Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

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

Facility

$115,781.93

Service Code	MSDRG 447
Min. Negotiated Rate	$75,011.31
Max. Negotiated Rate	$115,781.93
Rate for Payer: EPIC Health Plan Medicare	$75,011.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$75,011.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$86,263.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$94,514.25
Rate for Payer: Molina Healthcare of CA Medicare	$94,514.25
Rate for Payer: Multiplan WC	$115,781.93

MS-DRG 42.00: MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC

Facility

$70,517.03

Service Code	MSDRG 448
Min. Negotiated Rate	$45,810.46
Max. Negotiated Rate	$70,517.03
Rate for Payer: EPIC Health Plan Medicare	$45,810.46
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$45,810.46
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$52,682.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$57,721.18
Rate for Payer: Molina Healthcare of CA Medicare	$57,721.18
Rate for Payer: Multiplan WC	$70,517.03

MS-DRG 42.00: MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC

Facility

$21,130.07

Service Code	MSDRG 059
Min. Negotiated Rate	$13,950.44
Max. Negotiated Rate	$21,130.07
Rate for Payer: EPIC Health Plan Medicare	$13,950.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,950.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,043.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,577.55
Rate for Payer: Molina Healthcare of CA Medicare	$17,577.55
Rate for Payer: Multiplan WC	$21,130.07

MS-DRG 42.00: MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC

Facility

$31,876.43

Service Code	MSDRG 058
Min. Negotiated Rate	$20,883.03
Max. Negotiated Rate	$31,876.43
Rate for Payer: EPIC Health Plan Medicare	$20,883.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,883.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,015.48
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,312.62
Rate for Payer: Molina Healthcare of CA Medicare	$26,312.62
Rate for Payer: Multiplan WC	$31,876.43

MS-DRG 42.00: MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC

Facility

$15,410.66

Service Code	MSDRG 060
Min. Negotiated Rate	$10,260.79
Max. Negotiated Rate	$15,410.66
Rate for Payer: EPIC Health Plan Medicare	$10,260.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,260.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,799.91
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,928.60
Rate for Payer: Molina Healthcare of CA Medicare	$12,928.60
Rate for Payer: Multiplan WC	$15,410.66

MS-DRG 42.00: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC

Facility

$40,752.57

Service Code	MSDRG 827
Min. Negotiated Rate	$26,609.13
Max. Negotiated Rate	$40,752.57
Rate for Payer: EPIC Health Plan Medicare	$26,609.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,609.13
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,600.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$33,527.50
Rate for Payer: Molina Healthcare of CA Medicare	$33,527.50
Rate for Payer: Multiplan WC	$40,752.57

MS-DRG 42.00: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC

Facility

$82,467.02

Service Code	MSDRG 826
Min. Negotiated Rate	$53,519.52
Max. Negotiated Rate	$82,467.02
Rate for Payer: EPIC Health Plan Medicare	$53,519.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$53,519.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$61,547.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$67,434.60
Rate for Payer: Molina Healthcare of CA Medicare	$67,434.60
Rate for Payer: Multiplan WC	$82,467.02

MS-DRG 42.00: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC

Facility

$27,680.12

Service Code	MSDRG 828
Min. Negotiated Rate	$18,175.94
Max. Negotiated Rate	$27,680.12
Rate for Payer: EPIC Health Plan Medicare	$18,175.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,175.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,902.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,901.68
Rate for Payer: Molina Healthcare of CA Medicare	$22,901.68
Rate for Payer: Multiplan WC	$27,680.12

MS-DRG 42.00: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC

Facility

$53,253.44

Service Code	MSDRG 829
Min. Negotiated Rate	$34,673.55
Max. Negotiated Rate	$53,253.44
Rate for Payer: EPIC Health Plan Medicare	$34,673.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,673.55
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,874.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,688.67
Rate for Payer: Molina Healthcare of CA Medicare	$43,688.67
Rate for Payer: Multiplan WC	$53,253.44

MS-DRG 42.00: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC

Facility

$25,255.58

Service Code	MSDRG 830
Min. Negotiated Rate	$16,611.84
Max. Negotiated Rate	$25,255.58
Rate for Payer: EPIC Health Plan Medicare	$16,611.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,611.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,103.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,930.92
Rate for Payer: Molina Healthcare of CA Medicare	$20,930.92
Rate for Payer: Multiplan WC	$25,255.58

MS-DRG 42.00: NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY

Facility

$31,128.69

Service Code	MSDRG 789
Min. Negotiated Rate	$2,814.00
Max. Negotiated Rate	$31,128.69
Rate for Payer: EPIC Health Plan Medicare	$20,400.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,400.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,460.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,704.82
Rate for Payer: Molina Healthcare of CA Medicare	$25,704.82
Rate for Payer: Multiplan WC	$31,128.69
Rate for Payer: United Healthcare All Other HMO/non HMO	$3,334.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$2,814.00

MS-DRG 42.00: NEONATE WITH OTHER SIGNIFICANT PROBLEMS

Facility

$25,492.16

Service Code	MSDRG 794
Min. Negotiated Rate	$2,814.00
Max. Negotiated Rate	$25,492.16
Rate for Payer: EPIC Health Plan Medicare	$16,764.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,764.49
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,279.16
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,123.26
Rate for Payer: Molina Healthcare of CA Medicare	$21,123.26
Rate for Payer: Multiplan WC	$25,492.16
Rate for Payer: United Healthcare All Other HMO/non HMO	$3,334.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$2,814.00

MS-DRG 42.00: NERVOUS SYSTEM NEOPLASMS WITH MCC

Facility

$25,887.61

Service Code	MSDRG 054
Min. Negotiated Rate	$17,019.58
Max. Negotiated Rate	$25,887.61
Rate for Payer: EPIC Health Plan Medicare	$17,019.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,019.58
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,572.52
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,444.67
Rate for Payer: Molina Healthcare of CA Medicare	$21,444.67
Rate for Payer: Multiplan WC	$25,887.61

MS-DRG 42.00: NERVOUS SYSTEM NEOPLASMS WITHOUT MCC

Facility

$18,840.23

Service Code	MSDRG 055
Min. Negotiated Rate	$12,473.25
Max. Negotiated Rate	$18,840.23
Rate for Payer: EPIC Health Plan Medicare	$12,473.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,473.25
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,344.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,716.30
Rate for Payer: Molina Healthcare of CA Medicare	$15,716.30
Rate for Payer: Multiplan WC	$18,840.23

MS-DRG 42.00: NEUROLOGICAL EYE DISORDERS

Facility

$13,870.27

Service Code	MSDRG 123
Min. Negotiated Rate	$9,267.07
Max. Negotiated Rate	$13,870.27
Rate for Payer: EPIC Health Plan Medicare	$9,267.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,267.07
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,657.13
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,676.51
Rate for Payer: Molina Healthcare of CA Medicare	$11,676.51
Rate for Payer: Multiplan WC	$13,870.27

MS-DRG 42.00: NEUROSES EXCEPT DEPRESSIVE

Facility

$16,612.56

Service Code	MSDRG 882
Min. Negotiated Rate	$11,036.15
Max. Negotiated Rate	$16,612.56
Rate for Payer: EPIC Health Plan Medicare	$11,036.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,036.15
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,691.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,905.55
Rate for Payer: Molina Healthcare of CA Medicare	$13,905.55
Rate for Payer: Multiplan WC	$16,612.56

MS-DRG 42.00: NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC

Facility

$37,461.15

Service Code	MSDRG 098
Min. Negotiated Rate	$24,485.79
Max. Negotiated Rate	$37,461.15
Rate for Payer: EPIC Health Plan Medicare	$24,485.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,485.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,158.66
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,852.10
Rate for Payer: Molina Healthcare of CA Medicare	$30,852.10
Rate for Payer: Multiplan WC	$37,461.15

MS-DRG 42.00: NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC

Facility

$61,901.64

Service Code	MSDRG 097
Min. Negotiated Rate	$40,252.59
Max. Negotiated Rate	$61,901.64
Rate for Payer: EPIC Health Plan Medicare	$40,252.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$40,252.59
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$46,290.48
Rate for Payer: Molina Healthcare of CA Medi-Cal	$50,718.26
Rate for Payer: Molina Healthcare of CA Medicare	$50,718.26
Rate for Payer: Multiplan WC	$61,901.64

MS-DRG 42.00: NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$24,060.58

Service Code	MSDRG 099
Min. Negotiated Rate	$15,840.95
Max. Negotiated Rate	$24,060.58
Rate for Payer: EPIC Health Plan Medicare	$15,840.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,840.95
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,217.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,959.60
Rate for Payer: Molina Healthcare of CA Medicare	$19,959.60
Rate for Payer: Multiplan WC	$24,060.58

MS-DRG 42.00: NON-EXTENSIVE BURNS

Facility

$37,929.13

Service Code	MSDRG 935
Min. Negotiated Rate	$24,787.68
Max. Negotiated Rate	$37,929.13
Rate for Payer: EPIC Health Plan Medicare	$24,787.68
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,787.68
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,505.83
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,232.48
Rate for Payer: Molina Healthcare of CA Medicare	$31,232.48
Rate for Payer: Multiplan WC	$37,929.13

MS-DRG 42.00: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC

Facility

$29,633.21

Service Code	MSDRG 988
Min. Negotiated Rate	$19,435.90
Max. Negotiated Rate	$29,633.21
Rate for Payer: EPIC Health Plan Medicare	$19,435.90
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,435.90
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,351.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,489.23
Rate for Payer: Molina Healthcare of CA Medicare	$24,489.23
Rate for Payer: Multiplan WC	$29,633.21

MS-DRG 42.00: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC

Facility

$60,487.32

Service Code	MSDRG 987
Min. Negotiated Rate	$39,340.20
Max. Negotiated Rate	$60,487.32
Rate for Payer: EPIC Health Plan Medicare	$39,340.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,340.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$45,241.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$49,568.65
Rate for Payer: Molina Healthcare of CA Medicare	$49,568.65
Rate for Payer: Multiplan WC	$60,487.32

MS-DRG 42.00: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC

Facility

$19,954.06

Service Code	MSDRG 989
Min. Negotiated Rate	$13,191.80
Max. Negotiated Rate	$19,954.06
Rate for Payer: EPIC Health Plan Medicare	$13,191.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,191.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,170.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,621.67
Rate for Payer: Molina Healthcare of CA Medicare	$16,621.67
Rate for Payer: Multiplan WC	$19,954.06

MS-DRG 42.00: NON-MALIGNANT BREAST DISORDERS WITH CC/MCC

Facility

$16,519.31

Service Code	MSDRG 600
Min. Negotiated Rate	$10,975.99
Max. Negotiated Rate	$16,519.31
Rate for Payer: EPIC Health Plan Medicare	$10,975.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,975.99
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,622.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,829.75
Rate for Payer: Molina Healthcare of CA Medicare	$13,829.75
Rate for Payer: Multiplan WC	$16,519.31

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

Facility

$10,352.63

Service Code	MSDRG 601
Min. Negotiated Rate	$6,997.80
Max. Negotiated Rate	$10,352.63
Rate for Payer: EPIC Health Plan Medicare	$6,997.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$6,997.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,047.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,817.23
Rate for Payer: Molina Healthcare of CA Medicare	$8,817.23
Rate for Payer: Multiplan WC	$10,352.63

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