Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: PNEUMOTHORAX WITH CC

Facility

$19,125.16

Service Code	MSDRG 200
Min. Negotiated Rate	$12,657.09
Max. Negotiated Rate	$19,125.16
Rate for Payer: EPIC Health Plan Medicare	$12,657.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,657.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,555.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,947.93
Rate for Payer: Molina Healthcare of CA Medicare	$15,947.93
Rate for Payer: Multiplan WC	$19,125.16

MS-DRG 42.00: PNEUMOTHORAX WITH MCC

Facility

$30,484.57

Service Code	MSDRG 199
Min. Negotiated Rate	$19,985.16
Max. Negotiated Rate	$30,484.57
Rate for Payer: EPIC Health Plan Medicare	$19,985.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,985.16
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,982.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,181.30
Rate for Payer: Molina Healthcare of CA Medicare	$25,181.30
Rate for Payer: Multiplan WC	$30,484.57

MS-DRG 42.00: PNEUMOTHORAX WITHOUT CC/MCC

Facility

$11,692.68

Service Code	MSDRG 201
Min. Negotiated Rate	$7,862.34
Max. Negotiated Rate	$11,692.68
Rate for Payer: EPIC Health Plan Medicare	$7,862.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,862.34
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,041.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,906.55
Rate for Payer: Molina Healthcare of CA Medicare	$9,906.55
Rate for Payer: Multiplan WC	$11,692.68

MS-DRG 42.00: POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC

Facility

$28,315.61

Service Code	MSDRG 917
Min. Negotiated Rate	$18,585.95
Max. Negotiated Rate	$28,315.61
Rate for Payer: EPIC Health Plan Medicare	$18,585.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,585.95
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,373.84
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,418.30
Rate for Payer: Molina Healthcare of CA Medicare	$23,418.30
Rate for Payer: Multiplan WC	$28,315.61

MS-DRG 42.00: POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC

Facility

$15,275.96

Service Code	MSDRG 918
Min. Negotiated Rate	$10,173.94
Max. Negotiated Rate	$15,275.96
Rate for Payer: EPIC Health Plan Medicare	$10,173.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,173.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,700.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,819.16
Rate for Payer: Molina Healthcare of CA Medicare	$12,819.16
Rate for Payer: Multiplan WC	$15,275.96

MS-DRG 42.00: POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC

Facility

$31,752.09

Service Code	MSDRG 862
Min. Negotiated Rate	$20,802.85
Max. Negotiated Rate	$31,752.09
Rate for Payer: EPIC Health Plan Medicare	$20,802.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,802.85
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,923.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,211.59
Rate for Payer: Molina Healthcare of CA Medicare	$26,211.59
Rate for Payer: Multiplan WC	$31,752.09

MS-DRG 42.00: POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC

Facility

$17,267.04

Service Code	MSDRG 863
Min. Negotiated Rate	$11,458.40
Max. Negotiated Rate	$17,267.04
Rate for Payer: EPIC Health Plan Medicare	$11,458.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,458.40
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,177.16
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,437.58
Rate for Payer: Molina Healthcare of CA Medicare	$14,437.58
Rate for Payer: Multiplan WC	$17,267.04

MS-DRG 42.00: POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC

Facility

$37,626.92

Service Code	MSDRG 857
Min. Negotiated Rate	$24,592.77
Max. Negotiated Rate	$37,626.92
Rate for Payer: EPIC Health Plan Medicare	$24,592.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,592.77
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,281.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,986.89
Rate for Payer: Molina Healthcare of CA Medicare	$30,986.89
Rate for Payer: Multiplan WC	$37,626.92

MS-DRG 42.00: POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC

Facility

$77,909.79

Service Code	MSDRG 856
Min. Negotiated Rate	$50,579.64
Max. Negotiated Rate	$77,909.79
Rate for Payer: EPIC Health Plan Medicare	$50,579.64
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$50,579.64
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$58,166.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$63,730.35
Rate for Payer: Molina Healthcare of CA Medicare	$63,730.35
Rate for Payer: Multiplan WC	$77,909.79

MS-DRG 42.00: POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$22,249.09

Service Code	MSDRG 858
Min. Negotiated Rate	$14,672.36
Max. Negotiated Rate	$22,249.09
Rate for Payer: EPIC Health Plan Medicare	$14,672.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,672.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,873.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,487.17
Rate for Payer: Molina Healthcare of CA Medicare	$18,487.17
Rate for Payer: Multiplan WC	$22,249.09

MS-DRG 42.00: POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES

Facility

$23,994.96

Service Code	MSDRG 769
Min. Negotiated Rate	$15,798.65
Max. Negotiated Rate	$23,994.96
Rate for Payer: EPIC Health Plan Medicare	$15,798.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,798.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,168.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,906.30
Rate for Payer: Molina Healthcare of CA Medicare	$19,906.30
Rate for Payer: Multiplan WC	$23,994.96

MS-DRG 42.00: POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES

Facility

$12,321.27

Service Code	MSDRG 776
Min. Negotiated Rate	$8,267.84
Max. Negotiated Rate	$12,321.27
Rate for Payer: EPIC Health Plan Medicare	$8,267.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,267.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,508.02
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,417.48
Rate for Payer: Molina Healthcare of CA Medicare	$10,417.48
Rate for Payer: Multiplan WC	$12,321.27

MS-DRG 42.00: PREMATURITY WITH MAJOR PROBLEMS

Facility

$70,109.48

Service Code	MSDRG 791
Min. Negotiated Rate	$4,780.00
Max. Negotiated Rate	$70,109.48
Rate for Payer: EPIC Health Plan Medicare	$45,547.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$45,547.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$52,379.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$57,389.98
Rate for Payer: Molina Healthcare of CA Medicare	$57,389.98
Rate for Payer: Multiplan WC	$70,109.48
Rate for Payer: United Healthcare All Other HMO/non HMO	$5,681.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$4,780.00

MS-DRG 42.00: PREMATURITY WITHOUT MAJOR PROBLEMS

Facility

$42,303.31

Service Code	MSDRG 792
Min. Negotiated Rate	$2,814.00
Max. Negotiated Rate	$42,303.31
Rate for Payer: EPIC Health Plan Medicare	$27,609.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,609.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,750.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,788.05
Rate for Payer: Molina Healthcare of CA Medicare	$34,788.05
Rate for Payer: Multiplan WC	$42,303.31
Rate for Payer: United Healthcare All Other HMO/non HMO	$3,334.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$2,814.00

MS-DRG 42.00: PROSTATECTOMY WITH CC

Facility

$28,446.85

Service Code	MSDRG 666
Min. Negotiated Rate	$18,670.61
Max. Negotiated Rate	$28,446.85
Rate for Payer: EPIC Health Plan Medicare	$18,670.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,670.61
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,471.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,524.97
Rate for Payer: Molina Healthcare of CA Medicare	$23,524.97
Rate for Payer: Multiplan WC	$28,446.85

MS-DRG 42.00: PROSTATECTOMY WITH MCC

Facility

$59,294.06

Service Code	MSDRG 665
Min. Negotiated Rate	$38,570.45
Max. Negotiated Rate	$59,294.06
Rate for Payer: EPIC Health Plan Medicare	$38,570.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$38,570.45
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$44,356.02
Rate for Payer: Molina Healthcare of CA Medi-Cal	$48,598.77
Rate for Payer: Molina Healthcare of CA Medicare	$48,598.77
Rate for Payer: Multiplan WC	$59,294.06

MS-DRG 42.00: PROSTATECTOMY WITHOUT CC/MCC

Facility

$19,873.00

Service Code	MSDRG 667
Min. Negotiated Rate	$11,769.21
Max. Negotiated Rate	$19,873.00
Rate for Payer: EPIC Health Plan Medicare	$11,769.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,769.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,534.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,829.20
Rate for Payer: Molina Healthcare of CA Medicare	$14,829.20
Rate for Payer: Multiplan WC	$17,748.85
Rate for Payer: United Healthcare All Other HMO/non HMO	$19,873.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$16,674.00

MS-DRG 42.00: PSYCHOSES

Facility

$24,342.06

Service Code	MSDRG 885
Min. Negotiated Rate	$16,022.56
Max. Negotiated Rate	$24,342.06
Rate for Payer: EPIC Health Plan Medicare	$16,022.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,022.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,425.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,188.43
Rate for Payer: Molina Healthcare of CA Medicare	$20,188.43
Rate for Payer: Multiplan WC	$24,342.06

MS-DRG 42.00: PULMONARY EDEMA AND RESPIRATORY FAILURE

Facility

$21,368.38

Service Code	MSDRG 189
Min. Negotiated Rate	$14,104.21
Max. Negotiated Rate	$21,368.38
Rate for Payer: EPIC Health Plan Medicare	$14,104.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,104.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,219.84
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,771.30
Rate for Payer: Molina Healthcare of CA Medicare	$17,771.30
Rate for Payer: Multiplan WC	$21,368.38

MS-DRG 42.00: PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE

Facility

$24,333.43

Service Code	MSDRG 175
Min. Negotiated Rate	$16,016.99
Max. Negotiated Rate	$24,333.43
Rate for Payer: EPIC Health Plan Medicare	$16,016.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,016.99
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,419.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,181.41
Rate for Payer: Molina Healthcare of CA Medicare	$20,181.41
Rate for Payer: Multiplan WC	$24,333.43

MS-DRG 42.00: PULMONARY EMBOLISM WITHOUT MCC

Facility

$14,065.41

Service Code	MSDRG 176
Min. Negotiated Rate	$9,393.00
Max. Negotiated Rate	$14,065.41
Rate for Payer: EPIC Health Plan Medicare	$9,393.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,393.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,801.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,835.18
Rate for Payer: Molina Healthcare of CA Medicare	$11,835.18
Rate for Payer: Multiplan WC	$14,065.41

MS-DRG 42.00: RADIOTHERAPY

Facility

$46,126.62

Service Code	MSDRG 849
Min. Negotiated Rate	$30,076.00
Max. Negotiated Rate	$46,126.62
Rate for Payer: EPIC Health Plan Medicare	$30,076.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,076.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,587.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,895.76
Rate for Payer: Molina Healthcare of CA Medicare	$37,895.76
Rate for Payer: Multiplan WC	$46,126.62

MS-DRG 42.00: RECTAL RESECTION WITH CC

Facility

$36,701.32

Service Code	MSDRG 333
Min. Negotiated Rate	$23,995.65
Max. Negotiated Rate	$36,701.32
Rate for Payer: EPIC Health Plan Medicare	$23,995.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,995.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,595.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,234.52
Rate for Payer: Molina Healthcare of CA Medicare	$30,234.52
Rate for Payer: Multiplan WC	$36,701.32

MS-DRG 42.00: RECTAL RESECTION WITH MCC

Facility

$59,900.19

Service Code	MSDRG 332
Min. Negotiated Rate	$38,961.47
Max. Negotiated Rate	$59,900.19
Rate for Payer: EPIC Health Plan Medicare	$38,961.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$38,961.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$44,805.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$49,091.45
Rate for Payer: Molina Healthcare of CA Medicare	$49,091.45
Rate for Payer: Multiplan WC	$59,900.19

MS-DRG 42.00: RECTAL RESECTION WITHOUT CC/MCC

Facility

$28,641.99

Service Code	MSDRG 334
Min. Negotiated Rate	$18,796.48
Max. Negotiated Rate	$28,641.99
Rate for Payer: EPIC Health Plan Medicare	$18,796.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,796.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,615.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,683.56
Rate for Payer: Molina Healthcare of CA Medicare	$23,683.56
Rate for Payer: Multiplan WC	$28,641.99

Know your out-of-pocket cost for care.

All Charges