Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: RED BLOOD CELL DISORDERS WITHOUT MCC

Facility

$15,937.35

Service Code	MSDRG 812
Min. Negotiated Rate	$10,600.57
Max. Negotiated Rate	$15,937.35
Rate for Payer: EPIC Health Plan Medicare	$10,600.57
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,600.57
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,190.66
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,356.72
Rate for Payer: Molina Healthcare of CA Medicare	$13,356.72
Rate for Payer: Multiplan WC	$15,937.35

MS-DRG 42.00: REHABILITATION WITH CC/MCC

Facility

$26,360.78

Service Code	MSDRG 945
Min. Negotiated Rate	$17,324.84
Max. Negotiated Rate	$26,360.78
Rate for Payer: EPIC Health Plan Medicare	$17,324.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,324.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,923.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,829.30
Rate for Payer: Molina Healthcare of CA Medicare	$21,829.30
Rate for Payer: Multiplan WC	$26,360.78

MS-DRG 42.00: REHABILITATION WITHOUT CC/MCC

Facility

$19,280.59

Service Code	MSDRG 946
Min. Negotiated Rate	$12,757.31
Max. Negotiated Rate	$19,280.59
Rate for Payer: EPIC Health Plan Medicare	$12,757.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,757.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,670.91
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,074.21
Rate for Payer: Molina Healthcare of CA Medicare	$16,074.21
Rate for Payer: Multiplan WC	$19,280.59

MS-DRG 42.00: RENAL FAILURE WITH CC

Facility

$15,350.21

Service Code	MSDRG 683
Min. Negotiated Rate	$10,221.80
Max. Negotiated Rate	$15,350.21
Rate for Payer: EPIC Health Plan Medicare	$10,221.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,221.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,755.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,879.47
Rate for Payer: Molina Healthcare of CA Medicare	$12,879.47
Rate for Payer: Multiplan WC	$15,350.21

MS-DRG 42.00: RENAL FAILURE WITH MCC

Facility

$25,935.96

Service Code	MSDRG 682
Min. Negotiated Rate	$17,050.78
Max. Negotiated Rate	$25,935.96
Rate for Payer: EPIC Health Plan Medicare	$17,050.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,050.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,608.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,483.98
Rate for Payer: Molina Healthcare of CA Medicare	$21,483.98
Rate for Payer: Multiplan WC	$25,935.96

MS-DRG 42.00: RENAL FAILURE WITHOUT CC/MCC

Facility

$10,489.05

Service Code	MSDRG 684
Min. Negotiated Rate	$7,085.80
Max. Negotiated Rate	$10,489.05
Rate for Payer: EPIC Health Plan Medicare	$7,085.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,085.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,148.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,928.11
Rate for Payer: Molina Healthcare of CA Medicare	$8,928.11
Rate for Payer: Multiplan WC	$10,489.05

MS-DRG 42.00: RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC

Facility

$17,132.35

Service Code	MSDRG 178
Min. Negotiated Rate	$11,371.48
Max. Negotiated Rate	$17,132.35
Rate for Payer: EPIC Health Plan Medicare	$11,371.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,371.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,077.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,328.06
Rate for Payer: Molina Healthcare of CA Medicare	$14,328.06
Rate for Payer: Multiplan WC	$17,132.35

MS-DRG 42.00: RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC

Facility

$27,914.97

Service Code	MSDRG 177
Min. Negotiated Rate	$18,327.44
Max. Negotiated Rate	$27,914.97
Rate for Payer: EPIC Health Plan Medicare	$18,327.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,327.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,076.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,092.57
Rate for Payer: Molina Healthcare of CA Medicare	$23,092.57
Rate for Payer: Multiplan WC	$27,914.97

MS-DRG 42.00: RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC

Facility

$13,291.77

Service Code	MSDRG 179
Min. Negotiated Rate	$8,893.86
Max. Negotiated Rate	$13,291.77
Rate for Payer: EPIC Health Plan Medicare	$8,893.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,893.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,227.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,206.26
Rate for Payer: Molina Healthcare of CA Medicare	$11,206.26
Rate for Payer: Multiplan WC	$13,291.77

MS-DRG 42.00: RESPIRATORY NEOPLASMS WITH CC

Facility

$19,173.51

Service Code	MSDRG 181
Min. Negotiated Rate	$12,688.25
Max. Negotiated Rate	$19,173.51
Rate for Payer: EPIC Health Plan Medicare	$12,688.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,688.25
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,591.49
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,987.19
Rate for Payer: Molina Healthcare of CA Medicare	$15,987.19
Rate for Payer: Multiplan WC	$19,173.51

MS-DRG 42.00: RESPIRATORY NEOPLASMS WITH MCC

Facility

$30,182.36

Service Code	MSDRG 180
Min. Negotiated Rate	$19,790.17
Max. Negotiated Rate	$30,182.36
Rate for Payer: EPIC Health Plan Medicare	$19,790.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,790.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,758.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,935.61
Rate for Payer: Molina Healthcare of CA Medicare	$24,935.61
Rate for Payer: Multiplan WC	$30,182.36

MS-DRG 42.00: RESPIRATORY NEOPLASMS WITHOUT CC/MCC

Facility

$14,462.59

Service Code	MSDRG 182
Min. Negotiated Rate	$9,649.19
Max. Negotiated Rate	$14,462.59
Rate for Payer: EPIC Health Plan Medicare	$9,649.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,649.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,096.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,157.98
Rate for Payer: Molina Healthcare of CA Medicare	$12,157.98
Rate for Payer: Multiplan WC	$14,462.59

MS-DRG 42.00: RESPIRATORY SIGNS AND SYMPTOMS

Facility

$14,004.97

Service Code	MSDRG 204
Min. Negotiated Rate	$9,353.97
Max. Negotiated Rate	$14,004.97
Rate for Payer: EPIC Health Plan Medicare	$9,353.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,353.97
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,757.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,786.00
Rate for Payer: Molina Healthcare of CA Medicare	$11,786.00
Rate for Payer: Multiplan WC	$14,004.97

MS-DRG 42.00: RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS

Facility

$46,345.93

Service Code	MSDRG 208
Min. Negotiated Rate	$30,217.44
Max. Negotiated Rate	$46,345.93
Rate for Payer: EPIC Health Plan Medicare	$30,217.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,217.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,750.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,073.97
Rate for Payer: Molina Healthcare of CA Medicare	$38,073.97
Rate for Payer: Multiplan WC	$46,345.93

MS-DRG 42.00: RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS

Facility

$111,680.60

Service Code	MSDRG 207
Min. Negotiated Rate	$72,365.49
Max. Negotiated Rate	$111,680.60
Rate for Payer: EPIC Health Plan Medicare	$72,365.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$72,365.49
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$83,220.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$91,180.52
Rate for Payer: Molina Healthcare of CA Medicare	$91,180.52
Rate for Payer: Multiplan WC	$111,680.60

MS-DRG 42.00: RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC

Facility

$17,546.80

Service Code	MSDRG 815
Min. Negotiated Rate	$11,638.85
Max. Negotiated Rate	$17,546.80
Rate for Payer: EPIC Health Plan Medicare	$11,638.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,638.85
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,384.68
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,664.95
Rate for Payer: Molina Healthcare of CA Medicare	$14,664.95
Rate for Payer: Multiplan WC	$17,546.80

MS-DRG 42.00: RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC

Facility

$36,100.37

Service Code	MSDRG 814
Min. Negotiated Rate	$23,607.93
Max. Negotiated Rate	$36,100.37
Rate for Payer: EPIC Health Plan Medicare	$23,607.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,607.93
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,149.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,745.99
Rate for Payer: Molina Healthcare of CA Medicare	$29,745.99
Rate for Payer: Multiplan WC	$36,100.37

MS-DRG 42.00: RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC

Facility

$11,387.03

Service Code	MSDRG 816
Min. Negotiated Rate	$7,665.11
Max. Negotiated Rate	$11,387.03
Rate for Payer: EPIC Health Plan Medicare	$7,665.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,665.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,814.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,658.04
Rate for Payer: Molina Healthcare of CA Medicare	$9,658.04
Rate for Payer: Multiplan WC	$11,387.03

MS-DRG 42.00: REVISION OF HIP OR KNEE REPLACEMENT WITH CC

Facility

$59,149.00

Service Code	MSDRG 467
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$59,149.00
Rate for Payer: EPIC Health Plan Medicare	$38,476.84
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$38,476.84
Rate for Payer: Kaiser Permanente of CA Commercial	$9,944.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$44,248.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$48,480.82
Rate for Payer: Molina Healthcare of CA Medicare	$48,480.82
Rate for Payer: Multiplan WC	$59,149.00

MS-DRG 42.00: REVISION OF HIP OR KNEE REPLACEMENT WITH MCC

Facility

$87,977.49

Service Code	MSDRG 466
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$87,977.49
Rate for Payer: EPIC Health Plan Medicare	$57,074.39
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$57,074.39
Rate for Payer: Kaiser Permanente of CA Commercial	$9,944.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$65,635.55
Rate for Payer: Molina Healthcare of CA Medi-Cal	$71,913.73
Rate for Payer: Molina Healthcare of CA Medicare	$71,913.73
Rate for Payer: Multiplan WC	$87,977.49

MS-DRG 42.00: REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC

Facility

$45,301.17

Service Code	MSDRG 468
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$45,301.17
Rate for Payer: EPIC Health Plan Medicare	$29,543.45
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,543.45
Rate for Payer: Kaiser Permanente of CA Commercial	$9,944.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,974.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,224.75
Rate for Payer: Molina Healthcare of CA Medicare	$37,224.75
Rate for Payer: Multiplan WC	$45,301.17

MS-DRG 42.00: SALIVARY GLAND PROCEDURES

Facility

$23,710.02

Service Code	MSDRG 139
Min. Negotiated Rate	$15,614.79
Max. Negotiated Rate	$23,710.02
Rate for Payer: EPIC Health Plan Medicare	$15,614.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,614.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,957.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,674.64
Rate for Payer: Molina Healthcare of CA Medicare	$19,674.64
Rate for Payer: Multiplan WC	$23,710.02

MS-DRG 42.00: SEIZURES WITH MCC

Facility

$34,283.69

Service Code	MSDRG 100
Min. Negotiated Rate	$22,435.99
Max. Negotiated Rate	$34,283.69
Rate for Payer: EPIC Health Plan Medicare	$22,435.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,435.99
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,801.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,269.35
Rate for Payer: Molina Healthcare of CA Medicare	$28,269.35
Rate for Payer: Multiplan WC	$34,283.69

MS-DRG 42.00: SEIZURES WITHOUT MCC

Facility

$15,916.63

Service Code	MSDRG 101
Min. Negotiated Rate	$10,587.18
Max. Negotiated Rate	$15,916.63
Rate for Payer: EPIC Health Plan Medicare	$10,587.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,587.18
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,175.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,339.85
Rate for Payer: Molina Healthcare of CA Medicare	$13,339.85
Rate for Payer: Multiplan WC	$15,916.63

MS-DRG 42.00: SEPTIC ARTHRITIS WITH CC

Facility

$20,810.59

Service Code	MSDRG 549
Min. Negotiated Rate	$13,744.34
Max. Negotiated Rate	$20,810.59
Rate for Payer: EPIC Health Plan Medicare	$13,744.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,744.34
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,805.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,317.87
Rate for Payer: Molina Healthcare of CA Medicare	$17,317.87
Rate for Payer: Multiplan WC	$20,810.59

Know your out-of-pocket cost for care.

All Charges