Plan Medicare	$22,298.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,298.99
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,643.84
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,096.73
Rate for Payer: Molina Healthcare of CA Medicare	$28,096.73
Rate for Payer: Multiplan WC	$34,071.29

MS-DRG 42.00: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC

Facility

$60,796.44

Service Code	MSDRG 495
Min. Negotiated Rate	$39,539.65
Max. Negotiated Rate	$60,796.44
Rate for Payer: EPIC Health Plan Medicare	$39,539.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,539.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$45,470.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$49,819.96
Rate for Payer: Molina Healthcare of CA Medicare	$49,819.96
Rate for Payer: Multiplan WC	$60,796.44

MS-DRG 42.00: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC

Facility

$23,185.06

Service Code	MSDRG 497
Min. Negotiated Rate	$15,276.18
Max. Negotiated Rate	$23,185.06
Rate for Payer: EPIC Health Plan Medicare	$15,276.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,276.18
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,567.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,247.99
Rate for Payer: Molina Healthcare of CA Medicare	$19,247.99
Rate for Payer: Multiplan WC	$23,185.06

MS-DRG 42.00: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC

Facility

$43,601.92

Service Code	MSDRG 498
Min. Negotiated Rate	$28,447.31
Max. Negotiated Rate	$43,601.92
Rate for Payer: EPIC Health Plan Medicare	$28,447.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,447.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,714.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,843.61
Rate for Payer: Molina Healthcare of CA Medicare	$35,843.61
Rate for Payer: Multiplan WC	$43,601.92

MS-DRG 42.00: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC

Facility

$20,045.59

Service Code	MSDRG 499
Min. Negotiated Rate	$13,250.88
Max. Negotiated Rate	$20,045.59
Rate for Payer: EPIC Health Plan Medicare	$13,250.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,250.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,238.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,696.11
Rate for Payer: Molina Healthcare of CA Medicare	$16,696.11
Rate for Payer: Multiplan WC	$20,045.59

MS-DRG 42.00: LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC

Facility

$41,462.32

Service Code	MSDRG 493
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$41,462.32
Rate for Payer: EPIC Health Plan Medicare	$27,067.00
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,067.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,127.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,104.42
Rate for Payer: Molina Healthcare of CA Medicare	$34,104.42
Rate for Payer: Multiplan WC	$41,462.32

MS-DRG 42.00: LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC

Facility

$61,324.86

Service Code	MSDRG 492
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$61,324.86
Rate for Payer: EPIC Health Plan Medicare	$39,880.53
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,880.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$45,862.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$50,249.47
Rate for Payer: Molina Healthcare of CA Medicare	$50,249.47
Rate for Payer: Multiplan WC	$61,324.86

MS-DRG 42.00: LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC

Facility

$32,558.54

Service Code	MSDRG 494
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$32,558.54
Rate for Payer: EPIC Health Plan Medicare	$21,323.10
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,323.10
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,521.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,867.11
Rate for Payer: Molina Healthcare of CA Medicare	$26,867.11
Rate for Payer: Multiplan WC	$32,558.54

MS-DRG 42.00: LUNG TRANSPLANT

Facility

$225,682.13

Service Code	MSDRG 007
Min. Negotiated Rate	$145,909.08
Max. Negotiated Rate	$225,682.13
Rate for Payer: EPIC Health Plan Medicare	$145,909.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$145,909.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$167,795.44
Rate for Payer: Molina Healthcare of CA Medi-Cal	$183,845.44
Rate for Payer: Molina Healthcare of CA Medicare	$183,845.44
Rate for Payer: Multiplan WC	$225,682.13

Know your out-of-pocket cost for care.

All Charges