Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

OTHER CIRCULATORY SYSTEM O.R. PROCEDURES

Facility

$51,998.06

Service Code	MSDRG 264
Min. Negotiated Rate	$38,804.52
Max. Negotiated Rate	$51,998.06
Rate for Payer: EPIC Health Plan Medicare	$38,804.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$38,804.52
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$44,625.20
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$51,998.06

OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC

Facility

$15,069.71

Service Code	MSDRG 394
Min. Negotiated Rate	$11,246.05
Max. Negotiated Rate	$15,069.71
Rate for Payer: EPIC Health Plan Medicare	$11,246.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,246.05
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$12,932.96
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$15,069.71

OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC

Facility

$25,259.59

Service Code	MSDRG 393
Min. Negotiated Rate	$18,850.44
Max. Negotiated Rate	$25,259.59
Rate for Payer: EPIC Health Plan Medicare	$18,850.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,850.44
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$21,678.01
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$25,259.59

OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$10,667.30

Service Code	MSDRG 395
Min. Negotiated Rate	$7,960.67
Max. Negotiated Rate	$10,667.30
Rate for Payer: EPIC Health Plan Medicare	$7,960.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,960.67
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$9,154.77
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$10,667.30

OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC

Facility

$36,410.72

Service Code	MSDRG 357
Min. Negotiated Rate	$27,172.18
Max. Negotiated Rate	$36,410.72
Rate for Payer: EPIC Health Plan Medicare	$27,172.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,172.18
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$31,248.01
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$36,410.72

OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC

Facility

$68,155.11

Service Code	MSDRG 356
Min. Negotiated Rate	$50,862.02
Max. Negotiated Rate	$68,155.11
Rate for Payer: EPIC Health Plan Medicare	$50,862.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$50,862.02
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$58,491.32
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$68,155.11

OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$22,167.00

Service Code	MSDRG 358
Min. Negotiated Rate	$16,542.54
Max. Negotiated Rate	$22,167.00
Rate for Payer: EPIC Health Plan Medicare	$16,542.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,542.54
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$19,023.92
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$22,167.00

OTHER DISORDERS OF NERVOUS SYSTEM WITH CC

Facility

$16,410.24

Service Code	MSDRG 092
Min. Negotiated Rate	$12,246.45
Max. Negotiated Rate	$16,410.24
Rate for Payer: EPIC Health Plan Medicare	$12,246.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,246.45
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$14,083.42
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$16,410.24

OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC

Facility

$27,668.87

Service Code	MSDRG 091
Min. Negotiated Rate	$20,648.41
Max. Negotiated Rate	$27,668.87
Rate for Payer: EPIC Health Plan Medicare	$20,648.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,648.41
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$23,745.67
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$27,668.87

OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility

$12,929.15

Service Code	MSDRG 093
Min. Negotiated Rate	$9,648.62
Max. Negotiated Rate	$12,929.15
Rate for Payer: EPIC Health Plan Medicare	$9,648.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,648.62
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$11,095.91
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$12,929.15

OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT

Facility

$21,018.42

Service Code	MSDRG 124
Min. Negotiated Rate	$15,685.39
Max. Negotiated Rate	$21,018.42
Rate for Payer: EPIC Health Plan Medicare	$15,685.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,685.39
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$18,038.20
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$21,018.42

OTHER DISORDERS OF THE EYE WITHOUT MCC

Facility

$12,491.52

Service Code	MSDRG 125
Min. Negotiated Rate	$9,322.03
Max. Negotiated Rate	$12,491.52
Rate for Payer: EPIC Health Plan Medicare	$9,322.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,322.03
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$10,720.33
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$12,491.52

OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC

Facility

$14,774.89

Service Code	MSDRG 155
Min. Negotiated Rate	$11,026.04
Max. Negotiated Rate	$14,774.89
Rate for Payer: EPIC Health Plan Medicare	$11,026.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,026.04
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$12,679.95
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$14,774.89

OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC

Facility

$24,709.85

Service Code	MSDRG 154
Min. Negotiated Rate	$18,440.19
Max. Negotiated Rate	$24,709.85
Rate for Payer: EPIC Health Plan Medicare	$18,440.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,440.19
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$21,206.22
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$24,709.85

OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC

Facility

$11,313.78

Service Code	MSDRG 156
Min. Negotiated Rate	$8,443.12
Max. Negotiated Rate	$11,313.78
Rate for Payer: EPIC Health Plan Medicare	$8,443.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,443.12
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$9,709.59
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$11,313.78

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC

Facility

$27,311.08

Service Code	MSDRG 144
Min. Negotiated Rate	$20,381.40
Max. Negotiated Rate	$27,311.08
Rate for Payer: EPIC Health Plan Medicare	$20,381.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,381.40
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$23,438.61
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$27,311.08

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC

Facility

$58,232.38

Service Code	MSDRG 143
Min. Negotiated Rate	$43,457.00
Max. Negotiated Rate	$58,232.38
Rate for Payer: EPIC Health Plan Medicare	$43,457.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$43,457.00
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$49,975.55
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$58,232.38

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$19,163.49

Service Code	MSDRG 145
Min. Negotiated Rate	$14,301.11
Max. Negotiated Rate	$19,163.49
Rate for Payer: EPIC Health Plan Medicare	$14,301.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,301.11
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$16,446.28
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$19,163.49

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC

Facility

$34,158.10

Service Code	MSDRG 629
Min. Negotiated Rate	$25,491.12
Max. Negotiated Rate	$34,158.10
Rate for Payer: EPIC Health Plan Medicare	$25,491.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,491.12
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$29,314.79
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$34,158.10

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC

Facility

$57,928.35

Service Code	MSDRG 628
Min. Negotiated Rate	$43,230.11
Max. Negotiated Rate	$57,928.35
Rate for Payer: EPIC Health Plan Medicare	$43,230.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$43,230.11
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$49,714.63
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$57,928.35

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC

Facility

$23,112.88

Service Code	MSDRG 630
Min. Negotiated Rate	$17,248.42
Max. Negotiated Rate	$23,112.88
Rate for Payer: EPIC Health Plan Medicare	$17,248.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,248.42
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$19,835.68
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$23,112.88

OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC

Facility

$69,231.52

Service Code	MSDRG 319
Min. Negotiated Rate	$51,665.31
Max. Negotiated Rate	$69,231.52
Rate for Payer: EPIC Health Plan Medicare	$51,665.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$51,665.31
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$59,415.11
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$69,231.52

OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC

Facility

$37,636.08

Service Code	MSDRG 320
Min. Negotiated Rate	$28,086.63
Max. Negotiated Rate	$37,636.08
Rate for Payer: EPIC Health Plan Medicare	$28,086.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,086.63
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$32,299.62
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$37,636.08

OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$9,239.23

Service Code	MSDRG 951
Min. Negotiated Rate	$6,894.95
Max. Negotiated Rate	$9,239.23
Rate for Payer: EPIC Health Plan Medicare	$6,894.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$6,894.95
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$7,929.19
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$9,239.23

OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC

Facility

$40,128.28

Service Code	MSDRG 749
Min. Negotiated Rate	$29,946.48
Max. Negotiated Rate	$40,128.28
Rate for Payer: EPIC Health Plan Medicare	$29,946.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,946.48
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$34,438.45
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$40,128.28

Know your out-of-pocket cost for care.

All Charges