Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC

Facility

$13,559.44

Service Code	MSDRG 437
Min. Negotiated Rate	$9,066.56
Max. Negotiated Rate	$13,559.44
Rate for Payer: EPIC Health Plan Medicare	$9,066.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,066.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,426.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,423.87
Rate for Payer: Molina Healthcare of CA Medicare	$11,423.87
Rate for Payer: Multiplan WC	$13,559.44

MS-DRG 42.00: MALIGNANT BREAST DISORDERS WITH CC

Facility

$18,631.28

Service Code	MSDRG 598
Min. Negotiated Rate	$12,338.44
Max. Negotiated Rate	$18,631.28
Rate for Payer: EPIC Health Plan Medicare	$12,338.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,338.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,189.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,546.43
Rate for Payer: Molina Healthcare of CA Medicare	$15,546.43
Rate for Payer: Multiplan WC	$18,631.28

MS-DRG 42.00: MALIGNANT BREAST DISORDERS WITH MCC

Facility

$30,336.06

Service Code	MSDRG 597
Min. Negotiated Rate	$19,889.32
Max. Negotiated Rate	$30,336.06
Rate for Payer: EPIC Health Plan Medicare	$19,889.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,889.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,872.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,060.54
Rate for Payer: Molina Healthcare of CA Medicare	$25,060.54
Rate for Payer: Multiplan WC	$30,336.06

MS-DRG 42.00: MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility

$14,763.07

Service Code	MSDRG 599
Min. Negotiated Rate	$9,843.03
Max. Negotiated Rate	$14,763.07
Rate for Payer: EPIC Health Plan Medicare	$9,843.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,843.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,319.48
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,402.22
Rate for Payer: Molina Healthcare of CA Medicare	$12,402.22
Rate for Payer: Multiplan WC	$14,763.07

MS-DRG 42.00: MASTECTOMY FOR MALIGNANCY WITH CC/MCC

Facility

$30,241.08

Service Code	MSDRG 582
Min. Negotiated Rate	$19,828.04
Max. Negotiated Rate	$30,241.08
Rate for Payer: EPIC Health Plan Medicare	$19,828.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,828.04
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,802.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,983.33
Rate for Payer: Molina Healthcare of CA Medicare	$24,983.33
Rate for Payer: Multiplan WC	$30,241.08

MS-DRG 42.00: MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC

Facility

$28,367.41

Service Code	MSDRG 583
Min. Negotiated Rate	$18,619.32
Max. Negotiated Rate	$28,367.41
Rate for Payer: EPIC Health Plan Medicare	$18,619.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,619.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,412.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,460.34
Rate for Payer: Molina Healthcare of CA Medicare	$23,460.34
Rate for Payer: Multiplan WC	$28,367.41

MS-DRG 42.00: MEDICAL BACK PROBLEMS WITH MCC

Facility

$29,467.43

Service Code	MSDRG 551
Min. Negotiated Rate	$19,328.96
Max. Negotiated Rate	$29,467.43
Rate for Payer: EPIC Health Plan Medicare	$19,328.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,328.96
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,228.30
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,354.49
Rate for Payer: Molina Healthcare of CA Medicare	$24,354.49
Rate for Payer: Multiplan WC	$29,467.43

MS-DRG 42.00: MEDICAL BACK PROBLEMS WITHOUT MCC

Facility

$16,643.64

Service Code	MSDRG 552
Min. Negotiated Rate	$11,056.21
Max. Negotiated Rate	$16,643.64
Rate for Payer: EPIC Health Plan Medicare	$11,056.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,056.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,714.64
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,930.82
Rate for Payer: Molina Healthcare of CA Medicare	$13,930.82
Rate for Payer: Multiplan WC	$16,643.64

MS-DRG 42.00: MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC

Facility

$17,020.10

Service Code	MSDRG 760
Min. Negotiated Rate	$11,299.05
Max. Negotiated Rate	$17,020.10
Rate for Payer: EPIC Health Plan Medicare	$11,299.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,299.05
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,993.91
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,236.80
Rate for Payer: Molina Healthcare of CA Medicare	$14,236.80
Rate for Payer: Multiplan WC	$17,020.10

MS-DRG 42.00: MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC

Facility

$10,946.68

Service Code	MSDRG 761
Min. Negotiated Rate	$7,381.03
Max. Negotiated Rate	$10,946.68
Rate for Payer: EPIC Health Plan Medicare	$7,381.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,381.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,488.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,300.10
Rate for Payer: Molina Healthcare of CA Medicare	$9,300.10
Rate for Payer: Multiplan WC	$10,946.68

MS-DRG 42.00: MINOR BLADDER PROCEDURES WITH CC

Facility

$26,376.32

Service Code	MSDRG 663
Min. Negotiated Rate	$17,334.84
Max. Negotiated Rate	$26,376.32
Rate for Payer: EPIC Health Plan Medicare	$17,334.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,334.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,935.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,841.90
Rate for Payer: Molina Healthcare of CA Medicare	$21,841.90
Rate for Payer: Multiplan WC	$26,376.32

MS-DRG 42.00: MINOR BLADDER PROCEDURES WITH MCC

Facility

$53,871.66

Service Code	MSDRG 662
Min. Negotiated Rate	$35,072.38
Max. Negotiated Rate	$53,871.66
Rate for Payer: EPIC Health Plan Medicare	$35,072.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,072.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,333.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$44,191.20
Rate for Payer: Molina Healthcare of CA Medicare	$44,191.20
Rate for Payer: Multiplan WC	$53,871.66

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

Facility

$18,646.82

Service Code	MSDRG 664
Min. Negotiated Rate	$12,348.48
Max. Negotiated Rate	$18,646.82
Rate for Payer: EPIC Health Plan Medicare	$12,348.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,348.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,200.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,559.08
Rate for Payer: Molina Healthcare of CA Medicare	$15,559.08
Rate for Payer: Multiplan WC	$18,646.82

MS-DRG 42.00: MINOR SKIN DISORDERS WITH MCC

Facility

$27,807.90

Service Code	MSDRG 606
Min. Negotiated Rate	$18,258.38
Max. Negotiated Rate	$27,807.90
Rate for Payer: EPIC Health Plan Medicare	$18,258.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,258.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,997.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,005.56
Rate for Payer: Molina Healthcare of CA Medicare	$23,005.56
Rate for Payer: Multiplan WC	$27,807.90

MS-DRG 42.00: MINOR SKIN DISORDERS WITHOUT MCC

Facility

$14,923.68

Service Code	MSDRG 607
Min. Negotiated Rate	$9,946.61
Max. Negotiated Rate	$14,923.68
Rate for Payer: EPIC Health Plan Medicare	$9,946.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,946.61
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,438.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,532.73
Rate for Payer: Molina Healthcare of CA Medicare	$12,532.73
Rate for Payer: Multiplan WC	$14,923.68

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

Facility

$25,708.02

Service Code	MSDRG 345
Min. Negotiated Rate	$16,903.73
Max. Negotiated Rate	$25,708.02
Rate for Payer: EPIC Health Plan Medicare	$16,903.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,903.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,439.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,298.70
Rate for Payer: Molina Healthcare of CA Medicare	$21,298.70
Rate for Payer: Multiplan WC	$25,708.02

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

Facility

$46,530.70

Service Code	MSDRG 344
Min. Negotiated Rate	$30,336.63
Max. Negotiated Rate	$46,530.70
Rate for Payer: EPIC Health Plan Medicare	$30,336.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,336.63
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,887.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,224.15
Rate for Payer: Molina Healthcare of CA Medicare	$38,224.15
Rate for Payer: Multiplan WC	$46,530.70

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

Facility

$21,504.81

Service Code	MSDRG 346
Min. Negotiated Rate	$14,192.19
Max. Negotiated Rate	$21,504.81
Rate for Payer: EPIC Health Plan Medicare	$14,192.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,192.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,321.02
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,882.16
Rate for Payer: Molina Healthcare of CA Medicare	$17,882.16
Rate for Payer: Multiplan WC	$21,504.81

MS-DRG 42.00: MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC

Facility

$22,932.93

Service Code	MSDRG 640
Min. Negotiated Rate	$15,113.48
Max. Negotiated Rate	$22,932.93
Rate for Payer: EPIC Health Plan Medicare	$15,113.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,113.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,380.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,042.98
Rate for Payer: Molina Healthcare of CA Medicare	$19,042.98
Rate for Payer: Multiplan WC	$22,932.93

MS-DRG 42.00: MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC

Facility

$13,493.82

Service Code	MSDRG 641
Min. Negotiated Rate	$9,024.21
Max. Negotiated Rate	$13,493.82
Rate for Payer: EPIC Health Plan Medicare	$9,024.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,024.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,377.84
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,370.50
Rate for Payer: Molina Healthcare of CA Medicare	$11,370.50
Rate for Payer: Multiplan WC	$13,493.82

MS-DRG 42.00: MOUTH PROCEDURES WITH CC/MCC

Facility

$24,152.10

Service Code	MSDRG 137
Min. Negotiated Rate	$15,899.98
Max. Negotiated Rate	$24,152.10
Rate for Payer: EPIC Health Plan Medicare	$15,899.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,899.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,284.98
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,033.97
Rate for Payer: Molina Healthcare of CA Medicare	$20,033.97
Rate for Payer: Multiplan WC	$24,152.10

MS-DRG 42.00: MOUTH PROCEDURES WITHOUT CC/MCC

Facility

$14,048.14

Service Code	MSDRG 138
Min. Negotiated Rate	$9,381.82
Max. Negotiated Rate	$14,048.14
Rate for Payer: EPIC Health Plan Medicare	$9,381.82
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,381.82
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,789.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,821.09
Rate for Payer: Molina Healthcare of CA Medicare	$11,821.09
Rate for Payer: Multiplan WC	$14,048.14

MS-DRG 42.00: MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC

Facility

$122,654.91

Service Code	MSDRG 427
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$122,654.91
Rate for Payer: EPIC Health Plan Medicare	$79,445.13
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	$79,445.13
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$91,361.90
Rate for Payer: Molina Healthcare of CA Medi-Cal	$100,100.86
Rate for Payer: Molina Healthcare of CA Medicare	$100,100.86
Rate for Payer: Multiplan WC	$122,654.91

MS-DRG 42.00: MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE

Facility

$180,897.30

Service Code	MSDRG 426
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$180,897.30
Rate for Payer: EPIC Health Plan Medicare	$117,017.90
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	$117,017.90
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$134,570.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$147,442.55
Rate for Payer: Molina Healthcare of CA Medicare	$147,442.55
Rate for Payer: Multiplan WC	$180,897.30

MS-DRG 42.00: MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC

Facility

$95,049.04

Service Code	MSDRG 428
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$95,049.04
Rate for Payer: EPIC Health Plan Medicare	$61,636.31
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	$61,636.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$70,881.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$77,661.75
Rate for Payer: Molina Healthcare of CA Medicare	$77,661.75
Rate for Payer: Multiplan WC	$95,049.04

Know your out-of-pocket cost for care.

All Charges