Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC

Facility

$36,312.77

Service Code	MSDRG 734
Min. Negotiated Rate	$23,744.99
Max. Negotiated Rate	$36,312.77
Rate for Payer: EPIC Health Plan Medicare	$23,744.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,744.99
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,306.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,918.69
Rate for Payer: Molina Healthcare of CA Medicare	$29,918.69
Rate for Payer: Multiplan WC	$36,312.77

MS-DRG 42.00: PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC

Facility

$20,962.56

Service Code	MSDRG 735
Min. Negotiated Rate	$13,842.41
Max. Negotiated Rate	$20,962.56
Rate for Payer: EPIC Health Plan Medicare	$13,842.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,842.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,918.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,441.44
Rate for Payer: Molina Healthcare of CA Medicare	$17,441.44
Rate for Payer: Multiplan WC	$20,962.56

MS-DRG 42.00: PENIS PROCEDURES WITH CC/MCC

Facility

$38,804.66

Service Code	MSDRG 709
Min. Negotiated Rate	$25,352.54
Max. Negotiated Rate	$38,804.66
Rate for Payer: EPIC Health Plan Medicare	$25,352.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,352.54
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,155.42
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,944.20
Rate for Payer: Molina Healthcare of CA Medicare	$31,944.20
Rate for Payer: Multiplan WC	$38,804.66

MS-DRG 42.00: PENIS PROCEDURES WITHOUT CC/MCC

Facility

$25,927.33

Service Code	MSDRG 710
Min. Negotiated Rate	$17,045.24
Max. Negotiated Rate	$25,927.33
Rate for Payer: EPIC Health Plan Medicare	$17,045.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,045.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,602.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,477.00
Rate for Payer: Molina Healthcare of CA Medicare	$21,477.00
Rate for Payer: Multiplan WC	$25,927.33

MS-DRG 42.00: PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC

Facility

$67,526.08

Service Code	MSDRG 273
Min. Negotiated Rate	$7,571.00
Max. Negotiated Rate	$67,526.08
Rate for Payer: Aetna of CA Gatekeeper	$14,118.00
Rate for Payer: EPIC Health Plan Medicare	$43,881.02
Rate for Payer: Heritage Provider Network Commercial	$8,325.00
Rate for Payer: Heritage Provider Network Senior	$7,571.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$43,881.02
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$50,463.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$55,290.09
Rate for Payer: Molina Healthcare of CA Medicare	$55,290.09
Rate for Payer: Multiplan WC	$67,526.08

MS-DRG 42.00: PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC

Facility

$53,895.83

Service Code	MSDRG 274
Min. Negotiated Rate	$7,571.00
Max. Negotiated Rate	$53,895.83
Rate for Payer: Aetna of CA Gatekeeper	$14,118.00
Rate for Payer: EPIC Health Plan Medicare	$35,088.01
Rate for Payer: Heritage Provider Network Commercial	$8,325.00
Rate for Payer: Heritage Provider Network Senior	$7,571.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,088.01
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,351.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$44,210.89
Rate for Payer: Molina Healthcare of CA Medicare	$44,210.89
Rate for Payer: Multiplan WC	$53,895.83

MS-DRG 42.00: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES

Facility

$49,160.74

Service Code	MSDRG 321
Min. Negotiated Rate	$32,033.35
Max. Negotiated Rate	$49,160.74
Rate for Payer: EPIC Health Plan Medicare	$32,033.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,033.35
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,838.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$40,362.02
Rate for Payer: Molina Healthcare of CA Medicare	$40,362.02
Rate for Payer: Multiplan WC	$49,160.74

MS-DRG 42.00: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC

Facility

$31,242.66

Service Code	MSDRG 322
Min. Negotiated Rate	$20,474.23
Max. Negotiated Rate	$31,242.66
Rate for Payer: EPIC Health Plan Medicare	$20,474.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,474.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,545.36
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,797.53
Rate for Payer: Molina Healthcare of CA Medicare	$25,797.53
Rate for Payer: Multiplan WC	$31,242.66

MS-DRG 42.00: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC

Facility

$39,935.76

Service Code	MSDRG 250
Min. Negotiated Rate	$8,633.00
Max. Negotiated Rate	$39,935.76
Rate for Payer: Aetna of CA Gatekeeper	$14,118.00
Rate for Payer: EPIC Health Plan Medicare	$26,082.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,082.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,994.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,863.58
Rate for Payer: Molina Healthcare of CA Medicare	$32,863.58
Rate for Payer: Multiplan WC	$39,935.76

MS-DRG 42.00: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC

Facility

$26,984.18

Service Code	MSDRG 251
Min. Negotiated Rate	$9,725.00
Max. Negotiated Rate	$26,984.18
Rate for Payer: Aetna of CA Gatekeeper	$14,118.00
Rate for Payer: EPIC Health Plan Medicare	$17,727.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,727.04
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,386.10
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,336.07
Rate for Payer: Molina Healthcare of CA Medicare	$22,336.07
Rate for Payer: Multiplan WC	$26,984.18

MS-DRG 42.00: PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR

Facility

$38,996.34

Service Code	MSDRG 041
Min. Negotiated Rate	$25,476.20
Max. Negotiated Rate	$38,996.34
Rate for Payer: EPIC Health Plan Medicare	$25,476.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,476.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,297.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,100.01
Rate for Payer: Molina Healthcare of CA Medicare	$32,100.01
Rate for Payer: Multiplan WC	$38,996.34

MS-DRG 42.00: PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC

Facility

$65,139.53

Service Code	MSDRG 040
Min. Negotiated Rate	$42,341.42
Max. Negotiated Rate	$65,139.53
Rate for Payer: EPIC Health Plan Medicare	$42,341.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$42,341.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$48,692.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$53,350.19
Rate for Payer: Molina Healthcare of CA Medicare	$53,350.19
Rate for Payer: Multiplan WC	$65,139.53

MS-DRG 42.00: PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC

Facility

$30,351.59

Service Code	MSDRG 042
Min. Negotiated Rate	$19,899.38
Max. Negotiated Rate	$30,351.59
Rate for Payer: EPIC Health Plan Medicare	$19,899.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,899.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,884.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,073.22
Rate for Payer: Molina Healthcare of CA Medicare	$25,073.22
Rate for Payer: Multiplan WC	$30,351.59

MS-DRG 42.00: PERIPHERAL VASCULAR DISORDERS WITH CC

Facility

$18,487.94

Service Code	MSDRG 300
Min. Negotiated Rate	$12,246.03
Max. Negotiated Rate	$18,487.94
Rate for Payer: EPIC Health Plan Medicare	$12,246.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,246.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,082.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,430.00
Rate for Payer: Molina Healthcare of CA Medicare	$15,430.00
Rate for Payer: Multiplan WC	$18,487.94

MS-DRG 42.00: PERIPHERAL VASCULAR DISORDERS WITH MCC

Facility

$27,933.97

Service Code	MSDRG 299
Min. Negotiated Rate	$18,339.73
Max. Negotiated Rate	$27,933.97
Rate for Payer: EPIC Health Plan Medicare	$18,339.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,339.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,090.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,108.06
Rate for Payer: Molina Healthcare of CA Medicare	$23,108.06
Rate for Payer: Multiplan WC	$27,933.97

MS-DRG 42.00: PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC

Facility

$12,319.54

Service Code	MSDRG 301
Min. Negotiated Rate	$8,266.72
Max. Negotiated Rate	$12,319.54
Rate for Payer: EPIC Health Plan Medicare	$8,266.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,266.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,506.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,416.07
Rate for Payer: Molina Healthcare of CA Medicare	$10,416.07
Rate for Payer: Multiplan WC	$12,319.54

MS-DRG 42.00: PERITONEAL ADHESIOLYSIS WITH CC

Facility

$36,476.82

Service Code	MSDRG 336
Min. Negotiated Rate	$23,850.84
Max. Negotiated Rate	$36,476.82
Rate for Payer: EPIC Health Plan Medicare	$23,850.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,850.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,428.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,052.06
Rate for Payer: Molina Healthcare of CA Medicare	$30,052.06
Rate for Payer: Multiplan WC	$36,476.82

MS-DRG 42.00: PERITONEAL ADHESIOLYSIS WITH MCC

Facility

$62,571.67

Service Code	MSDRG 335
Min. Negotiated Rate	$40,684.88
Max. Negotiated Rate	$62,571.67
Rate for Payer: EPIC Health Plan Medicare	$40,684.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$40,684.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$46,787.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$51,262.95
Rate for Payer: Molina Healthcare of CA Medicare	$51,262.95
Rate for Payer: Multiplan WC	$62,571.67

MS-DRG 42.00: PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC

Facility

$26,509.29

Service Code	MSDRG 337
Min. Negotiated Rate	$17,420.68
Max. Negotiated Rate	$26,509.29
Rate for Payer: EPIC Health Plan Medicare	$17,420.68
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,420.68
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,033.78
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,950.06
Rate for Payer: Molina Healthcare of CA Medicare	$21,950.06
Rate for Payer: Multiplan WC	$26,509.29

MS-DRG 42.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC

Facility

$38,903.09

Service Code	MSDRG 243
Min. Negotiated Rate	$7,571.00
Max. Negotiated Rate	$38,903.09
Rate for Payer: Aetna of CA Gatekeeper	$28,979.00
Rate for Payer: EPIC Health Plan Medicare	$25,416.03
Rate for Payer: Heritage Provider Network Commercial	$8,325.00
Rate for Payer: Heritage Provider Network Senior	$7,571.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,416.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,228.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,024.20
Rate for Payer: Molina Healthcare of CA Medicare	$32,024.20
Rate for Payer: Multiplan WC	$38,903.09

MS-DRG 42.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC

Facility

$58,575.68

Service Code	MSDRG 242
Min. Negotiated Rate	$7,571.00
Max. Negotiated Rate	$58,575.68
Rate for Payer: Aetna of CA Gatekeeper	$28,979.00
Rate for Payer: EPIC Health Plan Medicare	$38,107.02
Rate for Payer: Heritage Provider Network Commercial	$8,325.00
Rate for Payer: Heritage Provider Network Senior	$7,571.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$38,107.02
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$43,823.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$48,014.85
Rate for Payer: Molina Healthcare of CA Medicare	$48,014.85
Rate for Payer: Multiplan WC	$58,575.68

MS-DRG 42.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC

Facility

$31,164.95

Service Code	MSDRG 244
Min. Negotiated Rate	$7,571.00
Max. Negotiated Rate	$31,164.95
Rate for Payer: Aetna of CA Gatekeeper	$28,979.00
Rate for Payer: EPIC Health Plan Medicare	$20,424.07
Rate for Payer: Heritage Provider Network Commercial	$8,325.00
Rate for Payer: Heritage Provider Network Senior	$7,571.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,424.07
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,487.68
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,734.33
Rate for Payer: Molina Healthcare of CA Medicare	$25,734.33
Rate for Payer: Multiplan WC	$31,164.95

MS-DRG 42.00: PLEURAL EFFUSION WITH CC

Facility

$17,337.85

Service Code	MSDRG 187
Min. Negotiated Rate	$11,504.07
Max. Negotiated Rate	$17,337.85
Rate for Payer: EPIC Health Plan Medicare	$11,504.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,504.07
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,229.68
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,495.13
Rate for Payer: Molina Healthcare of CA Medicare	$14,495.13
Rate for Payer: Multiplan WC	$17,337.85

MS-DRG 42.00: PLEURAL EFFUSION WITH MCC

Facility

$27,284.66

Service Code	MSDRG 186
Min. Negotiated Rate	$17,920.87
Max. Negotiated Rate	$27,284.66
Rate for Payer: EPIC Health Plan Medicare	$17,920.87
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,920.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,609.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,580.30
Rate for Payer: Molina Healthcare of CA Medicare	$22,580.30
Rate for Payer: Multiplan WC	$27,284.66

MS-DRG 42.00: PLEURAL EFFUSION WITHOUT CC/MCC

Facility

$12,678.73

Service Code	MSDRG 188
Min. Negotiated Rate	$8,498.44
Max. Negotiated Rate	$12,678.73
Rate for Payer: EPIC Health Plan Medicare	$8,498.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,498.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,773.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,708.03
Rate for Payer: Molina Healthcare of CA Medicare	$10,708.03
Rate for Payer: Multiplan WC	$12,678.73

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