Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

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	$13,141.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,141.66
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,112.91
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,558.49
Rate for Payer: Molina Healthcare of CA Medicare	$16,558.49
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	$6,109.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$6,109.93
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$7,026.42
Rate for Payer: Molina Healthcare of CA Medi-Cal	$7,698.51
Rate for Payer: Molina Healthcare of CA Medicare	$7,698.51
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	$55,834.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$55,834.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$64,209.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$70,351.44
Rate for Payer: Molina Healthcare of CA Medicare	$70,351.44
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	$34,924.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,924.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,162.83
Rate for Payer: Molina Healthcare of CA Medi-Cal	$44,004.49
Rate for Payer: Molina Healthcare of CA Medicare	$44,004.49
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	$11,039.49
Max. Negotiated Rate	$16,617.74
Rate for Payer: EPIC Health Plan Medicare	$11,039.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,039.49
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,695.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,909.76
Rate for Payer: Molina Healthcare of CA Medicare	$13,909.76
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	$24,309.75
Max. Negotiated Rate	$37,188.31
Rate for Payer: EPIC Health Plan Medicare	$24,309.75
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,309.75
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,956.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,630.28
Rate for Payer: Molina Healthcare of CA Medicare	$30,630.28
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	$7,924.69
Max. Negotiated Rate	$11,789.39
Rate for Payer: EPIC Health Plan Medicare	$7,924.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,924.69
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,113.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,985.11
Rate for Payer: Molina Healthcare of CA Medicare	$9,985.11
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	$39,255.53
Max. Negotiated Rate	$60,356.08
Rate for Payer: EPIC Health Plan Medicare	$39,255.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,255.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$45,143.86
Rate for Payer: Molina Healthcare of CA Medi-Cal	$49,461.97
Rate for Payer: Molina Healthcare of CA Medicare	$49,461.97
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	$10,805.56
Max. Negotiated Rate	$16,255.09
Rate for Payer: EPIC Health Plan Medicare	$10,805.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,805.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,426.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,615.01
Rate for Payer: Molina Healthcare of CA Medicare	$13,615.01
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	$18,767.50
Max. Negotiated Rate	$28,597.09
Rate for Payer: EPIC Health Plan Medicare	$18,767.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,767.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,582.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,647.05
Rate for Payer: Molina Healthcare of CA Medicare	$23,647.05
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	$7,408.89
Max. Negotiated Rate	$10,989.85
Rate for Payer: EPIC Health Plan Medicare	$7,408.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,408.89
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,520.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,335.20
Rate for Payer: Molina Healthcare of CA Medicare	$9,335.20
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	$25,407.08
Max. Negotiated Rate	$38,889.27
Rate for Payer: EPIC Health Plan Medicare	$25,407.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,407.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,218.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,012.92
Rate for Payer: Molina Healthcare of CA Medicare	$32,012.92
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	$47,840.23
Max. Negotiated Rate	$73,663.41
Rate for Payer: EPIC Health Plan Medicare	$47,840.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$47,840.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$55,016.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$60,278.69
Rate for Payer: Molina Healthcare of CA Medicare	$60,278.69
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	$15,415.39
Max. Negotiated Rate	$23,400.91
Rate for Payer: EPIC Health Plan Medicare	$15,415.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,415.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,727.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,423.39
Rate for Payer: Molina Healthcare of CA Medicare	$19,423.39
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	$12,113.40
Max. Negotiated Rate	$18,282.45
Rate for Payer: EPIC Health Plan Medicare	$12,113.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,113.40
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,930.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,262.88
Rate for Payer: Molina Healthcare of CA Medicare	$15,262.88
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	$20,626.80
Max. Negotiated Rate	$31,479.25
Rate for Payer: EPIC Health Plan Medicare	$20,626.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,626.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,720.82
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,989.77
Rate for Payer: Molina Healthcare of CA Medicare	$25,989.77
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	$9,112.23
Max. Negotiated Rate	$13,630.24
Rate for Payer: EPIC Health Plan Medicare	$9,112.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,112.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,479.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,481.41
Rate for Payer: Molina Healthcare of CA Medicare	$11,481.41
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	$14,845.00
Max. Negotiated Rate	$22,516.75
Rate for Payer: EPIC Health Plan Medicare	$14,845.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,845.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,071.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,704.70
Rate for Payer: Molina Healthcare of CA Medicare	$18,704.70
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	$9,517.73
Max. Negotiated Rate	$14,258.82
Rate for Payer: EPIC Health Plan Medicare	$9,517.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,517.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,945.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,992.34
Rate for Payer: Molina Healthcare of CA Medicare	$11,992.34
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	$10,719.77
Max. Negotiated Rate	$16,122.13
Rate for Payer: EPIC Health Plan Medicare	$10,719.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,719.77
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,327.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,506.91
Rate for Payer: Molina Healthcare of CA Medicare	$13,506.91
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	$18,436.62
Max. Negotiated Rate	$28,084.20
Rate for Payer: EPIC Health Plan Medicare	$18,436.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,436.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,202.11
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,230.14
Rate for Payer: Molina Healthcare of CA Medicare	$23,230.14
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	$7,809.92
Max. Negotiated Rate	$11,611.52
Rate for Payer: EPIC Health Plan Medicare	$7,809.92
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,809.92
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,981.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,840.50
Rate for Payer: Molina Healthcare of CA Medicare	$9,840.50
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	$19,889.32
Max. Negotiated Rate	$30,336.06
Rate for Payer: EPIC Health Plan Medicare	$19,889.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,889.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,872.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,060.54
Rate for Payer: Molina Healthcare of CA Medicare	$25,060.54
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	$37,103.25
Max. Negotiated Rate	$57,019.76
Rate for Payer: EPIC Health Plan Medicare	$37,103.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,103.25
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,668.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,750.10
Rate for Payer: Molina Healthcare of CA Medicare	$46,750.10
Rate for Payer: Multiplan WC	$57,019.76

MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$20,460.04

Service Code	MSDRG 145
Min. Negotiated Rate	$13,518.20
Max. Negotiated Rate	$20,460.04
Rate for Payer: EPIC Health Plan Medicare	$13,518.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,518.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,545.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,032.93
Rate for Payer: Molina Healthcare of CA Medicare	$17,032.93
Rate for Payer: Multiplan WC	$20,460.04

Know your out-of-pocket cost for care.

All Charges