Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

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

Facility

$86,939.00

Service Code	MSDRG 272
Min. Negotiated Rate	$28,194.37
Max. Negotiated Rate	$86,939.00
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: EPIC Health Plan Medicare	$28,194.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,194.37
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,423.53
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,524.91
Rate for Payer: Molina Healthcare of CA Medicare	$35,524.91
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	$12,583.53
Max. Negotiated Rate	$19,011.19
Rate for Payer: EPIC Health Plan Medicare	$12,583.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,583.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,471.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,855.25
Rate for Payer: Molina Healthcare of CA Medicare	$15,855.25
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	$7,080.24
Max. Negotiated Rate	$10,480.41
Rate for Payer: EPIC Health Plan Medicare	$7,080.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,080.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,142.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,921.10
Rate for Payer: Molina Healthcare of CA Medicare	$8,921.10
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	$20,989.97
Max. Negotiated Rate	$32,042.21
Rate for Payer: EPIC Health Plan Medicare	$20,989.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,989.97
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,138.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,447.36
Rate for Payer: Molina Healthcare of CA Medicare	$26,447.36
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	$14,042.91
Max. Negotiated Rate	$21,273.40
Rate for Payer: EPIC Health Plan Medicare	$14,042.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,042.91
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,149.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,694.07
Rate for Payer: Molina Healthcare of CA Medicare	$17,694.07
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	$25,477.26
Max. Negotiated Rate	$38,998.07
Rate for Payer: EPIC Health Plan Medicare	$25,477.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,477.26
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,298.85
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,101.35
Rate for Payer: Molina Healthcare of CA Medicare	$32,101.35
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	$16,130.58
Max. Negotiated Rate	$24,509.56
Rate for Payer: EPIC Health Plan Medicare	$16,130.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,130.58
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,550.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,324.53
Rate for Payer: Molina Healthcare of CA Medicare	$20,324.53
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	$13,569.45
Max. Negotiated Rate	$20,539.48
Rate for Payer: EPIC Health Plan Medicare	$13,569.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,569.45
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,604.87
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,097.51
Rate for Payer: Molina Healthcare of CA Medicare	$17,097.51
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	$17,030.72
Max. Negotiated Rate	$25,904.89
Rate for Payer: EPIC Health Plan Medicare	$17,030.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,030.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,585.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,458.71
Rate for Payer: Molina Healthcare of CA Medicare	$21,458.71
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	$30,583.97
Max. Negotiated Rate	$46,914.07
Rate for Payer: EPIC Health Plan Medicare	$30,583.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,583.97
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,171.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,535.80
Rate for Payer: Molina Healthcare of CA Medicare	$38,535.80
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	$10,485.82
Max. Negotiated Rate	$15,759.48
Rate for Payer: EPIC Health Plan Medicare	$10,485.82
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,485.82
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,058.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,212.13
Rate for Payer: Molina Healthcare of CA Medicare	$13,212.13
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	$11,678.96
Max. Negotiated Rate	$17,608.96
Rate for Payer: EPIC Health Plan Medicare	$11,678.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,678.96
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,430.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,715.49
Rate for Payer: Molina Healthcare of CA Medicare	$14,715.49
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	$17,800.52
Max. Negotiated Rate	$27,098.16
Rate for Payer: EPIC Health Plan Medicare	$17,800.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,800.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,470.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,428.66
Rate for Payer: Molina Healthcare of CA Medicare	$22,428.66
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	$8,653.24
Max. Negotiated Rate	$12,918.77
Rate for Payer: EPIC Health Plan Medicare	$8,653.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,653.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,951.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,903.08
Rate for Payer: Molina Healthcare of CA Medicare	$10,903.08
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	$22,730.06
Max. Negotiated Rate	$34,739.59
Rate for Payer: EPIC Health Plan Medicare	$22,730.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,730.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,139.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,639.88
Rate for Payer: Molina Healthcare of CA Medicare	$28,639.88
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	$34,769.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,769.35
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,984.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,809.38
Rate for Payer: Molina Healthcare of CA Medicare	$43,809.38
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	$16,948.27
Max. Negotiated Rate	$27,318.00
Rate for Payer: EPIC Health Plan Medicare	$16,948.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,948.27
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,490.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,354.82
Rate for Payer: Molina Healthcare of CA Medicare	$21,354.82
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	$13,634.06
Max. Negotiated Rate	$20,639.63
Rate for Payer: EPIC Health Plan Medicare	$13,634.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,634.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,679.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,178.92
Rate for Payer: Molina Healthcare of CA Medicare	$17,178.92
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	$21,411.09
Max. Negotiated Rate	$32,694.97
Rate for Payer: EPIC Health Plan Medicare	$21,411.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,411.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,622.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,977.97
Rate for Payer: Molina Healthcare of CA Medicare	$26,977.97
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	$9,641.40
Max. Negotiated Rate	$14,450.51
Rate for Payer: EPIC Health Plan Medicare	$9,641.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,641.40
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,087.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,148.16
Rate for Payer: Molina Healthcare of CA Medicare	$12,148.16
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	$22,790.22
Max. Negotiated Rate	$34,832.84
Rate for Payer: EPIC Health Plan Medicare	$22,790.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,790.22
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,208.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,715.68
Rate for Payer: Molina Healthcare of CA Medicare	$28,715.68
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	$44,698.67
Max. Negotiated Rate	$68,793.61
Rate for Payer: EPIC Health Plan Medicare	$44,698.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$44,698.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$51,403.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$56,320.32
Rate for Payer: Molina Healthcare of CA Medicare	$56,320.32
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	$14,448.41
Max. Negotiated Rate	$21,901.98
Rate for Payer: EPIC Health Plan Medicare	$14,448.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,448.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,615.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,205.00
Rate for Payer: Molina Healthcare of CA Medicare	$18,205.00
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	$46,103.44
Max. Negotiated Rate	$70,971.20
Rate for Payer: EPIC Health Plan Medicare	$46,103.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$46,103.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$53,018.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$58,090.33
Rate for Payer: Molina Healthcare of CA Medicare	$58,090.33
Rate for Payer: Multiplan WC	$70,971.20

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

Facility

$128,897.57

Service Code	MSDRG 957
Min. Negotiated Rate	$83,472.35
Max. Negotiated Rate	$128,897.57
Rate for Payer: EPIC Health Plan Medicare	$83,472.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$83,472.35
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$95,993.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$105,175.16
Rate for Payer: Molina Healthcare of CA Medicare	$105,175.16
Rate for Payer: Multiplan WC	$128,897.57

Know your out-of-pocket cost for care.

All Charges