Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

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

Facility

$10,352.63

Service Code	MSDRG 601
Min. Negotiated Rate	$6,997.84
Max. Negotiated Rate	$10,352.63
Rate for Payer: EPIC Health Plan Medicare	$6,997.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$6,997.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,047.52
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,817.28
Rate for Payer: Molina Healthcare of CA Medicare	$8,817.28
Rate for Payer: Multiplan WC	$10,352.63

MS-DRG 42.00: NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC

Facility

$18,199.56

Service Code	MSDRG 071
Min. Negotiated Rate	$12,059.98
Max. Negotiated Rate	$18,199.56
Rate for Payer: EPIC Health Plan Medicare	$12,059.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,059.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,868.98
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,195.57
Rate for Payer: Molina Healthcare of CA Medicare	$15,195.57
Rate for Payer: Multiplan WC	$18,199.56

MS-DRG 42.00: NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC

Facility

$30,026.95

Service Code	MSDRG 070
Min. Negotiated Rate	$19,689.95
Max. Negotiated Rate	$30,026.95
Rate for Payer: EPIC Health Plan Medicare	$19,689.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,689.95
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,643.44
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,809.34
Rate for Payer: Molina Healthcare of CA Medicare	$24,809.34
Rate for Payer: Multiplan WC	$30,026.95

MS-DRG 42.00: NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC

Facility

$12,955.03

Service Code	MSDRG 072
Min. Negotiated Rate	$8,676.69
Max. Negotiated Rate	$12,955.03
Rate for Payer: EPIC Health Plan Medicare	$8,676.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,676.69
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,978.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,932.63
Rate for Payer: Molina Healthcare of CA Medicare	$10,932.63
Rate for Payer: Multiplan WC	$12,955.03

MS-DRG 42.00: NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC

Facility

$25,124.34

Service Code	MSDRG 067
Min. Negotiated Rate	$16,527.22
Max. Negotiated Rate	$25,124.34
Rate for Payer: EPIC Health Plan Medicare	$16,527.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,527.22
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,006.30
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,824.30
Rate for Payer: Molina Healthcare of CA Medicare	$20,824.30
Rate for Payer: Multiplan WC	$25,124.34

MS-DRG 42.00: NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC

Facility

$15,222.42

Service Code	MSDRG 068
Min. Negotiated Rate	$10,139.41
Max. Negotiated Rate	$15,222.42
Rate for Payer: EPIC Health Plan Medicare	$10,139.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,139.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,660.32
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,775.66
Rate for Payer: Molina Healthcare of CA Medicare	$12,775.66
Rate for Payer: Multiplan WC	$15,222.42

MS-DRG 42.00: NONTRAUMATIC STUPOR AND COMA WITH MCC

Facility

$34,326.86

Service Code	MSDRG 080
Min. Negotiated Rate	$22,463.87
Max. Negotiated Rate	$34,326.86
Rate for Payer: EPIC Health Plan Medicare	$22,463.87
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,463.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,833.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,304.48
Rate for Payer: Molina Healthcare of CA Medicare	$28,304.48
Rate for Payer: Multiplan WC	$34,326.86

MS-DRG 42.00: NONTRAUMATIC STUPOR AND COMA WITHOUT MCC

Facility

$15,624.79

Service Code	MSDRG 081
Min. Negotiated Rate	$10,398.96
Max. Negotiated Rate	$15,624.79
Rate for Payer: EPIC Health Plan Medicare	$10,398.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,398.96
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,958.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,102.69
Rate for Payer: Molina Healthcare of CA Medicare	$13,102.69
Rate for Payer: Multiplan WC	$15,624.79

MS-DRG 42.00: NORMAL NEWBORN

Facility

$3,450.30

Service Code	MSDRG 795
Min. Negotiated Rate	$920.00
Max. Negotiated Rate	$3,450.30
Rate for Payer: EPIC Health Plan Medicare	$2,545.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$2,545.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$2,926.84
Rate for Payer: Molina Healthcare of CA Medi-Cal	$3,206.80
Rate for Payer: Molina Healthcare of CA Medicare	$3,206.80
Rate for Payer: Multiplan WC	$3,450.30
Rate for Payer: United Healthcare All Other HMO/non HMO	$1,097.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$920.00

MS-DRG 42.00: ORBITAL PROCEDURES WITH CC/MCC

Facility

$38,968.71

Service Code	MSDRG 113
Min. Negotiated Rate	$25,458.38
Max. Negotiated Rate	$38,968.71
Rate for Payer: EPIC Health Plan Medicare	$25,458.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,458.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,277.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,077.56
Rate for Payer: Molina Healthcare of CA Medicare	$32,077.56
Rate for Payer: Multiplan WC	$38,968.71

MS-DRG 42.00: ORBITAL PROCEDURES WITHOUT CC/MCC

Facility

$20,413.42

Service Code	MSDRG 114
Min. Negotiated Rate	$13,488.14
Max. Negotiated Rate	$20,413.42
Rate for Payer: EPIC Health Plan Medicare	$13,488.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,488.14
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,511.36
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,995.06
Rate for Payer: Molina Healthcare of CA Medicare	$16,995.06
Rate for Payer: Multiplan WC	$20,413.42

MS-DRG 42.00: ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY

Facility

$28,842.30

Service Code	MSDRG 884
Min. Negotiated Rate	$18,925.72
Max. Negotiated Rate	$28,842.30
Rate for Payer: EPIC Health Plan Medicare	$18,925.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,925.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,764.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,846.41
Rate for Payer: Molina Healthcare of CA Medicare	$23,846.41
Rate for Payer: Multiplan WC	$28,842.30

MS-DRG 42.00: O.R. PROCEDURES FOR OBESITY WITH CC

Facility

$27,578.23

Service Code	MSDRG 620
Min. Negotiated Rate	$12,050.00
Max. Negotiated Rate	$27,578.23
Rate for Payer: EPIC Health Plan Medicare	$18,110.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,110.26
Rate for Payer: Kaiser Permanente of CA Commercial	$12,050.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,826.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,818.93
Rate for Payer: Molina Healthcare of CA Medicare	$22,818.93
Rate for Payer: Multiplan WC	$27,578.23
Rate for Payer: United Healthcare All Other HMO/non HMO	$22,991.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$19,290.00

MS-DRG 42.00: O.R. PROCEDURES FOR OBESITY WITH MCC

Facility

$47,083.31

Service Code	MSDRG 619
Min. Negotiated Rate	$12,050.00
Max. Negotiated Rate	$47,083.31
Rate for Payer: EPIC Health Plan Medicare	$30,693.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,693.18
Rate for Payer: Kaiser Permanente of CA Commercial	$12,050.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,297.16
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,673.41
Rate for Payer: Molina Healthcare of CA Medicare	$38,673.41
Rate for Payer: Multiplan WC	$47,083.31
Rate for Payer: United Healthcare All Other HMO/non HMO	$22,991.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$19,290.00

MS-DRG 42.00: O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC

Facility

$25,243.49

Service Code	MSDRG 621
Min. Negotiated Rate	$12,050.00
Max. Negotiated Rate	$25,243.49
Rate for Payer: EPIC Health Plan Medicare	$16,604.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,604.08
Rate for Payer: Kaiser Permanente of CA Commercial	$12,050.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,094.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,921.14
Rate for Payer: Molina Healthcare of CA Medicare	$20,921.14
Rate for Payer: Multiplan WC	$25,243.49
Rate for Payer: United Healthcare All Other HMO/non HMO	$22,991.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$19,290.00

MS-DRG 42.00: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC

Facility

$36,461.28

Service Code	MSDRG 940
Min. Negotiated Rate	$23,840.80
Max. Negotiated Rate	$36,461.28
Rate for Payer: EPIC Health Plan Medicare	$23,840.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,840.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,416.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,039.41
Rate for Payer: Molina Healthcare of CA Medicare	$30,039.41
Rate for Payer: Multiplan WC	$36,461.28

MS-DRG 42.00: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC

Facility

$54,811.09

Service Code	MSDRG 939
Min. Negotiated Rate	$35,678.44
Max. Negotiated Rate	$54,811.09
Rate for Payer: EPIC Health Plan Medicare	$35,678.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,678.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$41,030.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$44,954.83
Rate for Payer: Molina Healthcare of CA Medicare	$44,954.83
Rate for Payer: Multiplan WC	$54,811.09

MS-DRG 42.00: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC

Facility

$33,748.36

Service Code	MSDRG 941
Min. Negotiated Rate	$22,090.67
Max. Negotiated Rate	$33,748.36
Rate for Payer: EPIC Health Plan Medicare	$22,090.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,090.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,404.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,834.24
Rate for Payer: Molina Healthcare of CA Medicare	$27,834.24
Rate for Payer: Multiplan WC	$33,748.36

MS-DRG 42.00: O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS

Facility

$67,859.37

Service Code	MSDRG 876
Min. Negotiated Rate	$44,096.01
Max. Negotiated Rate	$67,859.37
Rate for Payer: EPIC Health Plan Medicare	$44,096.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$44,096.01
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$50,710.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$55,560.97
Rate for Payer: Molina Healthcare of CA Medicare	$55,560.97
Rate for Payer: Multiplan WC	$67,859.37

MS-DRG 42.00: OSTEOMYELITIS WITH CC

Facility

$22,347.52

Service Code	MSDRG 540
Min. Negotiated Rate	$14,735.86
Max. Negotiated Rate	$22,347.52
Rate for Payer: EPIC Health Plan Medicare	$14,735.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,735.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,946.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,567.18
Rate for Payer: Molina Healthcare of CA Medicare	$18,567.18
Rate for Payer: Multiplan WC	$22,347.52

MS-DRG 42.00: OSTEOMYELITIS WITH MCC

Facility

$34,924.37

Service Code	MSDRG 539
Min. Negotiated Rate	$22,849.31
Max. Negotiated Rate	$34,924.37
Rate for Payer: EPIC Health Plan Medicare	$22,849.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,849.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,276.71
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,790.13
Rate for Payer: Molina Healthcare of CA Medicare	$28,790.13
Rate for Payer: Multiplan WC	$34,924.37

MS-DRG 42.00: OSTEOMYELITIS WITHOUT CC/MCC

Facility

$15,108.44

Service Code	MSDRG 541
Min. Negotiated Rate	$10,065.87
Max. Negotiated Rate	$15,108.44
Rate for Payer: EPIC Health Plan Medicare	$10,065.87
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,065.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,575.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,683.00
Rate for Payer: Molina Healthcare of CA Medicare	$12,683.00
Rate for Payer: Multiplan WC	$15,108.44

MS-DRG 42.00: OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC

Facility

$22,242.18

Service Code	MSDRG 818
Min. Negotiated Rate	$3,737.00
Max. Negotiated Rate	$22,242.18
Rate for Payer: EPIC Health Plan Medicare	$14,667.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,667.91
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,868.10
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,481.57
Rate for Payer: Molina Healthcare of CA Medicare	$18,481.57
Rate for Payer: Multiplan WC	$22,242.18
Rate for Payer: United Healthcare All Other HMO/non HMO	$4,442.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$3,737.00

MS-DRG 42.00: OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC

Facility

$43,778.06

Service Code	MSDRG 817
Min. Negotiated Rate	$3,737.00
Max. Negotiated Rate	$43,778.06
Rate for Payer: EPIC Health Plan Medicare	$28,560.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,560.95
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,845.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,986.80
Rate for Payer: Molina Healthcare of CA Medicare	$35,986.80
Rate for Payer: Multiplan WC	$43,778.06
Rate for Payer: United Healthcare All Other HMO/non HMO	$4,442.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$3,737.00

MS-DRG 42.00: OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$14,099.96

Service Code	MSDRG 819
Min. Negotiated Rate	$3,737.00
Max. Negotiated Rate	$14,099.96
Rate for Payer: EPIC Health Plan Medicare	$9,415.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,415.28
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,827.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,863.25
Rate for Payer: Molina Healthcare of CA Medicare	$11,863.25
Rate for Payer: Multiplan WC	$14,099.96
Rate for Payer: United Healthcare All Other HMO/non HMO	$4,442.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$3,737.00

Know your out-of-pocket cost for care.

All Charges