Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

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	$83,472.39
Max. Negotiated Rate	$128,897.57
Rate for Payer: EPIC Health Plan Medicare	$83,472.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$83,472.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$95,993.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$105,175.21
Rate for Payer: Molina Healthcare of CA Medicare	$105,175.21
Rate for Payer: Multiplan WC	$128,897.57

MS-DRG 42.00: OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$45,656.91

Service Code	MSDRG 959
Min. Negotiated Rate	$29,772.97
Max. Negotiated Rate	$45,656.91
Rate for Payer: EPIC Health Plan Medicare	$29,772.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,772.97
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,238.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,513.94
Rate for Payer: Molina Healthcare of CA Medicare	$37,513.94
Rate for Payer: Multiplan WC	$45,656.91

MS-DRG 42.00: OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC

Facility

$30,738.42

Service Code	MSDRG 803
Min. Negotiated Rate	$20,148.92
Max. Negotiated Rate	$30,738.42
Rate for Payer: EPIC Health Plan Medicare	$20,148.92
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,148.92
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,171.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,387.64
Rate for Payer: Molina Healthcare of CA Medicare	$25,387.64
Rate for Payer: Multiplan WC	$30,738.42

MS-DRG 42.00: OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC

Facility

$61,905.09

Service Code	MSDRG 802
Min. Negotiated Rate	$40,254.86
Max. Negotiated Rate	$61,905.09
Rate for Payer: EPIC Health Plan Medicare	$40,254.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$40,254.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$46,293.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$50,721.12
Rate for Payer: Molina Healthcare of CA Medicare	$50,721.12
Rate for Payer: Multiplan WC	$61,905.09

MS-DRG 42.00: OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC

Facility

$19,092.35

Service Code	MSDRG 804
Min. Negotiated Rate	$12,635.94
Max. Negotiated Rate	$19,092.35
Rate for Payer: EPIC Health Plan Medicare	$12,635.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,635.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,531.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,921.28
Rate for Payer: Molina Healthcare of CA Medicare	$15,921.28
Rate for Payer: Multiplan WC	$19,092.35

MS-DRG 42.00: OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC

Facility

$32,599.98

Service Code	MSDRG 205
Min. Negotiated Rate	$21,349.83
Max. Negotiated Rate	$32,599.98
Rate for Payer: EPIC Health Plan Medicare	$21,349.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,349.83
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,552.30
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,900.79
Rate for Payer: Molina Healthcare of CA Medicare	$26,900.79
Rate for Payer: Multiplan WC	$32,599.98

MS-DRG 42.00: OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC

Facility

$15,642.05

Service Code	MSDRG 206
Min. Negotiated Rate	$10,410.11
Max. Negotiated Rate	$15,642.05
Rate for Payer: EPIC Health Plan Medicare	$10,410.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,410.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,971.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,116.74
Rate for Payer: Molina Healthcare of CA Medicare	$13,116.74
Rate for Payer: Multiplan WC	$15,642.05

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

Facility

$31,553.50

Service Code	MSDRG 167
Min. Negotiated Rate	$20,674.73
Max. Negotiated Rate	$31,553.50
Rate for Payer: EPIC Health Plan Medicare	$20,674.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,674.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,775.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,050.16
Rate for Payer: Molina Healthcare of CA Medicare	$26,050.16
Rate for Payer: Multiplan WC	$31,553.50

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

Facility

$66,489.95

Service Code	MSDRG 166
Min. Negotiated Rate	$43,212.60
Max. Negotiated Rate	$66,489.95
Rate for Payer: EPIC Health Plan Medicare	$43,212.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$43,212.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$49,694.49
Rate for Payer: Molina Healthcare of CA Medi-Cal	$54,447.88
Rate for Payer: Molina Healthcare of CA Medicare	$54,447.88
Rate for Payer: Multiplan WC	$66,489.95

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

Facility

$23,380.19

Service Code	MSDRG 168
Min. Negotiated Rate	$15,402.04
Max. Negotiated Rate	$23,380.19
Rate for Payer: EPIC Health Plan Medicare	$15,402.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,402.04
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,712.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,406.57
Rate for Payer: Molina Healthcare of CA Medicare	$19,406.57
Rate for Payer: Multiplan WC	$23,380.19

MS-DRG 42.00: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC

Facility

$30,617.53

Service Code	MSDRG 580
Min. Negotiated Rate	$20,070.93
Max. Negotiated Rate	$30,617.53
Rate for Payer: EPIC Health Plan Medicare	$20,070.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,070.93
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,081.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,289.37
Rate for Payer: Molina Healthcare of CA Medicare	$25,289.37
Rate for Payer: Multiplan WC	$30,617.53

MS-DRG 42.00: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC

Facility

$56,285.84

Service Code	MSDRG 579
Min. Negotiated Rate	$36,629.82
Max. Negotiated Rate	$56,285.84
Rate for Payer: EPIC Health Plan Medicare	$36,629.82
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,629.82
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,124.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,153.57
Rate for Payer: Molina Healthcare of CA Medicare	$46,153.57
Rate for Payer: Multiplan WC	$56,285.84

MS-DRG 42.00: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC

Facility

$24,853.22

Service Code	MSDRG 581
Min. Negotiated Rate	$16,352.32
Max. Negotiated Rate	$24,853.22
Rate for Payer: EPIC Health Plan Medicare	$16,352.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,352.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,805.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,603.92
Rate for Payer: Molina Healthcare of CA Medicare	$20,603.92
Rate for Payer: Multiplan WC	$24,853.22

MS-DRG 42.00: OTHER VASCULAR PROCEDURES WITH CC

Facility

$44,087.17

Service Code	MSDRG 253
Min. Negotiated Rate	$28,760.34
Max. Negotiated Rate	$44,087.17
Rate for Payer: EPIC Health Plan Medicare	$28,760.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,760.34
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,074.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$36,238.03
Rate for Payer: Molina Healthcare of CA Medicare	$36,238.03
Rate for Payer: Multiplan WC	$44,087.17

MS-DRG 42.00: OTHER VASCULAR PROCEDURES WITH MCC

Facility

$59,238.79

Service Code	MSDRG 252
Min. Negotiated Rate	$38,534.81
Max. Negotiated Rate	$59,238.79
Rate for Payer: EPIC Health Plan Medicare	$38,534.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$38,534.81
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$44,315.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$48,553.86
Rate for Payer: Molina Healthcare of CA Medicare	$48,553.86
Rate for Payer: Multiplan WC	$59,238.79

MS-DRG 42.00: OTHER VASCULAR PROCEDURES WITHOUT CC/MCC

Facility

$30,209.99

Service Code	MSDRG 254
Min. Negotiated Rate	$19,808.03
Max. Negotiated Rate	$30,209.99
Rate for Payer: EPIC Health Plan Medicare	$19,808.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,808.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,779.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,958.12
Rate for Payer: Molina Healthcare of CA Medicare	$24,958.12
Rate for Payer: Multiplan WC	$30,209.99

MS-DRG 42.00: OTITIS MEDIA AND URI WITH MCC

Facility

$19,596.60

Service Code	MSDRG 152
Min. Negotiated Rate	$12,961.23
Max. Negotiated Rate	$19,596.60
Rate for Payer: EPIC Health Plan Medicare	$12,961.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,961.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,905.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,331.15
Rate for Payer: Molina Healthcare of CA Medicare	$16,331.15
Rate for Payer: Multiplan WC	$19,596.60

MS-DRG 42.00: OTITIS MEDIA AND URI WITHOUT MCC

Facility

$12,290.19

Service Code	MSDRG 153
Min. Negotiated Rate	$8,247.78
Max. Negotiated Rate	$12,290.19
Rate for Payer: EPIC Health Plan Medicare	$8,247.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,247.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,484.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,392.20
Rate for Payer: Molina Healthcare of CA Medicare	$10,392.20
Rate for Payer: Multiplan WC	$12,290.19

MS-DRG 42.00: PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC

Facility

$48,497.62

Service Code	MSDRG 406
Min. Negotiated Rate	$31,605.56
Max. Negotiated Rate	$48,497.62
Rate for Payer: EPIC Health Plan Medicare	$31,605.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,605.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,346.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$39,823.01
Rate for Payer: Molina Healthcare of CA Medicare	$39,823.01
Rate for Payer: Multiplan WC	$48,497.62

MS-DRG 42.00: PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC

Facility

$93,746.99

Service Code	MSDRG 405
Min. Negotiated Rate	$60,796.37
Max. Negotiated Rate	$93,746.99
Rate for Payer: EPIC Health Plan Medicare	$60,796.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$60,796.37
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$69,915.83
Rate for Payer: Molina Healthcare of CA Medi-Cal	$76,603.43
Rate for Payer: Molina Healthcare of CA Medicare	$76,603.43
Rate for Payer: Multiplan WC	$93,746.99

MS-DRG 42.00: PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC

Facility

$36,882.64

Service Code	MSDRG 407
Min. Negotiated Rate	$24,112.62
Max. Negotiated Rate	$36,882.64
Rate for Payer: EPIC Health Plan Medicare	$24,112.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,112.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,729.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,381.90
Rate for Payer: Molina Healthcare of CA Medicare	$30,381.90
Rate for Payer: Multiplan WC	$36,882.64

MS-DRG 42.00: PANCREAS TRANSPLANT

Facility

$137,683.92

Service Code	MSDRG 010
Min. Negotiated Rate	$89,140.53
Max. Negotiated Rate	$137,683.92
Rate for Payer: EPIC Health Plan Medicare	$89,140.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$89,140.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$102,511.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$112,317.07
Rate for Payer: Molina Healthcare of CA Medicare	$112,317.07
Rate for Payer: Multiplan WC	$137,683.92

MS-DRG 42.00: PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC

Facility

$18,320.44

Service Code	MSDRG 543
Min. Negotiated Rate	$12,137.96
Max. Negotiated Rate	$18,320.44
Rate for Payer: EPIC Health Plan Medicare	$12,137.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,137.96
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,958.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,293.83
Rate for Payer: Molina Healthcare of CA Medicare	$15,293.83
Rate for Payer: Multiplan WC	$18,320.44

MS-DRG 42.00: PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC

Facility

$32,207.98

Service Code	MSDRG 542
Min. Negotiated Rate	$21,096.96
Max. Negotiated Rate	$32,207.98
Rate for Payer: EPIC Health Plan Medicare	$21,096.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,096.96
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,261.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,582.17
Rate for Payer: Molina Healthcare of CA Medicare	$26,582.17
Rate for Payer: Multiplan WC	$32,207.98

MS-DRG 42.00: PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC

Facility

$13,050.01

Service Code	MSDRG 544
Min. Negotiated Rate	$8,737.96
Max. Negotiated Rate	$13,050.01
Rate for Payer: EPIC Health Plan Medicare	$8,737.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,737.96
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,048.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,009.83
Rate for Payer: Molina Healthcare of CA Medicare	$11,009.83
Rate for Payer: Multiplan WC	$13,050.01

Know your out-of-pocket cost for care.

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