Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

OTHER MENTAL DISORDER DIAGNOSES

Facility

$17,145.77

Service Code	MSDRG 887
Min. Negotiated Rate	$12,795.35
Max. Negotiated Rate	$17,145.77
Rate for Payer: EPIC Health Plan Medicare	$12,795.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,795.35
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$14,714.65
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$17,145.77

OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$24,235.37

Service Code	MSDRG 964
Min. Negotiated Rate	$18,086.10
Max. Negotiated Rate	$24,235.37
Rate for Payer: EPIC Health Plan Medicare	$18,086.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,086.10
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$20,799.01
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$24,235.37

OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$42,680.37

Service Code	MSDRG 963
Min. Negotiated Rate	$31,851.02
Max. Negotiated Rate	$42,680.37
Rate for Payer: EPIC Health Plan Medicare	$31,851.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,851.02
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$36,628.67
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$42,680.37

OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$15,143.41

Service Code	MSDRG 965
Min. Negotiated Rate	$11,301.05
Max. Negotiated Rate	$15,143.41
Rate for Payer: EPIC Health Plan Medicare	$11,301.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,301.05
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$12,996.21
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$15,143.41

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC

Facility

$15,663.97

Service Code	MSDRG 565
Min. Negotiated Rate	$11,689.53
Max. Negotiated Rate	$15,663.97
Rate for Payer: EPIC Health Plan Medicare	$11,689.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,689.53
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$13,442.96
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$15,663.97

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC

Facility

$24,404.28

Service Code	MSDRG 564
Min. Negotiated Rate	$18,212.15
Max. Negotiated Rate	$24,404.28
Rate for Payer: EPIC Health Plan Medicare	$18,212.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,212.15
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$20,943.97
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$24,404.28

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC

Facility

$12,207.45

Service Code	MSDRG 566
Min. Negotiated Rate	$9,110.04
Max. Negotiated Rate	$12,207.45
Rate for Payer: EPIC Health Plan Medicare	$9,110.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,110.04
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$10,476.55
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$12,207.45

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC

Facility

$32,611.81

Service Code	MSDRG 516
Min. Negotiated Rate	$24,337.17
Max. Negotiated Rate	$32,611.81
Rate for Payer: EPIC Health Plan Medicare	$24,337.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,337.17
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$27,987.75
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$32,611.81

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC

Facility

$49,637.91

Service Code	MSDRG 515
Min. Negotiated Rate	$13,500.00
Max. Negotiated Rate	$49,637.91
Rate for Payer: EPIC Health Plan Medicare	$37,043.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,043.22
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$42,599.70
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$49,637.91

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC

Facility

$27,318.00

Service Code	MSDRG 517
Min. Negotiated Rate	$18,133.08
Max. Negotiated Rate	$27,318.00
Rate for Payer: EPIC Health Plan Medicare	$18,133.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,133.08
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$20,853.04
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$24,298.33

OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC

Facility

$19,395.35

Service Code	MSDRG 844
Min. Negotiated Rate	$14,474.14
Max. Negotiated Rate	$19,395.35
Rate for Payer: EPIC Health Plan Medicare	$14,474.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,474.14
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$16,645.26
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$19,395.35

OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC

Facility

$31,332.70

Service Code	MSDRG 843
Min. Negotiated Rate	$23,382.61
Max. Negotiated Rate	$31,332.70
Rate for Payer: EPIC Health Plan Medicare	$23,382.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,382.61
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$26,890.00
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$31,332.70

OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC

Facility

$13,778.30

Service Code	MSDRG 845
Min. Negotiated Rate	$10,282.31
Max. Negotiated Rate	$13,778.30
Rate for Payer: EPIC Health Plan Medicare	$10,282.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,282.31
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$11,824.66
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$13,778.30

OTHER O.R. PROCEDURES FOR INJURIES WITH CC

Facility

$31,338.82

Service Code	MSDRG 908
Min. Negotiated Rate	$23,387.18
Max. Negotiated Rate	$31,338.82
Rate for Payer: EPIC Health Plan Medicare	$23,387.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,387.18
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$26,895.26
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$31,338.82

OTHER O.R. PROCEDURES FOR INJURIES WITH MCC

Facility

$59,655.84

Service Code	MSDRG 907
Min. Negotiated Rate	$44,519.28
Max. Negotiated Rate	$59,655.84
Rate for Payer: EPIC Health Plan Medicare	$44,519.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$44,519.28
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$51,197.17
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$59,655.84

OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC

Facility

$20,858.72

Service Code	MSDRG 909
Min. Negotiated Rate	$15,566.21
Max. Negotiated Rate	$20,858.72
Rate for Payer: EPIC Health Plan Medicare	$15,566.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,566.21
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$17,901.14
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$20,858.72

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$65,408.00

Service Code	MSDRG 958
Min. Negotiated Rate	$48,811.94
Max. Negotiated Rate	$65,408.00
Rate for Payer: EPIC Health Plan Medicare	$48,811.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$48,811.94
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$56,133.73
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$65,408.00

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$117,708.71

Service Code	MSDRG 957
Min. Negotiated Rate	$87,842.32
Max. Negotiated Rate	$117,708.71
Rate for Payer: EPIC Health Plan Medicare	$87,842.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$87,842.32
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$101,018.67
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$117,708.71

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$45,909.62

Service Code	MSDRG 959
Min. Negotiated Rate	$34,260.91
Max. Negotiated Rate	$45,909.62
Rate for Payer: EPIC Health Plan Medicare	$34,260.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,260.91
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$39,400.05
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$45,909.62

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC

Facility

$29,245.85

Service Code	MSDRG 803
Min. Negotiated Rate	$21,825.26
Max. Negotiated Rate	$29,245.85
Rate for Payer: EPIC Health Plan Medicare	$21,825.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,825.26
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$25,099.05
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$29,245.85

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC

Facility

$61,879.32

Service Code	MSDRG 802
Min. Negotiated Rate	$46,178.60
Max. Negotiated Rate	$61,879.32
Rate for Payer: EPIC Health Plan Medicare	$46,178.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$46,178.60
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$53,105.39
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$61,879.32

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC

Facility

$21,523.63

Service Code	MSDRG 804
Min. Negotiated Rate	$16,062.41
Max. Negotiated Rate	$21,523.63
Rate for Payer: EPIC Health Plan Medicare	$16,062.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,062.41
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$18,471.77
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$21,523.63

OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC

Facility

$28,817.45

Service Code	MSDRG 205
Min. Negotiated Rate	$21,505.56
Max. Negotiated Rate	$28,817.45
Rate for Payer: EPIC Health Plan Medicare	$21,505.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,505.56
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$24,731.39
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$28,817.45

OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC

Facility

$15,152.64

Service Code	MSDRG 206
Min. Negotiated Rate	$11,307.94
Max. Negotiated Rate	$15,152.64
Rate for Payer: EPIC Health Plan Medicare	$11,307.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,307.94
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$13,004.13
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$15,152.64

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC

Facility

$28,393.64

Service Code	MSDRG 167
Min. Negotiated Rate	$21,189.28
Max. Negotiated Rate	$28,393.64
Rate for Payer: EPIC Health Plan Medicare	$21,189.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,189.28
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$24,367.67
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$28,393.64

Know your out-of-pocket cost for care.

All Charges