Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC

Facility

$88,640.61

Service Code	MSDRG 270
Min. Negotiated Rate	$57,502.22
Max. Negotiated Rate	$88,640.61
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: EPIC Health Plan Medicare	$57,502.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$57,502.22
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$66,127.55
Rate for Payer: Molina Healthcare of CA Medi-Cal	$72,452.80
Rate for Payer: Molina Healthcare of CA Medicare	$72,452.80
Rate for Payer: Multiplan WC	$88,640.61

MS-DRG 42.00: OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC

Facility

$86,939.00

Service Code	MSDRG 272
Min. Negotiated Rate	$28,194.41
Max. Negotiated Rate	$86,939.00
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: EPIC Health Plan Medicare	$28,194.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,194.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,423.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,524.96
Rate for Payer: Molina Healthcare of CA Medicare	$35,524.96
Rate for Payer: Multiplan WC	$43,209.92

MS-DRG 42.00: OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC

Facility

$19,011.19

Service Code	MSDRG 729
Min. Negotiated Rate	$12,583.57
Max. Negotiated Rate	$19,011.19
Rate for Payer: EPIC Health Plan Medicare	$12,583.57
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,583.57
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,471.11
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,855.30
Rate for Payer: Molina Healthcare of CA Medicare	$15,855.30
Rate for Payer: Multiplan WC	$19,011.19

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

Facility

$10,480.41

Service Code	MSDRG 730
Min. Negotiated Rate	$7,080.28
Max. Negotiated Rate	$10,480.41
Rate for Payer: EPIC Health Plan Medicare	$7,080.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,080.28
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,142.32
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,921.15
Rate for Payer: Molina Healthcare of CA Medicare	$8,921.15
Rate for Payer: Multiplan WC	$10,480.41

MS-DRG 42.00: OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC

Facility

$32,042.21

Service Code	MSDRG 717
Min. Negotiated Rate	$20,990.01
Max. Negotiated Rate	$32,042.21
Rate for Payer: EPIC Health Plan Medicare	$20,990.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,990.01
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,138.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,447.41
Rate for Payer: Molina Healthcare of CA Medicare	$26,447.41
Rate for Payer: Multiplan WC	$32,042.21

MS-DRG 42.00: OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC

Facility

$21,273.40

Service Code	MSDRG 718
Min. Negotiated Rate	$14,042.95
Max. Negotiated Rate	$21,273.40
Rate for Payer: EPIC Health Plan Medicare	$14,042.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,042.95
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,149.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,694.12
Rate for Payer: Molina Healthcare of CA Medicare	$17,694.12
Rate for Payer: Multiplan WC	$21,273.40

MS-DRG 42.00: OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC

Facility

$38,998.07

Service Code	MSDRG 715
Min. Negotiated Rate	$25,477.30
Max. Negotiated Rate	$38,998.07
Rate for Payer: EPIC Health Plan Medicare	$25,477.30
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,477.30
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,298.90
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,101.40
Rate for Payer: Molina Healthcare of CA Medicare	$32,101.40
Rate for Payer: Multiplan WC	$38,998.07

MS-DRG 42.00: OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC

Facility

$24,509.56

Service Code	MSDRG 716
Min. Negotiated Rate	$16,130.62
Max. Negotiated Rate	$24,509.56
Rate for Payer: EPIC Health Plan Medicare	$16,130.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,130.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,550.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,324.58
Rate for Payer: Molina Healthcare of CA Medicare	$20,324.58
Rate for Payer: Multiplan WC	$24,509.56

MS-DRG 42.00: OTHER MENTAL DISORDER DIAGNOSES

Facility

$20,539.48

Service Code	MSDRG 887
Min. Negotiated Rate	$13,569.49
Max. Negotiated Rate	$20,539.48
Rate for Payer: EPIC Health Plan Medicare	$13,569.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,569.49
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,604.91
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,097.56
Rate for Payer: Molina Healthcare of CA Medicare	$17,097.56
Rate for Payer: Multiplan WC	$20,539.48

MS-DRG 42.00: OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$25,904.89

Service Code	MSDRG 964
Min. Negotiated Rate	$17,030.76
Max. Negotiated Rate	$25,904.89
Rate for Payer: EPIC Health Plan Medicare	$17,030.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,030.76
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,585.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,458.76
Rate for Payer: Molina Healthcare of CA Medicare	$21,458.76
Rate for Payer: Multiplan WC	$25,904.89

MS-DRG 42.00: OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$46,914.07

Service Code	MSDRG 963
Min. Negotiated Rate	$30,584.01
Max. Negotiated Rate	$46,914.07
Rate for Payer: EPIC Health Plan Medicare	$30,584.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,584.01
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,171.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,535.85
Rate for Payer: Molina Healthcare of CA Medicare	$38,535.85
Rate for Payer: Multiplan WC	$46,914.07

MS-DRG 42.00: OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$15,759.48

Service Code	MSDRG 965
Min. Negotiated Rate	$10,485.86
Max. Negotiated Rate	$15,759.48
Rate for Payer: EPIC Health Plan Medicare	$10,485.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,485.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,058.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,212.18
Rate for Payer: Molina Healthcare of CA Medicare	$13,212.18
Rate for Payer: Multiplan WC	$15,759.48

MS-DRG 42.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC

Facility

$17,608.96

Service Code	MSDRG 565
Min. Negotiated Rate	$11,679.00
Max. Negotiated Rate	$17,608.96
Rate for Payer: EPIC Health Plan Medicare	$11,679.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,679.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,430.85
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,715.54
Rate for Payer: Molina Healthcare of CA Medicare	$14,715.54
Rate for Payer: Multiplan WC	$17,608.96

MS-DRG 42.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC

Facility

$27,098.16

Service Code	MSDRG 564
Min. Negotiated Rate	$17,800.56
Max. Negotiated Rate	$27,098.16
Rate for Payer: EPIC Health Plan Medicare	$17,800.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,800.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,470.64
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,428.71
Rate for Payer: Molina Healthcare of CA Medicare	$22,428.71
Rate for Payer: Multiplan WC	$27,098.16

MS-DRG 42.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC

Facility

$12,918.77

Service Code	MSDRG 566
Min. Negotiated Rate	$8,653.28
Max. Negotiated Rate	$12,918.77
Rate for Payer: EPIC Health Plan Medicare	$8,653.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,653.28
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,951.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,903.13
Rate for Payer: Molina Healthcare of CA Medicare	$10,903.13
Rate for Payer: Multiplan WC	$12,918.77

MS-DRG 42.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC

Facility

$34,739.59

Service Code	MSDRG 516
Min. Negotiated Rate	$22,730.10
Max. Negotiated Rate	$34,739.59
Rate for Payer: EPIC Health Plan Medicare	$22,730.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,730.10
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,139.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,639.93
Rate for Payer: Molina Healthcare of CA Medicare	$28,639.93
Rate for Payer: Multiplan WC	$34,739.59

MS-DRG 42.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC

Facility

$53,401.95

Service Code	MSDRG 515
Min. Negotiated Rate	$13,500.00
Max. Negotiated Rate	$53,401.95
Rate for Payer: EPIC Health Plan Medicare	$34,769.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,769.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,984.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,809.43
Rate for Payer: Molina Healthcare of CA Medicare	$43,809.43
Rate for Payer: Multiplan WC	$53,401.95

MS-DRG 42.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC

Facility

$27,318.00

Service Code	MSDRG 517
Min. Negotiated Rate	$16,948.31
Max. Negotiated Rate	$27,318.00
Rate for Payer: EPIC Health Plan Medicare	$16,948.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,948.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,490.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,354.87
Rate for Payer: Molina Healthcare of CA Medicare	$21,354.87
Rate for Payer: Multiplan WC	$25,777.10

MS-DRG 42.00: OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC

Facility

$20,639.63

Service Code	MSDRG 844
Min. Negotiated Rate	$13,634.10
Max. Negotiated Rate	$20,639.63
Rate for Payer: EPIC Health Plan Medicare	$13,634.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,634.10
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,679.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,178.97
Rate for Payer: Molina Healthcare of CA Medicare	$17,178.97
Rate for Payer: Multiplan WC	$20,639.63

MS-DRG 42.00: OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC

Facility

$32,694.97

Service Code	MSDRG 843
Min. Negotiated Rate	$21,411.13
Max. Negotiated Rate	$32,694.97
Rate for Payer: EPIC Health Plan Medicare	$21,411.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,411.13
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,622.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,978.02
Rate for Payer: Molina Healthcare of CA Medicare	$26,978.02
Rate for Payer: Multiplan WC	$32,694.97

MS-DRG 42.00: OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC

Facility

$14,450.51

Service Code	MSDRG 845
Min. Negotiated Rate	$9,641.44
Max. Negotiated Rate	$14,450.51
Rate for Payer: EPIC Health Plan Medicare	$9,641.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,641.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,087.66
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,148.21
Rate for Payer: Molina Healthcare of CA Medicare	$12,148.21
Rate for Payer: Multiplan WC	$14,450.51

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

Facility

$34,832.84

Service Code	MSDRG 908
Min. Negotiated Rate	$22,790.26
Max. Negotiated Rate	$34,832.84
Rate for Payer: EPIC Health Plan Medicare	$22,790.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,790.26
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,208.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,715.73
Rate for Payer: Molina Healthcare of CA Medicare	$28,715.73
Rate for Payer: Multiplan WC	$34,832.84

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

Facility

$68,793.61

Service Code	MSDRG 907
Min. Negotiated Rate	$44,698.71
Max. Negotiated Rate	$68,793.61
Rate for Payer: EPIC Health Plan Medicare	$44,698.71
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$44,698.71
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$51,403.52
Rate for Payer: Molina Healthcare of CA Medi-Cal	$56,320.37
Rate for Payer: Molina Healthcare of CA Medicare	$56,320.37
Rate for Payer: Multiplan WC	$68,793.61

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

Facility

$21,901.98

Service Code	MSDRG 909
Min. Negotiated Rate	$14,448.45
Max. Negotiated Rate	$21,901.98
Rate for Payer: EPIC Health Plan Medicare	$14,448.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,448.45
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,615.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,205.05
Rate for Payer: Molina Healthcare of CA Medicare	$18,205.05
Rate for Payer: Multiplan WC	$21,901.98

MS-DRG 42.00: OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$70,971.20

Service Code	MSDRG 958
Min. Negotiated Rate	$46,103.48
Max. Negotiated Rate	$70,971.20
Rate for Payer: EPIC Health Plan Medicare	$46,103.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$46,103.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$53,019.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$58,090.38
Rate for Payer: Molina Healthcare of CA Medicare	$58,090.38
Rate for Payer: Multiplan WC	$70,971.20

Know your out-of-pocket cost for care.

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