Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC

Facility

$38,550.81

Service Code	MSDRG 821
Min. Negotiated Rate	$25,188.78
Max. Negotiated Rate	$38,550.81
Rate for Payer: EPIC Health Plan Medicare	$25,188.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,188.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,967.10
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,737.86
Rate for Payer: Molina Healthcare of CA Medicare	$31,737.86
Rate for Payer: Multiplan WC	$38,550.81

MS-DRG 42.00: LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC

Facility

$100,543.97

Service Code	MSDRG 820
Min. Negotiated Rate	$65,181.17
Max. Negotiated Rate	$100,543.97
Rate for Payer: EPIC Health Plan Medicare	$65,181.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$65,181.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$74,958.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$82,128.27
Rate for Payer: Molina Healthcare of CA Medicare	$82,128.27
Rate for Payer: Multiplan WC	$100,543.97

MS-DRG 42.00: LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC

Facility

$19,750.29

Service Code	MSDRG 822
Min. Negotiated Rate	$13,060.36
Max. Negotiated Rate	$19,750.29
Rate for Payer: EPIC Health Plan Medicare	$13,060.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,060.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,019.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,456.05
Rate for Payer: Molina Healthcare of CA Medicare	$16,456.05
Rate for Payer: Multiplan WC	$19,750.29

MS-DRG 42.00: LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC

Facility

$27,077.44

Service Code	MSDRG 841
Min. Negotiated Rate	$17,787.18
Max. Negotiated Rate	$27,077.44
Rate for Payer: EPIC Health Plan Medicare	$17,787.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,787.18
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,455.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,411.85
Rate for Payer: Molina Healthcare of CA Medicare	$22,411.85
Rate for Payer: Multiplan WC	$27,077.44

MS-DRG 42.00: LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC

Facility

$55,070.11

Service Code	MSDRG 840
Min. Negotiated Rate	$35,845.54
Max. Negotiated Rate	$55,070.11
Rate for Payer: EPIC Health Plan Medicare	$35,845.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,845.54
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$41,222.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$45,165.38
Rate for Payer: Molina Healthcare of CA Medicare	$45,165.38
Rate for Payer: Multiplan WC	$55,070.11

MS-DRG 42.00: LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC

Facility

$37,980.94

Service Code	MSDRG 824
Min. Negotiated Rate	$24,821.14
Max. Negotiated Rate	$37,980.94
Rate for Payer: EPIC Health Plan Medicare	$24,821.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,821.14
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,544.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,274.64
Rate for Payer: Molina Healthcare of CA Medicare	$31,274.64
Rate for Payer: Multiplan WC	$37,980.94

MS-DRG 42.00: LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC

Facility

$80,809.22

Service Code	MSDRG 823
Min. Negotiated Rate	$52,450.10
Max. Negotiated Rate	$80,809.22
Rate for Payer: EPIC Health Plan Medicare	$52,450.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$52,450.10
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$60,317.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$66,087.13
Rate for Payer: Molina Healthcare of CA Medicare	$66,087.13
Rate for Payer: Multiplan WC	$80,809.22

MS-DRG 42.00: LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC

Facility

$21,254.41

Service Code	MSDRG 825
Min. Negotiated Rate	$14,030.69
Max. Negotiated Rate	$21,254.41
Rate for Payer: EPIC Health Plan Medicare	$14,030.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,030.69
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,135.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,678.67
Rate for Payer: Molina Healthcare of CA Medicare	$17,678.67
Rate for Payer: Multiplan WC	$21,254.41

MS-DRG 42.00: LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC

Facility

$18,165.03

Service Code	MSDRG 842
Min. Negotiated Rate	$12,037.69
Max. Negotiated Rate	$18,165.03
Rate for Payer: EPIC Health Plan Medicare	$12,037.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,037.69
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,843.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,167.49
Rate for Payer: Molina Healthcare of CA Medicare	$15,167.49
Rate for Payer: Multiplan WC	$18,165.03

MS-DRG 42.00: MAJOR BLADDER PROCEDURES WITH CC

Facility

$48,734.20

Service Code	MSDRG 654
Min. Negotiated Rate	$31,758.19
Max. Negotiated Rate	$48,734.20
Rate for Payer: EPIC Health Plan Medicare	$31,758.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,758.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,521.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$40,015.32
Rate for Payer: Molina Healthcare of CA Medicare	$40,015.32
Rate for Payer: Multiplan WC	$48,734.20

MS-DRG 42.00: MAJOR BLADDER PROCEDURES WITH MCC

Facility

$96,266.50

Service Code	MSDRG 653
Min. Negotiated Rate	$62,421.74
Max. Negotiated Rate	$96,266.50
Rate for Payer: EPIC Health Plan Medicare	$62,421.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$62,421.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$71,785.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$78,651.39
Rate for Payer: Molina Healthcare of CA Medicare	$78,651.39
Rate for Payer: Multiplan WC	$96,266.50

MS-DRG 42.00: MAJOR BLADDER PROCEDURES WITHOUT CC/MCC

Facility

$35,872.42

Service Code	MSDRG 655
Min. Negotiated Rate	$23,460.93
Max. Negotiated Rate	$35,872.42
Rate for Payer: EPIC Health Plan Medicare	$23,460.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,460.93
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,980.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,560.77
Rate for Payer: Molina Healthcare of CA Medicare	$29,560.77
Rate for Payer: Multiplan WC	$35,872.42

MS-DRG 42.00: MAJOR CHEST PROCEDURES WITH CC

Facility

$43,465.50

Service Code	MSDRG 164
Min. Negotiated Rate	$28,359.29
Max. Negotiated Rate	$43,465.50
Rate for Payer: EPIC Health Plan Medicare	$28,359.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,359.29
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,613.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,732.71
Rate for Payer: Molina Healthcare of CA Medicare	$35,732.71
Rate for Payer: Multiplan WC	$43,465.50

MS-DRG 42.00: MAJOR CHEST PROCEDURES WITH MCC

Facility

$79,595.23

Service Code	MSDRG 163
Min. Negotiated Rate	$51,666.93
Max. Negotiated Rate	$79,595.23
Rate for Payer: EPIC Health Plan Medicare	$51,666.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$51,666.93
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$59,416.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$65,100.33
Rate for Payer: Molina Healthcare of CA Medicare	$65,100.33
Rate for Payer: Multiplan WC	$79,595.23

MS-DRG 42.00: MAJOR CHEST PROCEDURES WITHOUT CC/MCC

Facility

$32,188.99

Service Code	MSDRG 165
Min. Negotiated Rate	$21,084.69
Max. Negotiated Rate	$32,188.99
Rate for Payer: EPIC Health Plan Medicare	$21,084.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,084.69
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,247.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,566.71
Rate for Payer: Molina Healthcare of CA Medicare	$26,566.71
Rate for Payer: Multiplan WC	$32,188.99

MS-DRG 42.00: MAJOR CHEST TRAUMA WITH CC

Facility

$18,444.78

Service Code	MSDRG 184
Min. Negotiated Rate	$12,218.19
Max. Negotiated Rate	$18,444.78
Rate for Payer: EPIC Health Plan Medicare	$12,218.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,218.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,050.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,394.92
Rate for Payer: Molina Healthcare of CA Medicare	$15,394.92
Rate for Payer: Multiplan WC	$18,444.78

MS-DRG 42.00: MAJOR CHEST TRAUMA WITH MCC

Facility

$27,410.72

Service Code	MSDRG 183
Min. Negotiated Rate	$18,002.19
Max. Negotiated Rate	$27,410.72
Rate for Payer: EPIC Health Plan Medicare	$18,002.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,002.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,702.52
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,682.76
Rate for Payer: Molina Healthcare of CA Medicare	$22,682.76
Rate for Payer: Multiplan WC	$27,410.72

MS-DRG 42.00: MAJOR CHEST TRAUMA WITHOUT CC/MCC

Facility

$13,429.92

Service Code	MSDRG 185
Min. Negotiated Rate	$8,983.04
Max. Negotiated Rate	$13,429.92
Rate for Payer: EPIC Health Plan Medicare	$8,983.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,983.04
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,330.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,318.63
Rate for Payer: Molina Healthcare of CA Medicare	$11,318.63
Rate for Payer: Multiplan WC	$13,429.92

MS-DRG 42.00: MAJOR ESOPHAGEAL DISORDERS WITH CC

Facility

$17,572.70

Service Code	MSDRG 369
Min. Negotiated Rate	$11,655.59
Max. Negotiated Rate	$17,572.70
Rate for Payer: EPIC Health Plan Medicare	$11,655.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,655.59
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,403.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,686.04
Rate for Payer: Molina Healthcare of CA Medicare	$14,686.04
Rate for Payer: Multiplan WC	$17,572.70

MS-DRG 42.00: MAJOR ESOPHAGEAL DISORDERS WITH MCC

Facility

$28,838.85

Service Code	MSDRG 368
Min. Negotiated Rate	$18,923.49
Max. Negotiated Rate	$28,838.85
Rate for Payer: EPIC Health Plan Medicare	$18,923.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,923.49
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,762.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,843.60
Rate for Payer: Molina Healthcare of CA Medicare	$23,843.60
Rate for Payer: Multiplan WC	$28,838.85

MS-DRG 42.00: MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC

Facility

$12,053.60

Service Code	MSDRG 370
Min. Negotiated Rate	$8,095.17
Max. Negotiated Rate	$12,053.60
Rate for Payer: EPIC Health Plan Medicare	$8,095.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,095.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,309.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,199.91
Rate for Payer: Molina Healthcare of CA Medicare	$10,199.91
Rate for Payer: Multiplan WC	$12,053.60

MS-DRG 42.00: MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC

Facility

$17,774.75

Service Code	MSDRG 372
Min. Negotiated Rate	$11,785.93
Max. Negotiated Rate	$17,774.75
Rate for Payer: EPIC Health Plan Medicare	$11,785.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,785.93
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,553.82
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,850.27
Rate for Payer: Molina Healthcare of CA Medicare	$14,850.27
Rate for Payer: Multiplan WC	$17,774.75

MS-DRG 42.00: MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC

Facility

$30,185.81

Service Code	MSDRG 371
Min. Negotiated Rate	$19,792.43
Max. Negotiated Rate	$30,185.81
Rate for Payer: EPIC Health Plan Medicare	$19,792.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,792.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,761.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,938.46
Rate for Payer: Molina Healthcare of CA Medicare	$24,938.46
Rate for Payer: Multiplan WC	$30,185.81

MS-DRG 42.00: MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC

Facility

$12,526.77

Service Code	MSDRG 373
Min. Negotiated Rate	$8,400.41
Max. Negotiated Rate	$12,526.77
Rate for Payer: EPIC Health Plan Medicare	$8,400.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,400.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,660.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,584.52
Rate for Payer: Molina Healthcare of CA Medicare	$10,584.52
Rate for Payer: Multiplan WC	$12,526.77

MS-DRG 42.00: MAJOR HEAD AND NECK PROCEDURES WITH CC

Facility

$37,101.96

Service Code	MSDRG 141
Min. Negotiated Rate	$24,254.09
Max. Negotiated Rate	$37,101.96
Rate for Payer: EPIC Health Plan Medicare	$24,254.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,254.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,892.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,560.15
Rate for Payer: Molina Healthcare of CA Medicare	$30,560.15
Rate for Payer: Multiplan WC	$37,101.96

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