Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC

Facility

$16,227.47

Service Code	MSDRG 714
Min. Negotiated Rate	$10,787.72
Max. Negotiated Rate	$16,227.47
Rate for Payer: EPIC Health Plan Medicare	$10,787.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,787.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,405.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,592.53
Rate for Payer: Molina Healthcare of CA Medicare	$13,592.53
Rate for Payer: Multiplan WC	$16,227.47

MS-DRG 42.00: TRAUMATIC INJURY WITH MCC

Facility

$27,946.05

Service Code	MSDRG 913
Min. Negotiated Rate	$18,347.51
Max. Negotiated Rate	$27,946.05
Rate for Payer: EPIC Health Plan Medicare	$18,347.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,347.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,099.64
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,117.86
Rate for Payer: Molina Healthcare of CA Medicare	$23,117.86
Rate for Payer: Multiplan WC	$27,946.05

MS-DRG 42.00: TRAUMATIC INJURY WITHOUT MCC

Facility

$15,825.10

Service Code	MSDRG 914
Min. Negotiated Rate	$10,528.15
Max. Negotiated Rate	$15,825.10
Rate for Payer: EPIC Health Plan Medicare	$10,528.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,528.15
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,107.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,265.47
Rate for Payer: Molina Healthcare of CA Medicare	$13,265.47
Rate for Payer: Multiplan WC	$15,825.10

MS-DRG 42.00: TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC

Facility

$22,649.72

Service Code	MSDRG 086
Min. Negotiated Rate	$14,930.77
Max. Negotiated Rate	$22,649.72
Rate for Payer: EPIC Health Plan Medicare	$14,930.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,930.77
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,170.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,812.77
Rate for Payer: Molina Healthcare of CA Medicare	$18,812.77
Rate for Payer: Multiplan WC	$22,649.72

MS-DRG 42.00: TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC

Facility

$24,010.50

Service Code	MSDRG 083
Min. Negotiated Rate	$15,808.63
Max. Negotiated Rate	$24,010.50
Rate for Payer: EPIC Health Plan Medicare	$15,808.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,808.63
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,179.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,918.87
Rate for Payer: Molina Healthcare of CA Medicare	$19,918.87
Rate for Payer: Multiplan WC	$24,010.50

MS-DRG 42.00: TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC

Facility

$39,131.04

Service Code	MSDRG 085
Min. Negotiated Rate	$25,563.04
Max. Negotiated Rate	$39,131.04
Rate for Payer: EPIC Health Plan Medicare	$25,563.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,563.04
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,397.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,209.43
Rate for Payer: Molina Healthcare of CA Medicare	$32,209.43
Rate for Payer: Multiplan WC	$39,131.04

MS-DRG 42.00: TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC

Facility

$40,067.01

Service Code	MSDRG 082
Min. Negotiated Rate	$26,166.86
Max. Negotiated Rate	$40,067.01
Rate for Payer: EPIC Health Plan Medicare	$26,166.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,166.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,091.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,970.24
Rate for Payer: Molina Healthcare of CA Medicare	$32,970.24
Rate for Payer: Multiplan WC	$40,067.01

MS-DRG 42.00: TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC

Facility

$15,265.60

Service Code	MSDRG 087
Min. Negotiated Rate	$10,167.20
Max. Negotiated Rate	$15,265.60
Rate for Payer: EPIC Health Plan Medicare	$10,167.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,167.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,692.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,810.67
Rate for Payer: Molina Healthcare of CA Medicare	$12,810.67
Rate for Payer: Multiplan WC	$15,265.60

MS-DRG 42.00: TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC

Facility

$16,510.68

Service Code	MSDRG 084
Min. Negotiated Rate	$10,970.43
Max. Negotiated Rate	$16,510.68
Rate for Payer: EPIC Health Plan Medicare	$10,970.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,970.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,615.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,822.74
Rate for Payer: Molina Healthcare of CA Medicare	$13,822.74
Rate for Payer: Multiplan WC	$16,510.68

MS-DRG 42.00: TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC

Facility

$25,656.21

Service Code	MSDRG 604
Min. Negotiated Rate	$16,870.30
Max. Negotiated Rate	$25,656.21
Rate for Payer: EPIC Health Plan Medicare	$16,870.30
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,870.30
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,400.85
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,256.58
Rate for Payer: Molina Healthcare of CA Medicare	$21,256.58
Rate for Payer: Multiplan WC	$25,656.21

MS-DRG 42.00: TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC

Facility

$15,951.17

Service Code	MSDRG 605
Min. Negotiated Rate	$10,609.48
Max. Negotiated Rate	$15,951.17
Rate for Payer: EPIC Health Plan Medicare	$10,609.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,609.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,200.90
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,367.94
Rate for Payer: Molina Healthcare of CA Medicare	$13,367.94
Rate for Payer: Multiplan WC	$15,951.17

MS-DRG 42.00: ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC

Facility

$86,400.85

Service Code	MSDRG 278
Min. Negotiated Rate	$56,057.28
Max. Negotiated Rate	$86,400.85
Rate for Payer: EPIC Health Plan Medicare	$56,057.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$56,057.28
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$64,465.87
Rate for Payer: Molina Healthcare of CA Medi-Cal	$70,632.17
Rate for Payer: Molina Healthcare of CA Medicare	$70,632.17
Rate for Payer: Multiplan WC	$86,400.85

MS-DRG 42.00: ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC

Facility

$55,336.05

Service Code	MSDRG 279
Min. Negotiated Rate	$36,017.06
Max. Negotiated Rate	$55,336.05
Rate for Payer: EPIC Health Plan Medicare	$36,017.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,017.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$41,419.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$45,381.50
Rate for Payer: Molina Healthcare of CA Medicare	$45,381.50
Rate for Payer: Multiplan WC	$55,336.05

MS-DRG 42.00: ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM

Facility

$52,990.95

Service Code	MSDRG 173
Min. Negotiated Rate	$34,504.22
Max. Negotiated Rate	$52,990.95
Rate for Payer: EPIC Health Plan Medicare	$34,504.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,504.22
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,679.85
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,475.32
Rate for Payer: Molina Healthcare of CA Medicare	$43,475.32
Rate for Payer: Multiplan WC	$52,990.95

MS-DRG 42.00: UNCOMPLICATED PEPTIC ULCER WITH MCC

Facility

$21,831.19

Service Code	MSDRG 383
Min. Negotiated Rate	$14,402.73
Max. Negotiated Rate	$21,831.19
Rate for Payer: EPIC Health Plan Medicare	$14,402.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,402.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,563.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,147.44
Rate for Payer: Molina Healthcare of CA Medicare	$18,147.44
Rate for Payer: Multiplan WC	$21,831.19

MS-DRG 42.00: UNCOMPLICATED PEPTIC ULCER WITHOUT MCC

Facility

$15,016.92

Service Code	MSDRG 384
Min. Negotiated Rate	$10,006.79
Max. Negotiated Rate	$15,016.92
Rate for Payer: EPIC Health Plan Medicare	$10,006.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,006.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,507.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,608.56
Rate for Payer: Molina Healthcare of CA Medicare	$12,608.56
Rate for Payer: Multiplan WC	$15,016.92

MS-DRG 42.00: UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC

Facility

$29,248.12

Service Code	MSDRG 256
Min. Negotiated Rate	$19,187.47
Max. Negotiated Rate	$29,248.12
Rate for Payer: EPIC Health Plan Medicare	$19,187.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,187.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,065.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,176.21
Rate for Payer: Molina Healthcare of CA Medicare	$24,176.21
Rate for Payer: Multiplan WC	$29,248.12

MS-DRG 42.00: UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC

Facility

$45,183.74

Service Code	MSDRG 255
Min. Negotiated Rate	$29,467.72
Max. Negotiated Rate	$45,183.74
Rate for Payer: EPIC Health Plan Medicare	$29,467.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,467.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,887.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,129.33
Rate for Payer: Molina Healthcare of CA Medicare	$37,129.33
Rate for Payer: Multiplan WC	$45,183.74

MS-DRG 42.00: UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC

Facility

$15,402.01

Service Code	MSDRG 257
Min. Negotiated Rate	$10,255.21
Max. Negotiated Rate	$15,402.01
Rate for Payer: EPIC Health Plan Medicare	$10,255.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,255.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,793.49
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,921.56
Rate for Payer: Molina Healthcare of CA Medicare	$12,921.56
Rate for Payer: Multiplan WC	$15,402.01

MS-DRG 42.00: URETHRAL PROCEDURES WITH CC/MCC

Facility

$29,766.19

Service Code	MSDRG 671
Min. Negotiated Rate	$19,521.69
Max. Negotiated Rate	$29,766.19
Rate for Payer: EPIC Health Plan Medicare	$19,521.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,521.69
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,449.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,597.33
Rate for Payer: Molina Healthcare of CA Medicare	$24,597.33
Rate for Payer: Multiplan WC	$29,766.19

MS-DRG 42.00: URETHRAL PROCEDURES WITHOUT CC/MCC

Facility

$18,898.95

Service Code	MSDRG 672
Min. Negotiated Rate	$12,511.12
Max. Negotiated Rate	$18,898.95
Rate for Payer: EPIC Health Plan Medicare	$12,511.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,511.12
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,387.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,764.01
Rate for Payer: Molina Healthcare of CA Medicare	$15,764.01
Rate for Payer: Multiplan WC	$18,898.95

MS-DRG 42.00: URETHRAL STRICTURE

Facility

$17,299.85

Service Code	MSDRG 697
Min. Negotiated Rate	$11,479.53
Max. Negotiated Rate	$17,299.85
Rate for Payer: EPIC Health Plan Medicare	$11,479.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,479.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,201.46
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,464.21
Rate for Payer: Molina Healthcare of CA Medicare	$14,464.21
Rate for Payer: Multiplan WC	$17,299.85

MS-DRG 42.00: URINARY STONES WITH MCC

Facility

$25,392.01

Service Code	MSDRG 693
Min. Negotiated Rate	$16,699.85
Max. Negotiated Rate	$25,392.01
Rate for Payer: EPIC Health Plan Medicare	$16,699.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,699.85
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,204.83
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,041.81
Rate for Payer: Molina Healthcare of CA Medicare	$21,041.81
Rate for Payer: Multiplan WC	$25,392.01

MS-DRG 42.00: URINARY STONES WITHOUT MCC

Facility

$13,493.82

Service Code	MSDRG 694
Min. Negotiated Rate	$9,024.21
Max. Negotiated Rate	$13,493.82
Rate for Payer: EPIC Health Plan Medicare	$9,024.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,024.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,377.84
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,370.50
Rate for Payer: Molina Healthcare of CA Medicare	$11,370.50
Rate for Payer: Multiplan WC	$13,493.82

MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC

Facility

$31,544.87

Service Code	MSDRG 742
Min. Negotiated Rate	$20,669.12
Max. Negotiated Rate	$31,544.87
Rate for Payer: EPIC Health Plan Medicare	$20,669.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,669.12
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,769.49
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,043.09
Rate for Payer: Molina Healthcare of CA Medicare	$26,043.09
Rate for Payer: Multiplan WC	$31,544.87

Know your out-of-pocket cost for care.

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