Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility

$45,983.29

Service Code	MSDRG 577
Min. Negotiated Rate	$29,983.50
Max. Negotiated Rate	$45,983.29
Rate for Payer: EPIC Health Plan Medicare	$29,983.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,983.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,481.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,779.21
Rate for Payer: Molina Healthcare of CA Medicare	$37,779.21
Rate for Payer: Multiplan WC	$45,983.29

MS-DRG 42.00: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility

$93,170.21

Service Code	MSDRG 576
Min. Negotiated Rate	$60,424.27
Max. Negotiated Rate	$93,170.21
Rate for Payer: EPIC Health Plan Medicare	$60,424.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$60,424.27
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$69,487.91
Rate for Payer: Molina Healthcare of CA Medi-Cal	$76,134.58
Rate for Payer: Molina Healthcare of CA Medicare	$76,134.58
Rate for Payer: Multiplan WC	$93,170.21

MS-DRG 42.00: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility

$29,191.13

Service Code	MSDRG 578
Min. Negotiated Rate	$19,150.69
Max. Negotiated Rate	$29,191.13
Rate for Payer: EPIC Health Plan Medicare	$19,150.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,150.69
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,023.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,129.87
Rate for Payer: Molina Healthcare of CA Medicare	$24,129.87
Rate for Payer: Multiplan WC	$29,191.13

MS-DRG 42.00: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility

$59,834.57

Service Code	MSDRG 574
Min. Negotiated Rate	$38,919.10
Max. Negotiated Rate	$59,834.57
Rate for Payer: EPIC Health Plan Medicare	$38,919.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$38,919.10
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$44,756.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$49,038.07
Rate for Payer: Molina Healthcare of CA Medicare	$49,038.07
Rate for Payer: Multiplan WC	$59,834.57

MS-DRG 42.00: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility

$106,344.55

Service Code	MSDRG 573
Min. Negotiated Rate	$68,923.16
Max. Negotiated Rate	$106,344.55
Rate for Payer: EPIC Health Plan Medicare	$68,923.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$68,923.16
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$79,261.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$86,843.18
Rate for Payer: Molina Healthcare of CA Medicare	$86,843.18
Rate for Payer: Multiplan WC	$106,344.55

MS-DRG 42.00: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility

$34,480.56

Service Code	MSDRG 575
Min. Negotiated Rate	$22,562.98
Max. Negotiated Rate	$34,480.56
Rate for Payer: EPIC Health Plan Medicare	$22,562.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,562.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,947.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,429.35
Rate for Payer: Molina Healthcare of CA Medicare	$28,429.35
Rate for Payer: Multiplan WC	$34,480.56

MS-DRG 42.00: SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC

Facility

$33,031.70

Service Code	MSDRG 623
Min. Negotiated Rate	$21,628.31
Max. Negotiated Rate	$33,031.70
Rate for Payer: EPIC Health Plan Medicare	$21,628.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,628.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,872.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,251.67
Rate for Payer: Molina Healthcare of CA Medicare	$27,251.67
Rate for Payer: Multiplan WC	$33,031.70

MS-DRG 42.00: SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC

Facility

$64,619.75

Service Code	MSDRG 622
Min. Negotiated Rate	$42,006.08
Max. Negotiated Rate	$64,619.75
Rate for Payer: EPIC Health Plan Medicare	$42,006.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$42,006.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$48,306.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$52,927.66
Rate for Payer: Molina Healthcare of CA Medicare	$52,927.66
Rate for Payer: Multiplan WC	$64,619.75

MS-DRG 42.00: SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC

Facility

$17,322.30

Service Code	MSDRG 624
Min. Negotiated Rate	$11,494.03
Max. Negotiated Rate	$17,322.30
Rate for Payer: EPIC Health Plan Medicare	$11,494.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,494.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,218.13
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,482.48
Rate for Payer: Molina Healthcare of CA Medicare	$14,482.48
Rate for Payer: Multiplan WC	$17,322.30

MS-DRG 42.00: SKIN GRAFTS FOR INJURIES WITH CC/MCC

Facility

$66,676.46

Service Code	MSDRG 904
Min. Negotiated Rate	$43,332.88
Max. Negotiated Rate	$66,676.46
Rate for Payer: EPIC Health Plan Medicare	$43,332.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$43,332.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$49,832.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$54,599.43
Rate for Payer: Molina Healthcare of CA Medicare	$54,599.43
Rate for Payer: Multiplan WC	$66,676.46

MS-DRG 42.00: SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC

Facility

$28,462.39

Service Code	MSDRG 905
Min. Negotiated Rate	$18,680.59
Max. Negotiated Rate	$28,462.39
Rate for Payer: EPIC Health Plan Medicare	$18,680.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,680.59
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,482.68
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,537.54
Rate for Payer: Molina Healthcare of CA Medicare	$23,537.54
Rate for Payer: Multiplan WC	$28,462.39

MS-DRG 42.00: SKIN ULCERS WITH CC

Facility

$21,114.53

Service Code	MSDRG 593
Min. Negotiated Rate	$13,940.41
Max. Negotiated Rate	$21,114.53
Rate for Payer: EPIC Health Plan Medicare	$13,940.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,940.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,031.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,564.92
Rate for Payer: Molina Healthcare of CA Medicare	$17,564.92
Rate for Payer: Multiplan WC	$21,114.53

MS-DRG 42.00: SKIN ULCERS WITH MCC

Facility

$35,509.78

Service Code	MSDRG 592
Min. Negotiated Rate	$23,226.94
Max. Negotiated Rate	$35,509.78
Rate for Payer: EPIC Health Plan Medicare	$23,226.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,226.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,710.98
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,265.94
Rate for Payer: Molina Healthcare of CA Medicare	$29,265.94
Rate for Payer: Multiplan WC	$35,509.78

MS-DRG 42.00: SKIN ULCERS WITHOUT CC/MCC

Facility

$14,656.01

Service Code	MSDRG 594
Min. Negotiated Rate	$9,773.95
Max. Negotiated Rate	$14,656.01
Rate for Payer: EPIC Health Plan Medicare	$9,773.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,773.95
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,240.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,315.18
Rate for Payer: Molina Healthcare of CA Medicare	$12,315.18
Rate for Payer: Multiplan WC	$14,656.01

MS-DRG 42.00: SOFT TISSUE PROCEDURES WITH CC

Facility

$30,819.58

Service Code	MSDRG 501
Min. Negotiated Rate	$20,201.23
Max. Negotiated Rate	$30,819.58
Rate for Payer: EPIC Health Plan Medicare	$20,201.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,201.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,231.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,453.55
Rate for Payer: Molina Healthcare of CA Medicare	$25,453.55
Rate for Payer: Multiplan WC	$30,819.58

MS-DRG 42.00: SOFT TISSUE PROCEDURES WITH MCC

Facility

$54,719.55

Service Code	MSDRG 500
Min. Negotiated Rate	$35,619.35
Max. Negotiated Rate	$54,719.55
Rate for Payer: EPIC Health Plan Medicare	$35,619.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,619.35
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,962.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$44,880.38
Rate for Payer: Molina Healthcare of CA Medicare	$44,880.38
Rate for Payer: Multiplan WC	$54,719.55

MS-DRG 42.00: SOFT TISSUE PROCEDURES WITHOUT CC/MCC

Facility

$24,127.93

Service Code	MSDRG 502
Min. Negotiated Rate	$15,884.40
Max. Negotiated Rate	$24,127.93
Rate for Payer: EPIC Health Plan Medicare	$15,884.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,884.40
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,267.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,014.34
Rate for Payer: Molina Healthcare of CA Medicare	$20,014.34
Rate for Payer: Multiplan WC	$24,127.93

MS-DRG 42.00: SPINAL DISORDERS AND INJURIES WITH CC/MCC

Facility

$34,753.41

Service Code	MSDRG 052
Min. Negotiated Rate	$22,738.99
Max. Negotiated Rate	$34,753.41
Rate for Payer: EPIC Health Plan Medicare	$22,738.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,738.99
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,149.84
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,651.13
Rate for Payer: Molina Healthcare of CA Medicare	$28,651.13
Rate for Payer: Multiplan WC	$34,753.41

MS-DRG 42.00: SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC

Facility

$15,911.45

Service Code	MSDRG 053
Min. Negotiated Rate	$10,583.87
Max. Negotiated Rate	$15,911.45
Rate for Payer: EPIC Health Plan Medicare	$10,583.87
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,583.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,171.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,335.68
Rate for Payer: Molina Healthcare of CA Medicare	$13,335.68
Rate for Payer: Multiplan WC	$15,911.45

MS-DRG 42.00: SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC

Facility

$99,112.39

Service Code	MSDRG 457
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$99,112.39
Rate for Payer: EPIC Health Plan Medicare	$64,257.61
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	$64,257.61
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$73,896.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$80,964.59
Rate for Payer: Molina Healthcare of CA Medicare	$80,964.59
Rate for Payer: Multiplan WC	$99,112.39

MS-DRG 42.00: SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC

Facility

$146,252.68

Service Code	MSDRG 456
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$146,252.68
Rate for Payer: EPIC Health Plan Medicare	$94,668.30
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	$94,668.30
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$108,868.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$119,282.06
Rate for Payer: Molina Healthcare of CA Medicare	$119,282.06
Rate for Payer: Multiplan WC	$146,252.68

MS-DRG 42.00: SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC

Facility

$74,566.55

Service Code	MSDRG 458
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$74,566.55
Rate for Payer: EPIC Health Plan Medicare	$48,422.87
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	$48,422.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$55,686.30
Rate for Payer: Molina Healthcare of CA Medi-Cal	$61,012.82
Rate for Payer: Molina Healthcare of CA Medicare	$61,012.82
Rate for Payer: Multiplan WC	$74,566.55

MS-DRG 42.00: SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS

Facility

$57,966.09

Service Code	MSDRG 029
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$57,966.09
Rate for Payer: EPIC Health Plan Medicare	$37,713.73
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	$37,713.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$43,370.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$47,519.30
Rate for Payer: Molina Healthcare of CA Medicare	$47,519.30
Rate for Payer: Multiplan WC	$57,966.09

MS-DRG 42.00: SPINAL PROCEDURES WITH MCC

Facility

$104,985.50

Service Code	MSDRG 028
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$104,985.50
Rate for Payer: EPIC Health Plan Medicare	$68,046.42
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	$68,046.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$78,253.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$85,738.49
Rate for Payer: Molina Healthcare of CA Medicare	$85,738.49
Rate for Payer: Multiplan WC	$104,985.50

MS-DRG 42.00: SPINAL PROCEDURES WITHOUT CC/MCC

Facility

$38,429.93

Service Code	MSDRG 030
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$38,429.93
Rate for Payer: EPIC Health Plan Medicare	$25,110.75
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	$25,110.75
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,877.36
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,639.54
Rate for Payer: Molina Healthcare of CA Medicare	$31,639.54
Rate for Payer: Multiplan WC	$38,429.93

Know your out-of-pocket cost for care.

All Charges