Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: SEPTIC ARTHRITIS WITH CC

Facility

$20,810.59

Service Code	MSDRG 549
Min. Negotiated Rate	$13,744.38
Max. Negotiated Rate	$20,810.59
Rate for Payer: EPIC Health Plan Medicare	$13,744.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,744.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,806.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,317.92
Rate for Payer: Molina Healthcare of CA Medicare	$17,317.92
Rate for Payer: Multiplan WC	$20,810.59

MS-DRG 42.00: SEPTIC ARTHRITIS WITH MCC

Facility

$34,789.67

Service Code	MSDRG 548
Min. Negotiated Rate	$22,762.44
Max. Negotiated Rate	$34,789.67
Rate for Payer: EPIC Health Plan Medicare	$22,762.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,762.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,176.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,680.67
Rate for Payer: Molina Healthcare of CA Medicare	$28,680.67
Rate for Payer: Multiplan WC	$34,789.67

MS-DRG 42.00: SEPTIC ARTHRITIS WITHOUT CC/MCC

Facility

$14,887.41

Service Code	MSDRG 550
Min. Negotiated Rate	$9,923.28
Max. Negotiated Rate	$14,887.41
Rate for Payer: EPIC Health Plan Medicare	$9,923.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,923.28
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,411.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,503.33
Rate for Payer: Molina Healthcare of CA Medicare	$12,503.33
Rate for Payer: Multiplan WC	$14,887.41

MS-DRG 42.00: SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS

Facility

$120,130.21

Service Code	MSDRG 870
Min. Negotiated Rate	$77,816.47
Max. Negotiated Rate	$120,130.21
Rate for Payer: EPIC Health Plan Medicare	$77,816.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$77,816.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$89,488.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$98,048.75
Rate for Payer: Molina Healthcare of CA Medicare	$98,048.75
Rate for Payer: Multiplan WC	$120,130.21

MS-DRG 42.00: SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC

Facility

$33,883.06

Service Code	MSDRG 871
Min. Negotiated Rate	$22,177.56
Max. Negotiated Rate	$33,883.06
Rate for Payer: EPIC Health Plan Medicare	$22,177.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,177.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,504.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,943.73
Rate for Payer: Molina Healthcare of CA Medicare	$27,943.73
Rate for Payer: Multiplan WC	$33,883.06

MS-DRG 42.00: SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC

Facility

$17,804.10

Service Code	MSDRG 872
Min. Negotiated Rate	$11,804.87
Max. Negotiated Rate	$17,804.10
Rate for Payer: EPIC Health Plan Medicare	$11,804.87
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,804.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,575.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,874.14
Rate for Payer: Molina Healthcare of CA Medicare	$14,874.14
Rate for Payer: Multiplan WC	$17,804.10

MS-DRG 42.00: SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC

Facility

$33,867.52

Service Code	MSDRG 511
Min. Negotiated Rate	$22,167.54
Max. Negotiated Rate	$33,867.52
Rate for Payer: EPIC Health Plan Medicare	$22,167.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,167.54
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,492.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,931.10
Rate for Payer: Molina Healthcare of CA Medicare	$27,931.10
Rate for Payer: Multiplan WC	$33,867.52

MS-DRG 42.00: SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC

Facility

$49,355.88

Service Code	MSDRG 510
Min. Negotiated Rate	$32,159.23
Max. Negotiated Rate	$49,355.88
Rate for Payer: EPIC Health Plan Medicare	$32,159.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,159.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,983.11
Rate for Payer: Molina Healthcare of CA Medi-Cal	$40,520.63
Rate for Payer: Molina Healthcare of CA Medicare	$40,520.63
Rate for Payer: Multiplan WC	$49,355.88

MS-DRG 42.00: SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC

Facility

$27,764.73

Service Code	MSDRG 512
Min. Negotiated Rate	$18,230.58
Max. Negotiated Rate	$27,764.73
Rate for Payer: EPIC Health Plan Medicare	$18,230.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,230.58
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,965.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,970.53
Rate for Payer: Molina Healthcare of CA Medicare	$22,970.53
Rate for Payer: Multiplan WC	$27,764.73

MS-DRG 42.00: SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$23,254.13

Service Code	MSDRG 555
Min. Negotiated Rate	$15,320.73
Max. Negotiated Rate	$23,254.13
Rate for Payer: EPIC Health Plan Medicare	$15,320.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,320.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,618.84
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,304.12
Rate for Payer: Molina Healthcare of CA Medicare	$19,304.12
Rate for Payer: Multiplan WC	$23,254.13

MS-DRG 42.00: SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC

Facility

$14,099.96

Service Code	MSDRG 556
Min. Negotiated Rate	$9,415.28
Max. Negotiated Rate	$14,099.96
Rate for Payer: EPIC Health Plan Medicare	$9,415.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,415.28
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,827.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,863.25
Rate for Payer: Molina Healthcare of CA Medicare	$11,863.25
Rate for Payer: Multiplan WC	$14,099.96

MS-DRG 42.00: SIGNS AND SYMPTOMS WITH MCC

Facility

$22,211.09

Service Code	MSDRG 947
Min. Negotiated Rate	$14,647.85
Max. Negotiated Rate	$22,211.09
Rate for Payer: EPIC Health Plan Medicare	$14,647.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,647.85
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,845.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,456.29
Rate for Payer: Molina Healthcare of CA Medicare	$18,456.29
Rate for Payer: Multiplan WC	$22,211.09

MS-DRG 42.00: SIGNS AND SYMPTOMS WITHOUT MCC

Facility

$13,720.04

Service Code	MSDRG 948
Min. Negotiated Rate	$9,170.19
Max. Negotiated Rate	$13,720.04
Rate for Payer: EPIC Health Plan Medicare	$9,170.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,170.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,545.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,554.44
Rate for Payer: Molina Healthcare of CA Medicare	$11,554.44
Rate for Payer: Multiplan WC	$13,720.04

MS-DRG 42.00: SIMPLE PNEUMONIA AND PLEURISY WITH CC

Facility

$14,160.39

Service Code	MSDRG 194
Min. Negotiated Rate	$9,454.26
Max. Negotiated Rate	$14,160.39
Rate for Payer: EPIC Health Plan Medicare	$9,454.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,454.26
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,872.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,912.37
Rate for Payer: Molina Healthcare of CA Medicare	$11,912.37
Rate for Payer: Multiplan WC	$14,160.39

MS-DRG 42.00: SIMPLE PNEUMONIA AND PLEURISY WITH MCC

Facility

$22,755.06

Service Code	MSDRG 193
Min. Negotiated Rate	$14,998.78
Max. Negotiated Rate	$22,755.06
Rate for Payer: EPIC Health Plan Medicare	$14,998.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,998.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,248.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,898.46
Rate for Payer: Molina Healthcare of CA Medicare	$18,898.46
Rate for Payer: Multiplan WC	$22,755.06

MS-DRG 42.00: SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC

Facility

$10,753.27

Service Code	MSDRG 195
Min. Negotiated Rate	$7,256.30
Max. Negotiated Rate	$10,753.27
Rate for Payer: EPIC Health Plan Medicare	$7,256.30
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,256.30
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,344.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,142.94
Rate for Payer: Molina Healthcare of CA Medicare	$9,142.94
Rate for Payer: Multiplan WC	$10,753.27

MS-DRG 42.00: SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT

Facility

$93,961.12

Service Code	MSDRG 008
Min. Negotiated Rate	$60,934.53
Max. Negotiated Rate	$93,961.12
Rate for Payer: EPIC Health Plan Medicare	$60,934.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$60,934.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$70,074.71
Rate for Payer: Molina Healthcare of CA Medi-Cal	$76,777.51
Rate for Payer: Molina Healthcare of CA Medicare	$76,777.51
Rate for Payer: Multiplan WC	$93,961.12

MS-DRG 42.00: SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS

Facility

$136,894.74

Service Code	MSDRG 019
Min. Negotiated Rate	$88,631.43
Max. Negotiated Rate	$136,894.74
Rate for Payer: EPIC Health Plan Medicare	$88,631.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$88,631.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$101,926.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$111,675.60
Rate for Payer: Molina Healthcare of CA Medicare	$111,675.60
Rate for Payer: Multiplan WC	$136,894.74

MS-DRG 42.00: SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL

Facility

$67,558.89

Service Code	MSDRG 402
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$67,558.89
Rate for Payer: EPIC Health Plan Medicare	$43,902.19
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	$43,902.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$50,487.52
Rate for Payer: Molina Healthcare of CA Medi-Cal	$55,316.76
Rate for Payer: Molina Healthcare of CA Medicare	$55,316.76
Rate for Payer: Multiplan WC	$67,558.89

MS-DRG 42.00: SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE

Facility

$88,935.90

Service Code	MSDRG 450
Min. Negotiated Rate	$57,692.72
Max. Negotiated Rate	$88,935.90
Rate for Payer: EPIC Health Plan Medicare	$57,692.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$57,692.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$66,346.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$72,692.83
Rate for Payer: Molina Healthcare of CA Medicare	$72,692.83
Rate for Payer: Multiplan WC	$88,935.90

MS-DRG 42.00: SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC

Facility

$53,291.43

Service Code	MSDRG 451
Min. Negotiated Rate	$34,698.09
Max. Negotiated Rate	$53,291.43
Rate for Payer: EPIC Health Plan Medicare	$34,698.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,698.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,902.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,719.59
Rate for Payer: Molina Healthcare of CA Medicare	$43,719.59
Rate for Payer: Multiplan WC	$53,291.43

MS-DRG 42.00: SINUS AND MASTOID PROCEDURES WITH CC/MCC

Facility

$41,636.74

Service Code	MSDRG 135
Min. Negotiated Rate	$27,179.54
Max. Negotiated Rate	$41,636.74
Rate for Payer: EPIC Health Plan Medicare	$27,179.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,179.54
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,256.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,246.22
Rate for Payer: Molina Healthcare of CA Medicare	$34,246.22
Rate for Payer: Multiplan WC	$41,636.74

MS-DRG 42.00: SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC

Facility

$16,892.31

Service Code	MSDRG 136
Min. Negotiated Rate	$11,216.65
Max. Negotiated Rate	$16,892.31
Rate for Payer: EPIC Health Plan Medicare	$11,216.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,216.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,899.15
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,132.98
Rate for Payer: Molina Healthcare of CA Medicare	$14,132.98
Rate for Payer: Multiplan WC	$16,892.31

MS-DRG 42.00: SKIN DEBRIDEMENT WITH CC

Facility

$28,913.11

Service Code	MSDRG 571
Min. Negotiated Rate	$18,971.38
Max. Negotiated Rate	$28,913.11
Rate for Payer: EPIC Health Plan Medicare	$18,971.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,971.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,817.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,903.94
Rate for Payer: Molina Healthcare of CA Medicare	$23,903.94
Rate for Payer: Multiplan WC	$28,913.11

MS-DRG 42.00: SKIN DEBRIDEMENT WITH MCC

Facility

$51,982.45

Service Code	MSDRG 570
Min. Negotiated Rate	$33,853.66
Max. Negotiated Rate	$51,982.45
Rate for Payer: EPIC Health Plan Medicare	$33,853.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,853.66
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$38,931.71
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,655.61
Rate for Payer: Molina Healthcare of CA Medicare	$42,655.61
Rate for Payer: Multiplan WC	$51,982.45

Know your out-of-pocket cost for care.

All Charges