Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT MS-DRG 453: COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC

Facility

$149,411.17

Service Code	MS-DRG 453
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$149,411.17
Rate for Payer: Cigna of CA HMO/PPO	$21,600.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$99,987.74
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$99,987.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$99,987.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$117,985.53
Rate for Payer: Molina Healthcare of CA Medi-Cal	$125,984.55
Rate for Payer: Molina Healthcare of CA Medicare	$125,984.55
Rate for Payer: Multiplan WC	$149,411.17

INPATIENT MS-DRG 454: COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC

Facility

$99,406.70

Service Code	MS-DRG 454
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$99,406.70
Rate for Payer: Cigna of CA HMO/PPO	$21,600.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$69,076.67
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$69,076.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$69,076.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$81,510.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$87,036.60
Rate for Payer: Molina Healthcare of CA Medicare	$87,036.60
Rate for Payer: Multiplan WC	$99,406.70

INPATIENT MS-DRG 455: COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC

Facility

$78,142.69

Service Code	MS-DRG 455
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$78,142.69
Rate for Payer: Cigna of CA HMO/PPO	$21,600.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$52,065.51
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$52,065.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$52,065.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$61,437.30
Rate for Payer: Molina Healthcare of CA Medi-Cal	$65,602.54
Rate for Payer: Molina Healthcare of CA Medicare	$65,602.54
Rate for Payer: Multiplan WC	$78,142.69

INPATIENT MS-DRG 456: SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC

Facility

$137,895.41

Service Code	MS-DRG 456
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$137,895.41
Rate for Payer: Cigna of CA HMO/PPO	$21,600.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$95,123.23
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$95,123.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$95,123.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$112,245.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$119,855.27
Rate for Payer: Molina Healthcare of CA Medicare	$119,855.27
Rate for Payer: Multiplan WC	$137,895.41

INPATIENT MS-DRG 457: SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC

Facility

$98,523.76

Service Code	MS-DRG 457
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$98,523.76
Rate for Payer: Cigna of CA HMO/PPO	$21,600.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$68,615.00
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$68,615.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$68,615.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$80,965.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$86,454.90
Rate for Payer: Molina Healthcare of CA Medicare	$86,454.90
Rate for Payer: Multiplan WC	$98,523.76

INPATIENT MS-DRG 458: SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC

Facility

$78,552.33

Service Code	MS-DRG 458
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$78,552.33
Rate for Payer: Cigna of CA HMO/PPO	$21,600.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$51,225.48
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$51,225.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$51,225.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$60,446.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$64,544.10
Rate for Payer: Molina Healthcare of CA Medicare	$64,544.10
Rate for Payer: Multiplan WC	$78,552.33

INPATIENT MS-DRG 459: SPINAL FUSION EXCEPT CERVICAL WITH MCC

Facility

$108,254.06

Service Code	MS-DRG 459
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$108,254.06
Rate for Payer: Cigna of CA HMO/PPO	$21,600.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$74,887.08
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$74,887.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$74,887.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$88,366.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$94,357.72
Rate for Payer: Molina Healthcare of CA Medicare	$94,357.72
Rate for Payer: Multiplan WC	$108,254.06

INPATIENT MS-DRG 460: SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC

Facility

$61,463.11

Service Code	MS-DRG 460
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$61,463.11
Rate for Payer: Cigna of CA HMO/PPO	$21,600.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$41,393.98
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$41,393.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$41,393.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$48,844.90
Rate for Payer: Molina Healthcare of CA Medi-Cal	$52,156.41
Rate for Payer: Molina Healthcare of CA Medicare	$52,156.41
Rate for Payer: Multiplan WC	$61,463.11

INPATIENT MS-DRG 461: BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC

Facility

$104,699.45

Service Code	MS-DRG 461
Min. Negotiated Rate	$9,561.00
Max. Negotiated Rate	$104,699.45
Rate for Payer: Cigna of CA HMO/PPO	$21,600.00
Rate for Payer: EPIC Health Plan Commercial	$24,040.00
Rate for Payer: EPIC Health Plan Medicare	$76,983.77
Rate for Payer: Humana Medicare	$76,983.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$76,983.77
Rate for Payer: Kaiser Permanente of CA Commercial	$9,561.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$90,840.85
Rate for Payer: Molina Healthcare of CA Medi-Cal	$96,999.55
Rate for Payer: Molina Healthcare of CA Medicare	$96,999.55
Rate for Payer: Multiplan WC	$104,699.45

INPATIENT MS-DRG 462: BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC

Facility

$48,726.57

Service Code	MS-DRG 462
Min. Negotiated Rate	$9,561.00
Max. Negotiated Rate	$48,726.57
Rate for Payer: Cigna of CA HMO/PPO	$21,600.00
Rate for Payer: EPIC Health Plan Commercial	$24,040.00
Rate for Payer: EPIC Health Plan Medicare	$32,255.00
Rate for Payer: Humana Medicare	$32,255.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,255.00
Rate for Payer: Kaiser Permanente of CA Commercial	$9,561.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$38,060.90
Rate for Payer: Molina Healthcare of CA Medi-Cal	$40,641.30
Rate for Payer: Molina Healthcare of CA Medicare	$40,641.30
Rate for Payer: Multiplan WC	$48,726.57

INPATIENT MS-DRG 463: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$85,545.68

Service Code	MS-DRG 463
Min. Negotiated Rate	$63,980.19
Max. Negotiated Rate	$85,545.68
Rate for Payer: EPIC Health Plan Medicare	$63,980.19
Rate for Payer: Humana Medicare	$63,980.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$63,980.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$75,496.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$80,615.04
Rate for Payer: Molina Healthcare of CA Medicare	$80,615.04
Rate for Payer: Multiplan WC	$85,545.68

INPATIENT MS-DRG 464: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$48,752.68

Service Code	MS-DRG 464
Min. Negotiated Rate	$34,001.51
Max. Negotiated Rate	$48,752.68
Rate for Payer: EPIC Health Plan Medicare	$34,001.51
Rate for Payer: Humana Medicare	$34,001.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,001.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,121.78
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,841.90
Rate for Payer: Molina Healthcare of CA Medicare	$42,841.90
Rate for Payer: Multiplan WC	$48,752.68

INPATIENT MS-DRG 465: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$32,521.92

Service Code	MS-DRG 465
Min. Negotiated Rate	$21,270.42
Max. Negotiated Rate	$32,521.92
Rate for Payer: EPIC Health Plan Medicare	$21,270.42
Rate for Payer: Humana Medicare	$21,270.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,270.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,099.10
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,800.73
Rate for Payer: Molina Healthcare of CA Medicare	$26,800.73
Rate for Payer: Multiplan WC	$32,521.92

INPATIENT MS-DRG 466: REVISION OF HIP OR KNEE REPLACEMENT WITH MCC

Facility

$85,602.80

Service Code	MS-DRG 466
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$85,602.80
Rate for Payer: Cigna of CA HMO/PPO	$17,300.00
Rate for Payer: EPIC Health Plan Commercial	$24,040.00
Rate for Payer: EPIC Health Plan Medicare	$58,607.83
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$58,607.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$58,607.83
Rate for Payer: Kaiser Permanente of CA Commercial	$9,561.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$69,157.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$73,845.87
Rate for Payer: Molina Healthcare of CA Medicare	$73,845.87
Rate for Payer: Multiplan WC	$85,602.80

INPATIENT MS-DRG 467: REVISION OF HIP OR KNEE REPLACEMENT WITH CC

Facility

$59,176.60

Service Code	MS-DRG 467
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$59,176.60
Rate for Payer: Cigna of CA HMO/PPO	$17,300.00
Rate for Payer: EPIC Health Plan Commercial	$24,040.00
Rate for Payer: EPIC Health Plan Medicare	$39,461.68
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$39,461.68
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,461.68
Rate for Payer: Kaiser Permanente of CA Commercial	$9,561.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$46,564.78
Rate for Payer: Molina Healthcare of CA Medi-Cal	$49,721.72
Rate for Payer: Molina Healthcare of CA Medicare	$49,721.72
Rate for Payer: Multiplan WC	$59,176.60

INPATIENT MS-DRG 468: REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC

Facility

$45,522.85

Service Code	MS-DRG 468
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$45,522.85
Rate for Payer: Cigna of CA HMO/PPO	$17,300.00
Rate for Payer: EPIC Health Plan Commercial	$24,040.00
Rate for Payer: EPIC Health Plan Medicare	$30,265.28
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$30,265.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,265.28
Rate for Payer: Kaiser Permanente of CA Commercial	$9,561.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,713.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,134.25
Rate for Payer: Molina Healthcare of CA Medicare	$38,134.25
Rate for Payer: Multiplan WC	$45,522.85

INPATIENT MS-DRG 469: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT

Facility

$52,738.15

Service Code	MS-DRG 469
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$52,738.15
Rate for Payer: Cigna of CA HMO/PPO	$17,300.00
Rate for Payer: EPIC Health Plan Commercial	$24,040.00
Rate for Payer: EPIC Health Plan Medicare	$37,699.43
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$37,699.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,699.43
Rate for Payer: Kaiser Permanente of CA Commercial	$9,561.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$44,485.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$47,501.28
Rate for Payer: Molina Healthcare of CA Medicare	$47,501.28
Rate for Payer: Multiplan WC	$52,738.15

INPATIENT MS-DRG 470: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC

Facility

$31,203.22

Service Code	MS-DRG 470
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$31,203.22
Rate for Payer: Cigna of CA HMO/PPO	$17,300.00
Rate for Payer: EPIC Health Plan Commercial	$24,040.00
Rate for Payer: EPIC Health Plan Medicare	$21,393.16
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$21,393.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,393.16
Rate for Payer: Kaiser Permanente of CA Commercial	$9,561.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,243.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,955.38
Rate for Payer: Molina Healthcare of CA Medicare	$26,955.38
Rate for Payer: Multiplan WC	$31,203.22

INPATIENT MS-DRG 471: CERVICAL SPINAL FUSION WITH MCC

Facility

$82,206.50

Service Code	MS-DRG 471
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$82,206.50
Rate for Payer: Cigna of CA HMO/PPO	$21,600.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$55,594.55
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$55,594.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$55,594.55
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$65,601.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$70,049.13
Rate for Payer: Molina Healthcare of CA Medicare	$70,049.13
Rate for Payer: Multiplan WC	$82,206.50

INPATIENT MS-DRG 472: CERVICAL SPINAL FUSION WITH CC

Facility

$50,120.35

Service Code	MS-DRG 472
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$50,120.35
Rate for Payer: Cigna of CA HMO/PPO	$21,600.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$33,483.51
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$33,483.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,483.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,510.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,189.22
Rate for Payer: Molina Healthcare of CA Medicare	$42,189.22
Rate for Payer: Multiplan WC	$50,120.35

INPATIENT MS-DRG 473: CERVICAL SPINAL FUSION WITHOUT CC/MCC

Facility

$41,374.17

Service Code	MS-DRG 473
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$41,374.17
Rate for Payer: Cigna of CA HMO/PPO	$21,600.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$27,911.84
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$27,911.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,911.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,935.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,168.92
Rate for Payer: Molina Healthcare of CA Medicare	$35,168.92
Rate for Payer: Multiplan WC	$41,374.17

INPATIENT MS-DRG 474: AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$66,863.57

Service Code	MS-DRG 474
Min. Negotiated Rate	$48,655.86
Max. Negotiated Rate	$66,863.57
Rate for Payer: EPIC Health Plan Medicare	$48,655.86
Rate for Payer: Humana Medicare	$48,655.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$48,655.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$57,413.91
Rate for Payer: Molina Healthcare of CA Medi-Cal	$61,306.38
Rate for Payer: Molina Healthcare of CA Medicare	$61,306.38
Rate for Payer: Multiplan WC	$66,863.57

INPATIENT MS-DRG 475: AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$36,251.16

Service Code	MS-DRG 475
Min. Negotiated Rate	$24,354.66
Max. Negotiated Rate	$36,251.16
Rate for Payer: EPIC Health Plan Medicare	$24,354.66
Rate for Payer: Humana Medicare	$24,354.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,354.66
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,738.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,686.87
Rate for Payer: Molina Healthcare of CA Medicare	$30,686.87
Rate for Payer: Multiplan WC	$36,251.16

INPATIENT MS-DRG 476: AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$20,033.44

Service Code	MS-DRG 476
Min. Negotiated Rate	$13,456.80
Max. Negotiated Rate	$20,033.44
Rate for Payer: EPIC Health Plan Medicare	$13,456.80
Rate for Payer: Humana Medicare	$13,456.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,456.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,879.02
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,955.57
Rate for Payer: Molina Healthcare of CA Medicare	$16,955.57
Rate for Payer: Multiplan WC	$20,033.44

INPATIENT MS-DRG 477: BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$55,535.49

Service Code	MS-DRG 477
Min. Negotiated Rate	$38,140.84
Max. Negotiated Rate	$55,535.49
Rate for Payer: EPIC Health Plan Medicare	$38,140.84
Rate for Payer: Humana Medicare	$38,140.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$38,140.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$45,006.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$48,057.46
Rate for Payer: Molina Healthcare of CA Medicare	$48,057.46
Rate for Payer: Multiplan WC	$55,535.49

Know your out-of-pocket cost for care.

All Charges