Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: TRANSURETHRAL PROSTATECTOMY WITH CC/MCC

Facility

$24,970.65

Service Code	MSDRG 713
Min. Negotiated Rate	$16,428.08
Max. Negotiated Rate	$24,970.65
Rate for Payer: EPIC Health Plan Medicare	$16,428.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,428.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,892.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,699.38
Rate for Payer: Molina Healthcare of CA Medicare	$20,699.38
Rate for Payer: Multiplan WC	$24,970.65

MS-DRG 42.00: TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC

Facility

$16,227.47

Service Code	MSDRG 714
Min. Negotiated Rate	$10,787.76
Max. Negotiated Rate	$16,227.47
Rate for Payer: EPIC Health Plan Medicare	$10,787.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,787.76
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,405.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,592.58
Rate for Payer: Molina Healthcare of CA Medicare	$13,592.58
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	$18,347.55
Max. Negotiated Rate	$27,946.05
Rate for Payer: EPIC Health Plan Medicare	$18,347.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,347.55
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,099.68
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,117.91
Rate for Payer: Molina Healthcare of CA Medicare	$23,117.91
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	$10,528.19
Max. Negotiated Rate	$15,825.10
Rate for Payer: EPIC Health Plan Medicare	$10,528.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,528.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,107.42
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,265.52
Rate for Payer: Molina Healthcare of CA Medicare	$13,265.52
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	$14,930.81
Max. Negotiated Rate	$22,649.72
Rate for Payer: EPIC Health Plan Medicare	$14,930.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,930.81
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,170.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,812.82
Rate for Payer: Molina Healthcare of CA Medicare	$18,812.82
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	$15,808.67
Max. Negotiated Rate	$24,010.50
Rate for Payer: EPIC Health Plan Medicare	$15,808.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,808.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,179.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,918.92
Rate for Payer: Molina Healthcare of CA Medicare	$19,918.92
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	$25,563.08
Max. Negotiated Rate	$39,131.04
Rate for Payer: EPIC Health Plan Medicare	$25,563.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,563.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,397.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,209.48
Rate for Payer: Molina Healthcare of CA Medicare	$32,209.48
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	$26,166.90
Max. Negotiated Rate	$40,067.01
Rate for Payer: EPIC Health Plan Medicare	$26,166.90
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,166.90
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,091.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,970.29
Rate for Payer: Molina Healthcare of CA Medicare	$32,970.29
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	$10,167.24
Max. Negotiated Rate	$15,265.60
Rate for Payer: EPIC Health Plan Medicare	$10,167.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,167.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,692.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,810.72
Rate for Payer: Molina Healthcare of CA Medicare	$12,810.72
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	$10,970.47
Max. Negotiated Rate	$16,510.68
Rate for Payer: EPIC Health Plan Medicare	$10,970.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,970.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,616.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,822.79
Rate for Payer: Molina Healthcare of CA Medicare	$13,822.79
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	$16,870.34
Max. Negotiated Rate	$25,656.21
Rate for Payer: EPIC Health Plan Medicare	$16,870.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,870.34
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,400.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,256.63
Rate for Payer: Molina Healthcare of CA Medicare	$21,256.63
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	$10,609.52
Max. Negotiated Rate	$15,951.17
Rate for Payer: EPIC Health Plan Medicare	$10,609.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,609.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,200.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,368.00
Rate for Payer: Molina Healthcare of CA Medicare	$13,368.00
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	$56,057.32
Max. Negotiated Rate	$86,400.85
Rate for Payer: EPIC Health Plan Medicare	$56,057.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$56,057.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$64,465.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$70,632.22
Rate for Payer: Molina Healthcare of CA Medicare	$70,632.22
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	$36,017.10
Max. Negotiated Rate	$55,336.05
Rate for Payer: EPIC Health Plan Medicare	$36,017.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,017.10
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$41,419.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$45,381.55
Rate for Payer: Molina Healthcare of CA Medicare	$45,381.55
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	$34,504.26
Max. Negotiated Rate	$52,990.95
Rate for Payer: EPIC Health Plan Medicare	$34,504.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,504.26
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,679.90
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,475.37
Rate for Payer: Molina Healthcare of CA Medicare	$43,475.37
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	$14,402.77
Max. Negotiated Rate	$21,831.19
Rate for Payer: EPIC Health Plan Medicare	$14,402.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,402.77
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,563.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,147.49
Rate for Payer: Molina Healthcare of CA Medicare	$18,147.49
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	$10,006.83
Max. Negotiated Rate	$15,016.92
Rate for Payer: EPIC Health Plan Medicare	$10,006.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,006.83
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,507.85
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,608.61
Rate for Payer: Molina Healthcare of CA Medicare	$12,608.61
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	$19,187.51
Max. Negotiated Rate	$29,248.12
Rate for Payer: EPIC Health Plan Medicare	$19,187.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,187.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,065.64
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,176.26
Rate for Payer: Molina Healthcare of CA Medicare	$24,176.26
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	$29,467.76
Max. Negotiated Rate	$45,183.74
Rate for Payer: EPIC Health Plan Medicare	$29,467.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,467.76
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,887.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,129.38
Rate for Payer: Molina Healthcare of CA Medicare	$37,129.38
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	$10,255.25
Max. Negotiated Rate	$15,402.01
Rate for Payer: EPIC Health Plan Medicare	$10,255.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,255.25
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,793.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,921.61
Rate for Payer: Molina Healthcare of CA Medicare	$12,921.61
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	$19,521.73
Max. Negotiated Rate	$29,766.19
Rate for Payer: EPIC Health Plan Medicare	$19,521.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,521.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,449.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,597.38
Rate for Payer: Molina Healthcare of CA Medicare	$24,597.38
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	$12,511.16
Max. Negotiated Rate	$18,898.95
Rate for Payer: EPIC Health Plan Medicare	$12,511.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,511.16
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,387.83
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,764.06
Rate for Payer: Molina Healthcare of CA Medicare	$15,764.06
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	$11,479.57
Max. Negotiated Rate	$17,299.85
Rate for Payer: EPIC Health Plan Medicare	$11,479.57
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,479.57
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,201.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,464.26
Rate for Payer: Molina Healthcare of CA Medicare	$14,464.26
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	$16,699.89
Max. Negotiated Rate	$25,392.01
Rate for Payer: EPIC Health Plan Medicare	$16,699.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,699.89
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,204.87
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,041.86
Rate for Payer: Molina Healthcare of CA Medicare	$21,041.86
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	$9,024.25
Max. Negotiated Rate	$13,493.82
Rate for Payer: EPIC Health Plan Medicare	$9,024.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,024.25
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,377.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,370.56
Rate for Payer: Molina Healthcare of CA Medicare	$11,370.56
Rate for Payer: Multiplan WC	$13,493.82

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