Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: RED BLOOD CELL DISORDERS WITH MCC

Facility

$24,295.43

Service Code	MSDRG 811
Min. Negotiated Rate	$15,992.50
Max. Negotiated Rate	$24,295.43
Rate for Payer: EPIC Health Plan Medicare	$15,992.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,992.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,391.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,150.55
Rate for Payer: Molina Healthcare of CA Medicare	$20,150.55
Rate for Payer: Multiplan WC	$24,295.43

MS-DRG 42.00: RED BLOOD CELL DISORDERS WITHOUT MCC

Facility

$15,937.35

Service Code	MSDRG 812
Min. Negotiated Rate	$10,600.61
Max. Negotiated Rate	$15,937.35
Rate for Payer: EPIC Health Plan Medicare	$10,600.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,600.61
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,190.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,356.77
Rate for Payer: Molina Healthcare of CA Medicare	$13,356.77
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	$17,324.88
Max. Negotiated Rate	$26,360.78
Rate for Payer: EPIC Health Plan Medicare	$17,324.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,324.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,923.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,829.35
Rate for Payer: Molina Healthcare of CA Medicare	$21,829.35
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	$12,757.35
Max. Negotiated Rate	$19,280.59
Rate for Payer: EPIC Health Plan Medicare	$12,757.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,757.35
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,670.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,074.26
Rate for Payer: Molina Healthcare of CA Medicare	$16,074.26
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	$10,221.84
Max. Negotiated Rate	$15,350.21
Rate for Payer: EPIC Health Plan Medicare	$10,221.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,221.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,755.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,879.52
Rate for Payer: Molina Healthcare of CA Medicare	$12,879.52
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	$17,050.82
Max. Negotiated Rate	$25,935.96
Rate for Payer: EPIC Health Plan Medicare	$17,050.82
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,050.82
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,608.44
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,484.03
Rate for Payer: Molina Healthcare of CA Medicare	$21,484.03
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	$7,085.84
Max. Negotiated Rate	$10,489.05
Rate for Payer: EPIC Health Plan Medicare	$7,085.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,085.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,148.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,928.16
Rate for Payer: Molina Healthcare of CA Medicare	$8,928.16
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	$11,371.52
Max. Negotiated Rate	$17,132.35
Rate for Payer: EPIC Health Plan Medicare	$11,371.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,371.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,077.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,328.12
Rate for Payer: Molina Healthcare of CA Medicare	$14,328.12
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	$18,327.48
Max. Negotiated Rate	$27,914.97
Rate for Payer: EPIC Health Plan Medicare	$18,327.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,327.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,076.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,092.62
Rate for Payer: Molina Healthcare of CA Medicare	$23,092.62
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	$8,893.90
Max. Negotiated Rate	$13,291.77
Rate for Payer: EPIC Health Plan Medicare	$8,893.90
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,893.90
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,227.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,206.31
Rate for Payer: Molina Healthcare of CA Medicare	$11,206.31
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	$12,688.29
Max. Negotiated Rate	$19,173.51
Rate for Payer: EPIC Health Plan Medicare	$12,688.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,688.29
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,591.53
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,987.25
Rate for Payer: Molina Healthcare of CA Medicare	$15,987.25
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	$19,790.21
Max. Negotiated Rate	$30,182.36
Rate for Payer: EPIC Health Plan Medicare	$19,790.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,790.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,758.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,935.66
Rate for Payer: Molina Healthcare of CA Medicare	$24,935.66
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	$9,649.23
Max. Negotiated Rate	$14,462.59
Rate for Payer: EPIC Health Plan Medicare	$9,649.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,649.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,096.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,158.03
Rate for Payer: Molina Healthcare of CA Medicare	$12,158.03
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	$9,354.01
Max. Negotiated Rate	$14,004.97
Rate for Payer: EPIC Health Plan Medicare	$9,354.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,354.01
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,757.11
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,786.05
Rate for Payer: Molina Healthcare of CA Medicare	$11,786.05
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	$30,217.48
Max. Negotiated Rate	$46,345.93
Rate for Payer: EPIC Health Plan Medicare	$30,217.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,217.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,750.10
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,074.02
Rate for Payer: Molina Healthcare of CA Medicare	$38,074.02
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	$72,365.53
Max. Negotiated Rate	$111,680.60
Rate for Payer: EPIC Health Plan Medicare	$72,365.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$72,365.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$83,220.36
Rate for Payer: Molina Healthcare of CA Medi-Cal	$91,180.57
Rate for Payer: Molina Healthcare of CA Medicare	$91,180.57
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	$11,638.89
Max. Negotiated Rate	$17,546.80
Rate for Payer: EPIC Health Plan Medicare	$11,638.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,638.89
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,384.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,665.00
Rate for Payer: Molina Healthcare of CA Medicare	$14,665.00
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	$23,607.97
Max. Negotiated Rate	$36,100.37
Rate for Payer: EPIC Health Plan Medicare	$23,607.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,607.97
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,149.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,746.04
Rate for Payer: Molina Healthcare of CA Medicare	$29,746.04
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	$7,665.15
Max. Negotiated Rate	$11,387.03
Rate for Payer: EPIC Health Plan Medicare	$7,665.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,665.15
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,814.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,658.09
Rate for Payer: Molina Healthcare of CA Medicare	$9,658.09
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	$38,476.88
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	$38,476.88
Rate for Payer: Kaiser Permanente of CA Commercial	$9,944.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$44,248.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$48,480.87
Rate for Payer: Molina Healthcare of CA Medicare	$48,480.87
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	$57,074.43
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	$57,074.43
Rate for Payer: Kaiser Permanente of CA Commercial	$9,944.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$65,635.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$71,913.78
Rate for Payer: Molina Healthcare of CA Medicare	$71,913.78
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	$29,543.49
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	$29,543.49
Rate for Payer: Kaiser Permanente of CA Commercial	$9,944.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,975.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,224.80
Rate for Payer: Molina Healthcare of CA Medicare	$37,224.80
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	$15,614.83
Max. Negotiated Rate	$23,710.02
Rate for Payer: EPIC Health Plan Medicare	$15,614.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,614.83
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,957.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,674.69
Rate for Payer: Molina Healthcare of CA Medicare	$19,674.69
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	$22,436.03
Max. Negotiated Rate	$34,283.69
Rate for Payer: EPIC Health Plan Medicare	$22,436.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,436.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,801.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,269.40
Rate for Payer: Molina Healthcare of CA Medicare	$28,269.40
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	$10,587.22
Max. Negotiated Rate	$15,916.63
Rate for Payer: EPIC Health Plan Medicare	$10,587.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,587.22
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,175.30
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,339.90
Rate for Payer: Molina Healthcare of CA Medicare	$13,339.90
Rate for Payer: Multiplan WC	$15,916.63

Know your out-of-pocket cost for care.

All Charges