Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

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	$20,669.16
Max. Negotiated Rate	$31,544.87
Rate for Payer: EPIC Health Plan Medicare	$20,669.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,669.16
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,769.53
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,043.14
Rate for Payer: Molina Healthcare of CA Medicare	$26,043.14
Rate for Payer: Multiplan WC	$31,544.87

MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC

Facility

$20,700.08

Service Code	MSDRG 743
Min. Negotiated Rate	$13,673.09
Max. Negotiated Rate	$20,700.08
Rate for Payer: EPIC Health Plan Medicare	$13,673.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,673.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,724.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,228.09
Rate for Payer: Molina Healthcare of CA Medicare	$17,228.09
Rate for Payer: Multiplan WC	$20,700.08

MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC

Facility

$31,399.81

Service Code	MSDRG 740
Min. Negotiated Rate	$20,575.59
Max. Negotiated Rate	$31,399.81
Rate for Payer: EPIC Health Plan Medicare	$20,575.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,575.59
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,661.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,925.24
Rate for Payer: Molina Healthcare of CA Medicare	$25,925.24
Rate for Payer: Multiplan WC	$31,399.81

MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC

Facility

$68,745.26

Service Code	MSDRG 739
Min. Negotiated Rate	$44,667.51
Max. Negotiated Rate	$68,745.26
Rate for Payer: EPIC Health Plan Medicare	$44,667.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$44,667.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$51,367.64
Rate for Payer: Molina Healthcare of CA Medi-Cal	$56,281.06
Rate for Payer: Molina Healthcare of CA Medicare	$56,281.06
Rate for Payer: Multiplan WC	$68,745.26

MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$23,720.38

Service Code	MSDRG 741
Min. Negotiated Rate	$15,621.52
Max. Negotiated Rate	$23,720.38
Rate for Payer: EPIC Health Plan Medicare	$15,621.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,621.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,964.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,683.12
Rate for Payer: Molina Healthcare of CA Medicare	$19,683.12
Rate for Payer: Multiplan WC	$23,720.38

MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC

Facility

$34,509.92

Service Code	MSDRG 737
Min. Negotiated Rate	$22,581.95
Max. Negotiated Rate	$34,509.92
Rate for Payer: EPIC Health Plan Medicare	$22,581.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,581.95
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,969.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,453.26
Rate for Payer: Molina Healthcare of CA Medicare	$28,453.26
Rate for Payer: Multiplan WC	$34,509.92

MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC

Facility

$67,997.52

Service Code	MSDRG 736
Min. Negotiated Rate	$44,185.15
Max. Negotiated Rate	$67,997.52
Rate for Payer: EPIC Health Plan Medicare	$44,185.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$44,185.15
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$50,812.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$55,673.29
Rate for Payer: Molina Healthcare of CA Medicare	$55,673.29
Rate for Payer: Multiplan WC	$67,997.52

MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$26,195.00

Service Code	MSDRG 738
Min. Negotiated Rate	$17,217.92
Max. Negotiated Rate	$26,195.00
Rate for Payer: EPIC Health Plan Medicare	$17,217.92
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,217.92
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,800.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,694.58
Rate for Payer: Molina Healthcare of CA Medicare	$21,694.58
Rate for Payer: Multiplan WC	$26,195.00

MS-DRG 42.00: VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC

Facility

$28,918.28

Service Code	MSDRG 746
Min. Negotiated Rate	$18,974.74
Max. Negotiated Rate	$28,918.28
Rate for Payer: EPIC Health Plan Medicare	$18,974.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,974.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,820.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,908.17
Rate for Payer: Molina Healthcare of CA Medicare	$23,908.17
Rate for Payer: Multiplan WC	$28,918.28

MS-DRG 42.00: VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC

Facility

$16,495.13

Service Code	MSDRG 747
Min. Negotiated Rate	$10,960.43
Max. Negotiated Rate	$16,495.13
Rate for Payer: EPIC Health Plan Medicare	$10,960.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,960.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,604.49
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,810.14
Rate for Payer: Molina Healthcare of CA Medicare	$13,810.14
Rate for Payer: Multiplan WC	$16,495.13

MS-DRG 42.00: VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C

Facility

$18,931.76

Service Code	MSDRG 768
Min. Negotiated Rate	$4,895.00
Max. Negotiated Rate	$18,931.76
Rate for Payer: EPIC Health Plan Medicare	$12,532.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,532.32
Rate for Payer: Kaiser Permanente of CA Commercial	$9,593.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,412.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,790.72
Rate for Payer: Molina Healthcare of CA Medicare	$15,790.72
Rate for Payer: Multiplan WC	$18,931.76
Rate for Payer: United Healthcare All Other HMO/non HMO	$8,499.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$7,163.00

MS-DRG 42.00: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC

Facility

$12,495.69

Service Code	MSDRG 806
Min. Negotiated Rate	$5,677.00
Max. Negotiated Rate	$12,495.69
Rate for Payer: EPIC Health Plan Medicare	$8,380.34
Rate for Payer: Heritage Provider Network Commercial	$6,242.00
Rate for Payer: Heritage Provider Network Senior	$5,677.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,380.34
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,637.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,559.23
Rate for Payer: Molina Healthcare of CA Medicare	$10,559.23
Rate for Payer: Multiplan WC	$12,495.69
Rate for Payer: United Healthcare All Other HMO/non HMO	$8,499.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$7,163.00

MS-DRG 42.00: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC

Facility

$17,234.23

Service Code	MSDRG 805
Min. Negotiated Rate	$5,677.00
Max. Negotiated Rate	$17,234.23
Rate for Payer: EPIC Health Plan Medicare	$11,437.26
Rate for Payer: Heritage Provider Network Commercial	$6,242.00
Rate for Payer: Heritage Provider Network Senior	$5,677.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,437.26
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,152.85
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,410.95
Rate for Payer: Molina Healthcare of CA Medicare	$14,410.95
Rate for Payer: Multiplan WC	$17,234.23
Rate for Payer: United Healthcare All Other HMO/non HMO	$8,499.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$7,163.00

MS-DRG 42.00: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC

Facility

$11,005.39

Service Code	MSDRG 807
Min. Negotiated Rate	$5,677.00
Max. Negotiated Rate	$11,005.39
Rate for Payer: EPIC Health Plan Medicare	$7,418.94
Rate for Payer: Heritage Provider Network Commercial	$6,242.00
Rate for Payer: Heritage Provider Network Senior	$5,677.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,418.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,531.78
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,347.86
Rate for Payer: Molina Healthcare of CA Medicare	$9,347.86
Rate for Payer: Multiplan WC	$11,005.39
Rate for Payer: United Healthcare All Other HMO/non HMO	$8,499.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$7,163.00

MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC

Facility

$16,719.62

Service Code	MSDRG 797
Min. Negotiated Rate	$5,677.00
Max. Negotiated Rate	$16,719.62
Rate for Payer: EPIC Health Plan Medicare	$11,105.26
Rate for Payer: Heritage Provider Network Commercial	$6,242.00
Rate for Payer: Heritage Provider Network Senior	$5,677.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,105.26
Rate for Payer: Kaiser Permanente of CA Commercial	$9,593.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,771.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,992.63
Rate for Payer: Molina Healthcare of CA Medicare	$13,992.63
Rate for Payer: Multiplan WC	$16,719.62
Rate for Payer: United Healthcare All Other HMO/non HMO	$8,499.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$7,163.00

MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC

Facility

$22,045.32

Service Code	MSDRG 796
Min. Negotiated Rate	$5,677.00
Max. Negotiated Rate	$22,045.32
Rate for Payer: EPIC Health Plan Medicare	$14,540.92
Rate for Payer: Heritage Provider Network Commercial	$6,242.00
Rate for Payer: Heritage Provider Network Senior	$5,677.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,540.92
Rate for Payer: Kaiser Permanente of CA Commercial	$9,593.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,722.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,321.56
Rate for Payer: Molina Healthcare of CA Medicare	$18,321.56
Rate for Payer: Multiplan WC	$22,045.32
Rate for Payer: United Healthcare All Other HMO/non HMO	$8,499.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$7,163.00

MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC

Facility

$16,719.62

Service Code	MSDRG 798
Min. Negotiated Rate	$5,677.00
Max. Negotiated Rate	$16,719.62
Rate for Payer: EPIC Health Plan Medicare	$11,105.26
Rate for Payer: Heritage Provider Network Commercial	$6,242.00
Rate for Payer: Heritage Provider Network Senior	$5,677.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,105.26
Rate for Payer: Kaiser Permanente of CA Commercial	$9,593.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,771.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,992.63
Rate for Payer: Molina Healthcare of CA Medicare	$13,992.63
Rate for Payer: Multiplan WC	$16,719.62
Rate for Payer: United Healthcare All Other HMO/non HMO	$8,499.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$7,163.00

MS-DRG 42.00: VEIN LIGATION AND STRIPPING

Facility

$46,316.57

Service Code	MSDRG 263
Min. Negotiated Rate	$30,198.56
Max. Negotiated Rate	$46,316.57
Rate for Payer: EPIC Health Plan Medicare	$30,198.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,198.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,728.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,050.19
Rate for Payer: Molina Healthcare of CA Medicare	$38,050.19
Rate for Payer: Multiplan WC	$46,316.57

MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITH CC

Facility

$36,879.19

Service Code	MSDRG 032
Min. Negotiated Rate	$24,110.38
Max. Negotiated Rate	$36,879.19
Rate for Payer: EPIC Health Plan Medicare	$24,110.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,110.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,726.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,379.08
Rate for Payer: Molina Healthcare of CA Medicare	$30,379.08
Rate for Payer: Multiplan WC	$36,879.19

MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITH MCC

Facility

$72,366.51

Service Code	MSDRG 031
Min. Negotiated Rate	$47,003.62
Max. Negotiated Rate	$72,366.51
Rate for Payer: EPIC Health Plan Medicare	$47,003.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$47,003.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$54,054.16
Rate for Payer: Molina Healthcare of CA Medi-Cal	$59,224.56
Rate for Payer: Molina Healthcare of CA Medicare	$59,224.56
Rate for Payer: Multiplan WC	$72,366.51

MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC

Facility

$27,552.33

Service Code	MSDRG 033
Min. Negotiated Rate	$18,093.55
Max. Negotiated Rate	$27,552.33
Rate for Payer: EPIC Health Plan Medicare	$18,093.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,093.55
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,807.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,797.87
Rate for Payer: Molina Healthcare of CA Medicare	$22,797.87
Rate for Payer: Multiplan WC	$27,552.33

MS-DRG 42.00: VIRAL ILLNESS WITH MCC

Facility

$25,486.98

Service Code	MSDRG 865
Min. Negotiated Rate	$16,761.16
Max. Negotiated Rate	$25,486.98
Rate for Payer: EPIC Health Plan Medicare	$16,761.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,761.16
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,275.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,119.06
Rate for Payer: Molina Healthcare of CA Medicare	$21,119.06
Rate for Payer: Multiplan WC	$25,486.98

MS-DRG 42.00: VIRAL ILLNESS WITHOUT MCC

Facility

$15,279.41

Service Code	MSDRG 866
Min. Negotiated Rate	$10,176.16
Max. Negotiated Rate	$15,279.41
Rate for Payer: EPIC Health Plan Medicare	$10,176.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,176.16
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,702.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,821.96
Rate for Payer: Molina Healthcare of CA Medicare	$12,821.96
Rate for Payer: Multiplan WC	$15,279.41

MS-DRG 42.00: VIRAL MENINGITIS WITH CC/MCC

Facility

$29,743.74

Service Code	MSDRG 075
Min. Negotiated Rate	$19,507.24
Max. Negotiated Rate	$29,743.74
Rate for Payer: EPIC Health Plan Medicare	$19,507.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,507.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,433.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,579.12
Rate for Payer: Molina Healthcare of CA Medicare	$24,579.12
Rate for Payer: Multiplan WC	$29,743.74

MS-DRG 42.00: VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$15,833.73

Service Code	MSDRG 076
Min. Negotiated Rate	$10,533.75
Max. Negotiated Rate	$15,833.73
Rate for Payer: EPIC Health Plan Medicare	$10,533.75
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,533.75
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,113.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,272.52
Rate for Payer: Molina Healthcare of CA Medicare	$13,272.52
Rate for Payer: Multiplan WC	$15,833.73

Know your out-of-pocket cost for care.

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