Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: SPLENIC PROCEDURES WITH CC

Facility

$50,317.75

Service Code	MSDRG 800
Min. Negotiated Rate	$32,779.70
Max. Negotiated Rate	$50,317.75
Rate for Payer: EPIC Health Plan Medicare	$32,779.70
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,779.70
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,696.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$41,302.42
Rate for Payer: Molina Healthcare of CA Medicare	$41,302.42
Rate for Payer: Multiplan WC	$50,317.75

MS-DRG 42.00: SPLENIC PROCEDURES WITH MCC

Facility

$82,109.55

Service Code	MSDRG 799
Min. Negotiated Rate	$53,288.91
Max. Negotiated Rate	$82,109.55
Rate for Payer: EPIC Health Plan Medicare	$53,288.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$53,288.91
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$61,282.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$67,144.03
Rate for Payer: Molina Healthcare of CA Medicare	$67,144.03
Rate for Payer: Multiplan WC	$82,109.55

MS-DRG 42.00: SPLENIC PROCEDURES WITHOUT CC/MCC

Facility

$28,350.15

Service Code	MSDRG 801
Min. Negotiated Rate	$18,608.18
Max. Negotiated Rate	$28,350.15
Rate for Payer: EPIC Health Plan Medicare	$18,608.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,608.18
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,399.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,446.31
Rate for Payer: Molina Healthcare of CA Medicare	$23,446.31
Rate for Payer: Multiplan WC	$28,350.15

MS-DRG 42.00: SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC

Facility

$15,870.00

Service Code	MSDRG 537
Min. Negotiated Rate	$10,557.12
Max. Negotiated Rate	$15,870.00
Rate for Payer: EPIC Health Plan Medicare	$10,557.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,557.12
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,140.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,301.97
Rate for Payer: Molina Healthcare of CA Medicare	$13,301.97
Rate for Payer: Multiplan WC	$15,870.00

MS-DRG 42.00: SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC

Facility

$11,595.98

Service Code	MSDRG 538
Min. Negotiated Rate	$7,799.89
Max. Negotiated Rate	$11,595.98
Rate for Payer: EPIC Health Plan Medicare	$7,799.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,799.89
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,969.87
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,827.86
Rate for Payer: Molina Healthcare of CA Medicare	$9,827.86
Rate for Payer: Multiplan WC	$11,595.98

MS-DRG 42.00: STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC

Facility

$41,930.31

Service Code	MSDRG 327
Min. Negotiated Rate	$27,368.89
Max. Negotiated Rate	$41,930.31
Rate for Payer: EPIC Health Plan Medicare	$27,368.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,368.89
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,474.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,484.80
Rate for Payer: Molina Healthcare of CA Medicare	$34,484.80
Rate for Payer: Multiplan WC	$41,930.31

MS-DRG 42.00: STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC

Facility

$87,708.09

Service Code	MSDRG 326
Min. Negotiated Rate	$56,900.59
Max. Negotiated Rate	$87,708.09
Rate for Payer: EPIC Health Plan Medicare	$56,900.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$56,900.59
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$65,435.68
Rate for Payer: Molina Healthcare of CA Medi-Cal	$71,694.74
Rate for Payer: Molina Healthcare of CA Medicare	$71,694.74
Rate for Payer: Multiplan WC	$87,708.09

MS-DRG 42.00: STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC

Facility

$27,517.79

Service Code	MSDRG 328
Min. Negotiated Rate	$18,071.22
Max. Negotiated Rate	$27,517.79
Rate for Payer: EPIC Health Plan Medicare	$18,071.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,071.22
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,781.90
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,769.74
Rate for Payer: Molina Healthcare of CA Medicare	$22,769.74
Rate for Payer: Multiplan WC	$27,517.79

MS-DRG 42.00: SYNCOPE AND COLLAPSE

Facility

$15,046.28

Service Code	MSDRG 312
Min. Negotiated Rate	$10,025.74
Max. Negotiated Rate	$15,046.28
Rate for Payer: EPIC Health Plan Medicare	$10,025.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,025.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,529.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,632.43
Rate for Payer: Molina Healthcare of CA Medicare	$12,632.43
Rate for Payer: Multiplan WC	$15,046.28

MS-DRG 42.00: TENDONITIS, MYOSITIS AND BURSITIS WITH MCC

Facility

$26,761.42

Service Code	MSDRG 557
Min. Negotiated Rate	$17,583.27
Max. Negotiated Rate	$26,761.42
Rate for Payer: EPIC Health Plan Medicare	$17,583.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,583.27
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,220.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,154.92
Rate for Payer: Molina Healthcare of CA Medicare	$22,154.92
Rate for Payer: Multiplan WC	$26,761.42

MS-DRG 42.00: TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC

Facility

$14,916.77

Service Code	MSDRG 558
Min. Negotiated Rate	$9,942.16
Max. Negotiated Rate	$14,916.77
Rate for Payer: EPIC Health Plan Medicare	$9,942.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,942.16
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,433.48
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,527.12
Rate for Payer: Molina Healthcare of CA Medicare	$12,527.12
Rate for Payer: Multiplan WC	$14,916.77

MS-DRG 42.00: TESTES PROCEDURES WITH CC/MCC

Facility

$32,993.72

Service Code	MSDRG 711
Min. Negotiated Rate	$21,603.80
Max. Negotiated Rate	$32,993.72
Rate for Payer: EPIC Health Plan Medicare	$21,603.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,603.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,844.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,220.79
Rate for Payer: Molina Healthcare of CA Medicare	$27,220.79
Rate for Payer: Multiplan WC	$32,993.72

MS-DRG 42.00: TESTES PROCEDURES WITHOUT CC/MCC

Facility

$18,470.68

Service Code	MSDRG 712
Min. Negotiated Rate	$12,234.84
Max. Negotiated Rate	$18,470.68
Rate for Payer: EPIC Health Plan Medicare	$12,234.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,234.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,070.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,415.90
Rate for Payer: Molina Healthcare of CA Medicare	$15,415.90
Rate for Payer: Multiplan WC	$18,470.68

MS-DRG 42.00: THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC

Facility

$26,063.76

Service Code	MSDRG 626
Min. Negotiated Rate	$17,133.21
Max. Negotiated Rate	$26,063.76
Rate for Payer: EPIC Health Plan Medicare	$17,133.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,133.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,703.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,587.84
Rate for Payer: Molina Healthcare of CA Medicare	$21,587.84
Rate for Payer: Multiplan WC	$26,063.76

MS-DRG 42.00: THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC

Facility

$49,511.30

Service Code	MSDRG 625
Min. Negotiated Rate	$32,259.47
Max. Negotiated Rate	$49,511.30
Rate for Payer: EPIC Health Plan Medicare	$32,259.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,259.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,098.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$40,646.93
Rate for Payer: Molina Healthcare of CA Medicare	$40,646.93
Rate for Payer: Multiplan WC	$49,511.30

MS-DRG 42.00: THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC

Facility

$21,877.80

Service Code	MSDRG 627
Min. Negotiated Rate	$14,432.81
Max. Negotiated Rate	$21,877.80
Rate for Payer: EPIC Health Plan Medicare	$14,432.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,432.81
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,597.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,185.34
Rate for Payer: Molina Healthcare of CA Medicare	$18,185.34
Rate for Payer: Multiplan WC	$21,877.80

MS-DRG 42.00: TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC

Facility

$70,865.86

Service Code	MSDRG 012
Min. Negotiated Rate	$46,035.51
Max. Negotiated Rate	$70,865.86
Rate for Payer: EPIC Health Plan Medicare	$46,035.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$46,035.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$52,940.84
Rate for Payer: Molina Healthcare of CA Medi-Cal	$58,004.74
Rate for Payer: Molina Healthcare of CA Medicare	$58,004.74
Rate for Payer: Multiplan WC	$70,865.86

MS-DRG 42.00: TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC

Facility

$93,180.57

Service Code	MSDRG 011
Min. Negotiated Rate	$60,430.95
Max. Negotiated Rate	$93,180.57
Rate for Payer: EPIC Health Plan Medicare	$60,430.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$60,430.95
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$69,495.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$76,143.00
Rate for Payer: Molina Healthcare of CA Medicare	$76,143.00
Rate for Payer: Multiplan WC	$93,180.57

MS-DRG 42.00: TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC

Facility

$45,762.25

Service Code	MSDRG 013
Min. Negotiated Rate	$29,840.91
Max. Negotiated Rate	$45,762.25
Rate for Payer: EPIC Health Plan Medicare	$29,840.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,840.91
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,317.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,599.55
Rate for Payer: Molina Healthcare of CA Medicare	$37,599.55
Rate for Payer: Multiplan WC	$45,762.25

MS-DRG 42.00: TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES

Facility

$244,007.75

Service Code	MSDRG 004
Min. Negotiated Rate	$157,731.08
Max. Negotiated Rate	$244,007.75
Rate for Payer: EPIC Health Plan Medicare	$157,731.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$157,731.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$181,390.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$198,741.16
Rate for Payer: Molina Healthcare of CA Medicare	$198,741.16
Rate for Payer: Multiplan WC	$244,007.75

MS-DRG 42.00: TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC

Facility

$18,576.00

Service Code	MSDRG 069
Min. Negotiated Rate	$9,232.55
Max. Negotiated Rate	$18,576.00
Rate for Payer: EPIC Health Plan Medicare	$9,232.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,232.55
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,617.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,633.01
Rate for Payer: Molina Healthcare of CA Medicare	$11,633.01
Rate for Payer: Multiplan WC	$13,816.75

MS-DRG 42.00: TRANSURETHRAL PROCEDURES WITH CC

Facility

$26,723.42

Service Code	MSDRG 669
Min. Negotiated Rate	$17,558.77
Max. Negotiated Rate	$26,723.42
Rate for Payer: EPIC Health Plan Medicare	$17,558.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,558.77
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,192.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,124.05
Rate for Payer: Molina Healthcare of CA Medicare	$22,124.05
Rate for Payer: Multiplan WC	$26,723.42

MS-DRG 42.00: TRANSURETHRAL PROCEDURES WITH MCC

Facility

$50,360.92

Service Code	MSDRG 668
Min. Negotiated Rate	$32,807.56
Max. Negotiated Rate	$50,360.92
Rate for Payer: EPIC Health Plan Medicare	$32,807.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,807.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,728.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$41,337.53
Rate for Payer: Molina Healthcare of CA Medicare	$41,337.53
Rate for Payer: Multiplan WC	$50,360.92

MS-DRG 42.00: TRANSURETHRAL PROCEDURES WITHOUT CC/MCC

Facility

$16,503.77

Service Code	MSDRG 670
Min. Negotiated Rate	$10,965.97
Max. Negotiated Rate	$16,503.77
Rate for Payer: EPIC Health Plan Medicare	$10,965.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,965.97
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,610.87
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,817.12
Rate for Payer: Molina Healthcare of CA Medicare	$13,817.12
Rate for Payer: Multiplan WC	$16,503.77

MS-DRG 42.00: TRANSURETHRAL PROSTATECTOMY WITH CC/MCC

Facility

$24,970.65

Service Code	MSDRG 713
Min. Negotiated Rate	$16,428.04
Max. Negotiated Rate	$24,970.65
Rate for Payer: EPIC Health Plan Medicare	$16,428.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,428.04
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,892.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,699.33
Rate for Payer: Molina Healthcare of CA Medicare	$20,699.33
Rate for Payer: Multiplan WC	$24,970.65

Know your out-of-pocket cost for care.

All Charges