Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

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	$61,636.35
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	$61,636.35
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$70,881.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$77,661.80
Rate for Payer: Molina Healthcare of CA Medicare	$77,661.80
Rate for Payer: Multiplan WC	$95,049.04

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	$75,011.35
Max. Negotiated Rate	$115,781.93
Rate for Payer: EPIC Health Plan Medicare	$75,011.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$75,011.35
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$86,263.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$94,514.30
Rate for Payer: Molina Healthcare of CA Medicare	$94,514.30
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	$45,810.50
Max. Negotiated Rate	$70,517.03
Rate for Payer: EPIC Health Plan Medicare	$45,810.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$45,810.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$52,682.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$57,721.23
Rate for Payer: Molina Healthcare of CA Medicare	$57,721.23
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	$13,950.48
Max. Negotiated Rate	$21,130.07
Rate for Payer: EPIC Health Plan Medicare	$13,950.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,950.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,043.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,577.60
Rate for Payer: Molina Healthcare of CA Medicare	$17,577.60
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	$20,883.07
Max. Negotiated Rate	$31,876.43
Rate for Payer: EPIC Health Plan Medicare	$20,883.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,883.07
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,015.53
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,312.67
Rate for Payer: Molina Healthcare of CA Medicare	$26,312.67
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	$10,260.83
Max. Negotiated Rate	$15,410.66
Rate for Payer: EPIC Health Plan Medicare	$10,260.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,260.83
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,799.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,928.65
Rate for Payer: Molina Healthcare of CA Medicare	$12,928.65
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	$26,609.17
Max. Negotiated Rate	$40,752.57
Rate for Payer: EPIC Health Plan Medicare	$26,609.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,609.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,600.55
Rate for Payer: Molina Healthcare of CA Medi-Cal	$33,527.55
Rate for Payer: Molina Healthcare of CA Medicare	$33,527.55
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	$53,519.56
Max. Negotiated Rate	$82,467.02
Rate for Payer: EPIC Health Plan Medicare	$53,519.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$53,519.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$61,547.49
Rate for Payer: Molina Healthcare of CA Medi-Cal	$67,434.65
Rate for Payer: Molina Healthcare of CA Medicare	$67,434.65
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	$18,175.98
Max. Negotiated Rate	$27,680.12
Rate for Payer: EPIC Health Plan Medicare	$18,175.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,175.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,902.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,901.73
Rate for Payer: Molina Healthcare of CA Medicare	$22,901.73
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	$34,673.59
Max. Negotiated Rate	$53,253.44
Rate for Payer: EPIC Health Plan Medicare	$34,673.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,673.59
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,874.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,688.72
Rate for Payer: Molina Healthcare of CA Medicare	$43,688.72
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	$16,611.88
Max. Negotiated Rate	$25,255.58
Rate for Payer: EPIC Health Plan Medicare	$16,611.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,611.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,103.66
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,930.97
Rate for Payer: Molina Healthcare of CA Medicare	$20,930.97
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	$20,400.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,400.69
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,460.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,704.87
Rate for Payer: Molina Healthcare of CA Medicare	$25,704.87
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	$16,764.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,764.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,279.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,123.31
Rate for Payer: Molina Healthcare of CA Medicare	$21,123.31
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	$17,019.62
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: NERVOUS SYSTEM NEOPLASMS WITHOUT MCC

Facility

$18,840.23

Service Code	MSDRG 055
Min. Negotiated Rate	$12,473.29
Max. Negotiated Rate	$18,840.23
Rate for Payer: EPIC Health Plan Medicare	$12,473.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,473.29
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,344.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,716.35
Rate for Payer: Molina Healthcare of CA Medicare	$15,716.35
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	$9,267.11
Max. Negotiated Rate	$13,870.27
Rate for Payer: EPIC Health Plan Medicare	$9,267.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,267.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,657.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,676.56
Rate for Payer: Molina Healthcare of CA Medicare	$11,676.56
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	$11,036.19
Max. Negotiated Rate	$16,612.56
Rate for Payer: EPIC Health Plan Medicare	$11,036.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,036.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,691.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,905.60
Rate for Payer: Molina Healthcare of CA Medicare	$13,905.60
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	$24,485.83
Max. Negotiated Rate	$37,461.15
Rate for Payer: EPIC Health Plan Medicare	$24,485.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,485.83
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,158.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,852.15
Rate for Payer: Molina Healthcare of CA Medicare	$30,852.15
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	$40,252.63
Max. Negotiated Rate	$61,901.64
Rate for Payer: EPIC Health Plan Medicare	$40,252.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$40,252.63
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$46,290.52
Rate for Payer: Molina Healthcare of CA Medi-Cal	$50,718.31
Rate for Payer: Molina Healthcare of CA Medicare	$50,718.31
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	$15,840.99
Max. Negotiated Rate	$24,060.58
Rate for Payer: EPIC Health Plan Medicare	$15,840.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,840.99
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,217.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,959.65
Rate for Payer: Molina Healthcare of CA Medicare	$19,959.65
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	$24,787.72
Max. Negotiated Rate	$37,929.13
Rate for Payer: EPIC Health Plan Medicare	$24,787.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,787.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,505.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,232.53
Rate for Payer: Molina Healthcare of CA Medicare	$31,232.53
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	$19,435.94
Max. Negotiated Rate	$29,633.21
Rate for Payer: EPIC Health Plan Medicare	$19,435.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,435.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,351.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,489.28
Rate for Payer: Molina Healthcare of CA Medicare	$24,489.28
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	$39,340.24
Max. Negotiated Rate	$60,487.32
Rate for Payer: EPIC Health Plan Medicare	$39,340.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,340.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$45,241.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$49,568.70
Rate for Payer: Molina Healthcare of CA Medicare	$49,568.70
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	$13,191.84
Max. Negotiated Rate	$19,954.06
Rate for Payer: EPIC Health Plan Medicare	$13,191.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,191.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,170.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,621.72
Rate for Payer: Molina Healthcare of CA Medicare	$16,621.72
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	$10,976.03
Max. Negotiated Rate	$16,519.31
Rate for Payer: EPIC Health Plan Medicare	$10,976.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,976.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,622.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,829.80
Rate for Payer: Molina Healthcare of CA Medicare	$13,829.80
Rate for Payer: Multiplan WC	$16,519.31

Know your out-of-pocket cost for care.

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