Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

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

Facility

$73,033.09

Service Code	MSDRG 140
Min. Negotiated Rate	$47,433.63
Max. Negotiated Rate	$73,033.09
Rate for Payer: EPIC Health Plan Medicare	$47,433.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$47,433.63
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$54,548.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$59,766.37
Rate for Payer: Molina Healthcare of CA Medicare	$59,766.37
Rate for Payer: Multiplan WC	$73,033.09

MS-DRG 42.00: MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC

Facility

$27,153.42

Service Code	MSDRG 142
Min. Negotiated Rate	$17,836.20
Max. Negotiated Rate	$27,153.42
Rate for Payer: EPIC Health Plan Medicare	$17,836.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,836.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,511.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,473.61
Rate for Payer: Molina Healthcare of CA Medicare	$22,473.61
Rate for Payer: Multiplan WC	$27,153.42

MS-DRG 42.00: MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC

Facility

$21,387.37

Service Code	MSDRG 809
Min. Negotiated Rate	$14,116.46
Max. Negotiated Rate	$21,387.37
Rate for Payer: EPIC Health Plan Medicare	$14,116.46
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,116.46
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,233.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,786.74
Rate for Payer: Molina Healthcare of CA Medicare	$17,786.74
Rate for Payer: Multiplan WC	$21,387.37

MS-DRG 42.00: MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC

Facility

$39,550.67

Service Code	MSDRG 808
Min. Negotiated Rate	$25,833.79
Max. Negotiated Rate	$39,550.67
Rate for Payer: EPIC Health Plan Medicare	$25,833.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,833.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,708.86
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,550.58
Rate for Payer: Molina Healthcare of CA Medicare	$32,550.58
Rate for Payer: Multiplan WC	$39,550.67

MS-DRG 42.00: MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC

Facility

$16,436.41

Service Code	MSDRG 810
Min. Negotiated Rate	$10,922.57
Max. Negotiated Rate	$16,436.41
Rate for Payer: EPIC Health Plan Medicare	$10,922.57
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,922.57
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,560.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,762.44
Rate for Payer: Molina Healthcare of CA Medicare	$13,762.44
Rate for Payer: Multiplan WC	$16,436.41

MS-DRG 42.00: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT

Facility

$56,446.43

Service Code	MSDRG 469
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$56,446.43
Rate for Payer: EPIC Health Plan Medicare	$36,733.44
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	$36,733.44
Rate for Payer: Kaiser Permanente of CA Commercial	$9,944.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,243.46
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,284.13
Rate for Payer: Molina Healthcare of CA Medicare	$46,284.13
Rate for Payer: Multiplan WC	$56,446.43

MS-DRG 42.00: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC

Facility

$32,560.27

Service Code	MSDRG 470
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$32,560.27
Rate for Payer: EPIC Health Plan Medicare	$21,324.23
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	$21,324.23
Rate for Payer: Kaiser Permanente of CA Commercial	$9,944.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,522.86
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,868.53
Rate for Payer: Molina Healthcare of CA Medicare	$26,868.53
Rate for Payer: Multiplan WC	$32,560.27

MS-DRG 42.00: MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES

Facility

$44,004.28

Service Code	MSDRG 483
Min. Negotiated Rate	$28,706.86
Max. Negotiated Rate	$44,004.28
Rate for Payer: EPIC Health Plan Medicare	$28,706.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,706.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,012.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$36,170.64
Rate for Payer: Molina Healthcare of CA Medicare	$36,170.64
Rate for Payer: Multiplan WC	$44,004.28

MS-DRG 42.00: MAJOR MALE PELVIC PROCEDURES WITH CC/MCC

Facility

$33,511.78

Service Code	MSDRG 707
Min. Negotiated Rate	$16,674.00
Max. Negotiated Rate	$33,511.78
Rate for Payer: EPIC Health Plan Medicare	$21,938.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,938.04
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,228.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,641.93
Rate for Payer: Molina Healthcare of CA Medicare	$27,641.93
Rate for Payer: Multiplan WC	$33,511.78
Rate for Payer: United Healthcare All Other HMO/non HMO	$19,873.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$16,674.00

MS-DRG 42.00: MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC

Facility

$25,600.95

Service Code	MSDRG 708
Min. Negotiated Rate	$16,674.00
Max. Negotiated Rate	$25,600.95
Rate for Payer: EPIC Health Plan Medicare	$16,834.68
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,834.68
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,359.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,211.70
Rate for Payer: Molina Healthcare of CA Medicare	$21,211.70
Rate for Payer: Multiplan WC	$25,600.95
Rate for Payer: United Healthcare All Other HMO/non HMO	$19,873.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$16,674.00

MS-DRG 42.00: MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC

Facility

$33,470.33

Service Code	MSDRG 507
Min. Negotiated Rate	$21,911.31
Max. Negotiated Rate	$33,470.33
Rate for Payer: EPIC Health Plan Medicare	$21,911.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,911.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,198.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,608.25
Rate for Payer: Molina Healthcare of CA Medicare	$27,608.25
Rate for Payer: Multiplan WC	$33,470.33

MS-DRG 42.00: MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC

Facility

$22,287.08

Service Code	MSDRG 508
Min. Negotiated Rate	$14,696.89
Max. Negotiated Rate	$22,287.08
Rate for Payer: EPIC Health Plan Medicare	$14,696.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,696.89
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,901.42
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,518.08
Rate for Payer: Molina Healthcare of CA Medicare	$18,518.08
Rate for Payer: Multiplan WC	$22,287.08

MS-DRG 42.00: MAJOR SKIN DISORDERS WITH MCC

Facility

$36,525.18

Service Code	MSDRG 595
Min. Negotiated Rate	$23,882.01
Max. Negotiated Rate	$36,525.18
Rate for Payer: EPIC Health Plan Medicare	$23,882.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,882.01
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,464.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,091.33
Rate for Payer: Molina Healthcare of CA Medicare	$30,091.33
Rate for Payer: Multiplan WC	$36,525.18

MS-DRG 42.00: MAJOR SKIN DISORDERS WITHOUT MCC

Facility

$18,669.26

Service Code	MSDRG 596
Min. Negotiated Rate	$12,362.99
Max. Negotiated Rate	$18,669.26
Rate for Payer: EPIC Health Plan Medicare	$12,362.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,362.99
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,217.44
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,577.37
Rate for Payer: Molina Healthcare of CA Medicare	$15,577.37
Rate for Payer: Multiplan WC	$18,669.26

MS-DRG 42.00: MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC

Facility

$40,818.20

Service Code	MSDRG 330
Min. Negotiated Rate	$26,651.49
Max. Negotiated Rate	$40,818.20
Rate for Payer: EPIC Health Plan Medicare	$26,651.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,651.49
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,649.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$33,580.88
Rate for Payer: Molina Healthcare of CA Medicare	$33,580.88
Rate for Payer: Multiplan WC	$40,818.20

MS-DRG 42.00: MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC

Facility

$79,296.47

Service Code	MSDRG 329
Min. Negotiated Rate	$51,474.20
Max. Negotiated Rate	$79,296.47
Rate for Payer: EPIC Health Plan Medicare	$51,474.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$51,474.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$59,195.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$64,857.49
Rate for Payer: Molina Healthcare of CA Medicare	$64,857.49
Rate for Payer: Multiplan WC	$79,296.47

MS-DRG 42.00: MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC

Facility

$28,510.74

Service Code	MSDRG 331
Min. Negotiated Rate	$18,711.85
Max. Negotiated Rate	$28,510.74
Rate for Payer: EPIC Health Plan Medicare	$18,711.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,711.85
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,518.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,576.93
Rate for Payer: Molina Healthcare of CA Medicare	$23,576.93
Rate for Payer: Multiplan WC	$28,510.74

MS-DRG 42.00: MAJOR THUMB OR JOINT PROCEDURES

Facility

$25,887.61

Service Code	MSDRG 506
Min. Negotiated Rate	$17,019.62
Max. Negotiated Rate	$25,887.61
Rate for Payer: EPIC Health Plan Medicare	$17,019.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,019.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,572.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,444.72
Rate for Payer: Molina Healthcare of CA Medicare	$21,444.72
Rate for Payer: Multiplan WC	$25,887.61

MS-DRG 42.00: MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC

Facility

$19,170.06

Service Code	MSDRG 755
Min. Negotiated Rate	$12,686.05
Max. Negotiated Rate	$19,170.06
Rate for Payer: EPIC Health Plan Medicare	$12,686.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,686.05
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,588.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,984.42
Rate for Payer: Molina Healthcare of CA Medicare	$15,984.42
Rate for Payer: Multiplan WC	$19,170.06

MS-DRG 42.00: MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$31,244.39

Service Code	MSDRG 754
Min. Negotiated Rate	$20,475.32
Max. Negotiated Rate	$31,244.39
Rate for Payer: EPIC Health Plan Medicare	$20,475.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,475.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,546.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,798.90
Rate for Payer: Molina Healthcare of CA Medicare	$25,798.90
Rate for Payer: Multiplan WC	$31,244.39

MS-DRG 42.00: MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility

$16,491.68

Service Code	MSDRG 756
Min. Negotiated Rate	$10,958.20
Max. Negotiated Rate	$16,491.68
Rate for Payer: EPIC Health Plan Medicare	$10,958.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,958.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,601.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,807.33
Rate for Payer: Molina Healthcare of CA Medicare	$13,807.33
Rate for Payer: Multiplan WC	$16,491.68

MS-DRG 42.00: MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC

Facility

$19,391.10

Service Code	MSDRG 723
Min. Negotiated Rate	$12,828.66
Max. Negotiated Rate	$19,391.10
Rate for Payer: EPIC Health Plan Medicare	$12,828.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,828.66
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,752.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,164.11
Rate for Payer: Molina Healthcare of CA Medicare	$16,164.11
Rate for Payer: Multiplan WC	$19,391.10

MS-DRG 42.00: MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$29,855.98

Service Code	MSDRG 722
Min. Negotiated Rate	$19,579.67
Max. Negotiated Rate	$29,855.98
Rate for Payer: EPIC Health Plan Medicare	$19,579.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,579.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,516.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,670.38
Rate for Payer: Molina Healthcare of CA Medicare	$24,670.38
Rate for Payer: Multiplan WC	$29,855.98

MS-DRG 42.00: MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility

$12,582.02

Service Code	MSDRG 724
Min. Negotiated Rate	$8,436.06
Max. Negotiated Rate	$12,582.02
Rate for Payer: EPIC Health Plan Medicare	$8,436.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,436.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,701.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,629.44
Rate for Payer: Molina Healthcare of CA Medicare	$10,629.44
Rate for Payer: Multiplan WC	$12,582.02

MS-DRG 42.00: MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC

Facility

$19,473.99

Service Code	MSDRG 436
Min. Negotiated Rate	$12,882.14
Max. Negotiated Rate	$19,473.99
Rate for Payer: EPIC Health Plan Medicare	$12,882.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,882.14
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,814.46
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,231.50
Rate for Payer: Molina Healthcare of CA Medicare	$16,231.50
Rate for Payer: Multiplan WC	$19,473.99

Know your out-of-pocket cost for care.

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