Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

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

Facility

$12,906.68

Service Code	MSDRG 832
Min. Negotiated Rate	$3,737.00
Max. Negotiated Rate	$12,906.68
Rate for Payer: EPIC Health Plan Medicare	$8,645.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,645.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,942.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,893.29
Rate for Payer: Molina Healthcare of CA Medicare	$10,893.29
Rate for Payer: Multiplan WC	$12,906.68
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 WITHOUT O.R. PROCEDURES WITH MCC

Facility

$19,876.36

Service Code	MSDRG 831
Min. Negotiated Rate	$3,737.00
Max. Negotiated Rate	$19,876.36
Rate for Payer: EPIC Health Plan Medicare	$13,141.70
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,141.70
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,112.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,558.54
Rate for Payer: Molina Healthcare of CA Medicare	$16,558.54
Rate for Payer: Multiplan WC	$19,876.36
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 WITHOUT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$8,976.31

Service Code	MSDRG 833
Min. Negotiated Rate	$3,737.00
Max. Negotiated Rate	$8,976.31
Rate for Payer: EPIC Health Plan Medicare	$6,109.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$6,109.97
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$7,026.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$7,698.56
Rate for Payer: Molina Healthcare of CA Medicare	$7,698.56
Rate for Payer: Multiplan WC	$8,976.31
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 CARDIOTHORACIC PROCEDURES WITH MCC

Facility

$86,939.00

Service Code	MSDRG 228
Min. Negotiated Rate	$28,410.00
Max. Negotiated Rate	$86,939.00
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: EPIC Health Plan Medicare	$55,834.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$55,834.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$64,209.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$70,351.50
Rate for Payer: Molina Healthcare of CA Medicare	$70,351.50
Rate for Payer: Multiplan WC	$86,055.48

MS-DRG 42.00: OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC

Facility

$86,939.00

Service Code	MSDRG 229
Min. Negotiated Rate	$28,410.00
Max. Negotiated Rate	$86,939.00
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: EPIC Health Plan Medicare	$34,924.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,924.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,162.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$44,004.54
Rate for Payer: Molina Healthcare of CA Medicare	$44,004.54
Rate for Payer: Multiplan WC	$53,641.99

MS-DRG 42.00: OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC

Facility

$16,617.74

Service Code	MSDRG 315
Min. Negotiated Rate	$11,039.53
Max. Negotiated Rate	$16,617.74
Rate for Payer: EPIC Health Plan Medicare	$11,039.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,039.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,695.46
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,909.81
Rate for Payer: Molina Healthcare of CA Medicare	$13,909.81
Rate for Payer: Multiplan WC	$16,617.74

MS-DRG 42.00: OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC

Facility

$37,188.31

Service Code	MSDRG 314
Min. Negotiated Rate	$24,309.79
Max. Negotiated Rate	$37,188.31
Rate for Payer: EPIC Health Plan Medicare	$24,309.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,309.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,956.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,630.34
Rate for Payer: Molina Healthcare of CA Medicare	$30,630.34
Rate for Payer: Multiplan WC	$37,188.31

MS-DRG 42.00: OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$11,789.39

Service Code	MSDRG 316
Min. Negotiated Rate	$7,924.73
Max. Negotiated Rate	$11,789.39
Rate for Payer: EPIC Health Plan Medicare	$7,924.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,924.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,113.44
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,985.16
Rate for Payer: Molina Healthcare of CA Medicare	$9,985.16
Rate for Payer: Multiplan WC	$11,789.39

MS-DRG 42.00: OTHER CIRCULATORY SYSTEM O.R. PROCEDURES

Facility

$60,356.08

Service Code	MSDRG 264
Min. Negotiated Rate	$39,255.57
Max. Negotiated Rate	$60,356.08
Rate for Payer: EPIC Health Plan Medicare	$39,255.57
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,255.57
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$45,143.91
Rate for Payer: Molina Healthcare of CA Medi-Cal	$49,462.02
Rate for Payer: Molina Healthcare of CA Medicare	$49,462.02
Rate for Payer: Multiplan WC	$60,356.08

MS-DRG 42.00: OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC

Facility

$16,255.09

Service Code	MSDRG 394
Min. Negotiated Rate	$10,805.60
Max. Negotiated Rate	$16,255.09
Rate for Payer: EPIC Health Plan Medicare	$10,805.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,805.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,426.44
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,615.06
Rate for Payer: Molina Healthcare of CA Medicare	$13,615.06
Rate for Payer: Multiplan WC	$16,255.09

MS-DRG 42.00: OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC

Facility

$28,597.09

Service Code	MSDRG 393
Min. Negotiated Rate	$18,767.54
Max. Negotiated Rate	$28,597.09
Rate for Payer: EPIC Health Plan Medicare	$18,767.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,767.54
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,582.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,647.10
Rate for Payer: Molina Healthcare of CA Medicare	$23,647.10
Rate for Payer: Multiplan WC	$28,597.09

MS-DRG 42.00: OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$10,989.85

Service Code	MSDRG 395
Min. Negotiated Rate	$7,408.93
Max. Negotiated Rate	$10,989.85
Rate for Payer: EPIC Health Plan Medicare	$7,408.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,408.93
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,520.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,335.25
Rate for Payer: Molina Healthcare of CA Medicare	$9,335.25
Rate for Payer: Multiplan WC	$10,989.85

MS-DRG 42.00: OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC

Facility

$38,889.27

Service Code	MSDRG 357
Min. Negotiated Rate	$25,407.12
Max. Negotiated Rate	$38,889.27
Rate for Payer: EPIC Health Plan Medicare	$25,407.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,407.12
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,218.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,012.97
Rate for Payer: Molina Healthcare of CA Medicare	$32,012.97
Rate for Payer: Multiplan WC	$38,889.27

MS-DRG 42.00: OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC

Facility

$73,663.41

Service Code	MSDRG 356
Min. Negotiated Rate	$47,840.27
Max. Negotiated Rate	$73,663.41
Rate for Payer: EPIC Health Plan Medicare	$47,840.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$47,840.27
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$55,016.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$60,278.74
Rate for Payer: Molina Healthcare of CA Medicare	$60,278.74
Rate for Payer: Multiplan WC	$73,663.41

MS-DRG 42.00: OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$23,400.91

Service Code	MSDRG 358
Min. Negotiated Rate	$15,415.43
Max. Negotiated Rate	$23,400.91
Rate for Payer: EPIC Health Plan Medicare	$15,415.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,415.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,727.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,423.44
Rate for Payer: Molina Healthcare of CA Medicare	$19,423.44
Rate for Payer: Multiplan WC	$23,400.91

MS-DRG 42.00: OTHER DISORDERS OF NERVOUS SYSTEM WITH CC

Facility

$18,282.45

Service Code	MSDRG 092
Min. Negotiated Rate	$12,113.44
Max. Negotiated Rate	$18,282.45
Rate for Payer: EPIC Health Plan Medicare	$12,113.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,113.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,930.46
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,262.93
Rate for Payer: Molina Healthcare of CA Medicare	$15,262.93
Rate for Payer: Multiplan WC	$18,282.45

MS-DRG 42.00: OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC

Facility

$31,479.25

Service Code	MSDRG 091
Min. Negotiated Rate	$20,626.84
Max. Negotiated Rate	$31,479.25
Rate for Payer: EPIC Health Plan Medicare	$20,626.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,626.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,720.87
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,989.82
Rate for Payer: Molina Healthcare of CA Medicare	$25,989.82
Rate for Payer: Multiplan WC	$31,479.25

MS-DRG 42.00: OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility

$13,630.24

Service Code	MSDRG 093
Min. Negotiated Rate	$9,112.27
Max. Negotiated Rate	$13,630.24
Rate for Payer: EPIC Health Plan Medicare	$9,112.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,112.27
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,479.11
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,481.46
Rate for Payer: Molina Healthcare of CA Medicare	$11,481.46
Rate for Payer: Multiplan WC	$13,630.24

MS-DRG 42.00: OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT

Facility

$22,516.75

Service Code	MSDRG 124
Min. Negotiated Rate	$14,845.04
Max. Negotiated Rate	$22,516.75
Rate for Payer: EPIC Health Plan Medicare	$14,845.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,845.04
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,071.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,704.75
Rate for Payer: Molina Healthcare of CA Medicare	$18,704.75
Rate for Payer: Multiplan WC	$22,516.75

MS-DRG 42.00: OTHER DISORDERS OF THE EYE WITHOUT MCC

Facility

$14,258.82

Service Code	MSDRG 125
Min. Negotiated Rate	$9,517.77
Max. Negotiated Rate	$14,258.82
Rate for Payer: EPIC Health Plan Medicare	$9,517.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,517.77
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,945.44
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,992.39
Rate for Payer: Molina Healthcare of CA Medicare	$11,992.39
Rate for Payer: Multiplan WC	$14,258.82

MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC

Facility

$16,122.13

Service Code	MSDRG 155
Min. Negotiated Rate	$10,719.81
Max. Negotiated Rate	$16,122.13
Rate for Payer: EPIC Health Plan Medicare	$10,719.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,719.81
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,327.78
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,506.96
Rate for Payer: Molina Healthcare of CA Medicare	$13,506.96
Rate for Payer: Multiplan WC	$16,122.13

MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC

Facility

$28,084.20

Service Code	MSDRG 154
Min. Negotiated Rate	$18,436.66
Max. Negotiated Rate	$28,084.20
Rate for Payer: EPIC Health Plan Medicare	$18,436.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,436.66
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,202.16
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,230.19
Rate for Payer: Molina Healthcare of CA Medicare	$23,230.19
Rate for Payer: Multiplan WC	$28,084.20

MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC

Facility

$11,611.52

Service Code	MSDRG 156
Min. Negotiated Rate	$7,809.96
Max. Negotiated Rate	$11,611.52
Rate for Payer: EPIC Health Plan Medicare	$7,809.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,809.96
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,981.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,840.55
Rate for Payer: Molina Healthcare of CA Medicare	$9,840.55
Rate for Payer: Multiplan WC	$11,611.52

MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC

Facility

$30,336.06

Service Code	MSDRG 144
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: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC

Facility

$57,019.76

Service Code	MSDRG 143
Min. Negotiated Rate	$37,103.29
Max. Negotiated Rate	$57,019.76
Rate for Payer: EPIC Health Plan Medicare	$37,103.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,103.29
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,668.78
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,750.15
Rate for Payer: Molina Healthcare of CA Medicare	$46,750.15
Rate for Payer: Multiplan WC	$57,019.76

Know your out-of-pocket cost for care.

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