Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

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

Facility

$31,508.60

Service Code	MSDRG 435
Min. Negotiated Rate	$20,645.77
Max. Negotiated Rate	$31,508.60
Rate for Payer: EPIC Health Plan Medicare	$20,645.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,645.77
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,742.64
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,013.67
Rate for Payer: Molina Healthcare of CA Medicare	$26,013.67
Rate for Payer: Multiplan WC	$31,508.60

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

Facility

$13,559.44

Service Code	MSDRG 437
Min. Negotiated Rate	$9,066.60
Max. Negotiated Rate	$13,559.44
Rate for Payer: EPIC Health Plan Medicare	$9,066.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,066.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,426.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,423.92
Rate for Payer: Molina Healthcare of CA Medicare	$11,423.92
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	$12,338.48
Max. Negotiated Rate	$18,631.28
Rate for Payer: EPIC Health Plan Medicare	$12,338.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,338.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,189.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,546.48
Rate for Payer: Molina Healthcare of CA Medicare	$15,546.48
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	$19,889.36
Max. Negotiated Rate	$30,336.06
Rate for Payer: EPIC Health Plan Medicare	$19,889.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,889.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,872.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,060.59
Rate for Payer: Molina Healthcare of CA Medicare	$25,060.59
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	$9,843.07
Max. Negotiated Rate	$14,763.07
Rate for Payer: EPIC Health Plan Medicare	$9,843.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,843.07
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,319.53
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,402.27
Rate for Payer: Molina Healthcare of CA Medicare	$12,402.27
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	$19,828.08
Max. Negotiated Rate	$30,241.08
Rate for Payer: EPIC Health Plan Medicare	$19,828.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,828.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,802.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,983.38
Rate for Payer: Molina Healthcare of CA Medicare	$24,983.38
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	$18,619.36
Max. Negotiated Rate	$28,367.41
Rate for Payer: EPIC Health Plan Medicare	$18,619.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,619.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,412.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,460.39
Rate for Payer: Molina Healthcare of CA Medicare	$23,460.39
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	$19,329.00
Max. Negotiated Rate	$29,467.43
Rate for Payer: EPIC Health Plan Medicare	$19,329.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,329.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,228.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,354.54
Rate for Payer: Molina Healthcare of CA Medicare	$24,354.54
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	$11,056.25
Max. Negotiated Rate	$16,643.64
Rate for Payer: EPIC Health Plan Medicare	$11,056.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,056.25
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,714.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,930.88
Rate for Payer: Molina Healthcare of CA Medicare	$13,930.88
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	$11,299.09
Max. Negotiated Rate	$17,020.10
Rate for Payer: EPIC Health Plan Medicare	$11,299.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,299.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,993.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,236.85
Rate for Payer: Molina Healthcare of CA Medicare	$14,236.85
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	$7,381.07
Max. Negotiated Rate	$10,946.68
Rate for Payer: EPIC Health Plan Medicare	$7,381.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,381.07
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,488.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,300.15
Rate for Payer: Molina Healthcare of CA Medicare	$9,300.15
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	$17,334.88
Max. Negotiated Rate	$26,376.32
Rate for Payer: EPIC Health Plan Medicare	$17,334.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,334.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,935.11
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,841.95
Rate for Payer: Molina Healthcare of CA Medicare	$21,841.95
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	$35,072.42
Max. Negotiated Rate	$53,871.66
Rate for Payer: EPIC Health Plan Medicare	$35,072.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,072.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,333.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$44,191.25
Rate for Payer: Molina Healthcare of CA Medicare	$44,191.25
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	$12,348.52
Max. Negotiated Rate	$18,646.82
Rate for Payer: EPIC Health Plan Medicare	$12,348.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,348.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,200.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,559.14
Rate for Payer: Molina Healthcare of CA Medicare	$15,559.14
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	$18,258.42
Max. Negotiated Rate	$27,807.90
Rate for Payer: EPIC Health Plan Medicare	$18,258.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,258.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,997.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,005.61
Rate for Payer: Molina Healthcare of CA Medicare	$23,005.61
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	$9,946.65
Max. Negotiated Rate	$14,923.68
Rate for Payer: EPIC Health Plan Medicare	$9,946.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,946.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,438.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,532.78
Rate for Payer: Molina Healthcare of CA Medicare	$12,532.78
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	$16,903.77
Max. Negotiated Rate	$25,708.02
Rate for Payer: EPIC Health Plan Medicare	$16,903.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,903.77
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,439.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,298.75
Rate for Payer: Molina Healthcare of CA Medicare	$21,298.75
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	$30,336.67
Max. Negotiated Rate	$46,530.70
Rate for Payer: EPIC Health Plan Medicare	$30,336.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,336.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,887.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,224.20
Rate for Payer: Molina Healthcare of CA Medicare	$38,224.20
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	$14,192.23
Max. Negotiated Rate	$21,504.81
Rate for Payer: EPIC Health Plan Medicare	$14,192.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,192.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,321.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,882.21
Rate for Payer: Molina Healthcare of CA Medicare	$17,882.21
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	$15,113.52
Max. Negotiated Rate	$22,932.93
Rate for Payer: EPIC Health Plan Medicare	$15,113.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,113.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,380.55
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,043.04
Rate for Payer: Molina Healthcare of CA Medicare	$19,043.04
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	$9,024.25
Max. Negotiated Rate	$13,493.82
Rate for Payer: EPIC Health Plan Medicare	$9,024.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,024.25
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,377.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,370.56
Rate for Payer: Molina Healthcare of CA Medicare	$11,370.56
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	$15,900.02
Max. Negotiated Rate	$24,152.10
Rate for Payer: EPIC Health Plan Medicare	$15,900.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,900.02
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,285.02
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,034.03
Rate for Payer: Molina Healthcare of CA Medicare	$20,034.03
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	$9,381.86
Max. Negotiated Rate	$14,048.14
Rate for Payer: EPIC Health Plan Medicare	$9,381.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,381.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,789.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,821.14
Rate for Payer: Molina Healthcare of CA Medicare	$11,821.14
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	$79,445.17
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	$79,445.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$91,361.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$100,100.91
Rate for Payer: Molina Healthcare of CA Medicare	$100,100.91
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	$117,017.94
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	$117,017.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$134,570.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$147,442.60
Rate for Payer: Molina Healthcare of CA Medicare	$147,442.60
Rate for Payer: Multiplan WC	$180,897.30

Know your out-of-pocket cost for care.

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