Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT MS-DRG 478: BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC

Facility

$38,335.29

Service Code	MS-DRG 478
Min. Negotiated Rate	$27,045.91
Max. Negotiated Rate	$38,335.29
Rate for Payer: EPIC Health Plan Medicare	$27,045.91
Rate for Payer: Humana Medicare	$27,045.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,045.91
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,914.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,077.85
Rate for Payer: Molina Healthcare of CA Medicare	$34,077.85
Rate for Payer: Multiplan WC	$38,335.29

INPATIENT MS-DRG 479: BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC

Facility

$28,861.23

Service Code	MS-DRG 479
Min. Negotiated Rate	$21,193.86
Max. Negotiated Rate	$28,861.23
Rate for Payer: EPIC Health Plan Medicare	$21,193.86
Rate for Payer: Humana Medicare	$21,193.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,193.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,008.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,704.26
Rate for Payer: Molina Healthcare of CA Medicare	$26,704.26
Rate for Payer: Multiplan WC	$28,861.23

INPATIENT MS-DRG 480: HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC

Facility

$48,406.69

Service Code	MS-DRG 480
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$48,406.69
Rate for Payer: EPIC Health Plan Medicare	$33,410.32
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	$33,410.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,410.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,424.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,097.00
Rate for Payer: Molina Healthcare of CA Medicare	$42,097.00
Rate for Payer: Multiplan WC	$48,406.69

INPATIENT MS-DRG 481: HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC

Facility

$34,475.48

Service Code	MS-DRG 481
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$34,475.48
Rate for Payer: EPIC Health Plan Medicare	$23,568.70
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	$23,568.70
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,568.70
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,811.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,696.56
Rate for Payer: Molina Healthcare of CA Medicare	$29,696.56
Rate for Payer: Multiplan WC	$34,475.48

INPATIENT MS-DRG 482: HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC

Facility

$26,865.22

Service Code	MS-DRG 482
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$26,865.22
Rate for Payer: EPIC Health Plan Medicare	$18,090.48
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	$18,090.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,090.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,346.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,794.00
Rate for Payer: Molina Healthcare of CA Medicare	$22,794.00
Rate for Payer: Multiplan WC	$26,865.22

INPATIENT MS-DRG 483: MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES

Facility

$38,477.28

Service Code	MS-DRG 483
Min. Negotiated Rate	$28,177.60
Max. Negotiated Rate	$38,477.28
Rate for Payer: EPIC Health Plan Medicare	$28,177.60
Rate for Payer: Humana Medicare	$28,177.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,177.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,249.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,503.78
Rate for Payer: Molina Healthcare of CA Medicare	$35,503.78
Rate for Payer: Multiplan WC	$38,477.28

INPATIENT MS-DRG 485: KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC

Facility

$53,058.03

Service Code	MS-DRG 485
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$53,058.03
Rate for Payer: EPIC Health Plan Medicare	$37,296.31
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	$37,296.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,296.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$44,009.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,993.35
Rate for Payer: Molina Healthcare of CA Medicare	$46,993.35
Rate for Payer: Multiplan WC	$53,058.03

INPATIENT MS-DRG 486: KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC

Facility

$34,044.62

Service Code	MS-DRG 486
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$34,044.62
Rate for Payer: EPIC Health Plan Medicare	$22,818.75
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	$22,818.75
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,818.75
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,926.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,751.62
Rate for Payer: Molina Healthcare of CA Medicare	$28,751.62
Rate for Payer: Multiplan WC	$34,044.62

INPATIENT MS-DRG 487: KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

$26,178.12

Service Code	MS-DRG 487
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$26,178.12
Rate for Payer: EPIC Health Plan Medicare	$17,600.66
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	$17,600.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,600.66
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,768.78
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,176.83
Rate for Payer: Molina Healthcare of CA Medicare	$22,176.83
Rate for Payer: Multiplan WC	$26,178.12

INPATIENT MS-DRG 488: KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC

Facility

$37,034.54

Service Code	MS-DRG 488
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$37,034.54
Rate for Payer: EPIC Health Plan Medicare	$23,925.65
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	$23,925.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,925.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,232.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,146.32
Rate for Payer: Molina Healthcare of CA Medicare	$30,146.32
Rate for Payer: Multiplan WC	$37,034.54

INPATIENT MS-DRG 489: KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

$21,698.14

Service Code	MS-DRG 489
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$21,698.14
Rate for Payer: EPIC Health Plan Medicare	$14,141.43
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	$14,141.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,141.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,686.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,818.20
Rate for Payer: Molina Healthcare of CA Medicare	$17,818.20
Rate for Payer: Multiplan WC	$21,698.14

INPATIENT MS-DRG 492: LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC

Facility

$56,891.72

Service Code	MS-DRG 492
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$56,891.72
Rate for Payer: EPIC Health Plan Medicare	$39,189.20
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	$39,189.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,189.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$46,243.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$49,378.39
Rate for Payer: Molina Healthcare of CA Medicare	$49,378.39
Rate for Payer: Multiplan WC	$56,891.72

INPATIENT MS-DRG 493: LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC

Facility

$38,774.31

Service Code	MS-DRG 493
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$38,774.31
Rate for Payer: EPIC Health Plan Medicare	$27,248.60
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	$27,248.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,248.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,153.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,333.24
Rate for Payer: Molina Healthcare of CA Medicare	$34,333.24
Rate for Payer: Multiplan WC	$38,774.31

INPATIENT MS-DRG 494: LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC

Facility

$30,826.21

Service Code	MS-DRG 494
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$30,826.21
Rate for Payer: EPIC Health Plan Medicare	$21,252.42
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	$21,252.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,252.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,077.86
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,778.05
Rate for Payer: Molina Healthcare of CA Medicare	$26,778.05
Rate for Payer: Multiplan WC	$30,826.21

INPATIENT MS-DRG 495: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC

Facility

$60,620.97

Service Code	MS-DRG 495
Min. Negotiated Rate	$40,530.30
Max. Negotiated Rate	$60,620.97
Rate for Payer: EPIC Health Plan Medicare	$40,530.30
Rate for Payer: Humana Medicare	$40,530.30
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$40,530.30
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$47,825.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$51,068.18
Rate for Payer: Molina Healthcare of CA Medicare	$51,068.18
Rate for Payer: Multiplan WC	$60,620.97

INPATIENT MS-DRG 496: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC

Facility

$34,268.21

Service Code	MS-DRG 496
Min. Negotiated Rate	$22,584.52
Max. Negotiated Rate	$34,268.21
Rate for Payer: EPIC Health Plan Medicare	$22,584.52
Rate for Payer: Humana Medicare	$22,584.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,584.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,649.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,456.50
Rate for Payer: Molina Healthcare of CA Medicare	$28,456.50
Rate for Payer: Multiplan WC	$34,268.21

INPATIENT MS-DRG 497: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC

Facility

$24,834.94

Service Code	MS-DRG 497
Min. Negotiated Rate	$16,277.54
Max. Negotiated Rate	$24,834.94
Rate for Payer: EPIC Health Plan Medicare	$16,277.54
Rate for Payer: Humana Medicare	$16,277.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,277.54
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,207.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,509.70
Rate for Payer: Molina Healthcare of CA Medicare	$20,509.70
Rate for Payer: Multiplan WC	$24,834.94

INPATIENT MS-DRG 498: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC

Facility

$41,831.14

Service Code	MS-DRG 498
Min. Negotiated Rate	$29,605.41
Max. Negotiated Rate	$41,831.14
Rate for Payer: EPIC Health Plan Medicare	$29,605.41
Rate for Payer: Humana Medicare	$29,605.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,605.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,934.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,302.82
Rate for Payer: Molina Healthcare of CA Medicare	$37,302.82
Rate for Payer: Multiplan WC	$41,831.14

INPATIENT MS-DRG 499: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC

Facility

$21,521.88

Service Code	MS-DRG 499
Min. Negotiated Rate	$14,728.11
Max. Negotiated Rate	$21,521.88
Rate for Payer: EPIC Health Plan Medicare	$14,728.11
Rate for Payer: Humana Medicare	$14,728.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,728.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,379.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,557.42
Rate for Payer: Molina Healthcare of CA Medicare	$18,557.42
Rate for Payer: Multiplan WC	$21,521.88

INPATIENT MS-DRG 500: SOFT TISSUE PROCEDURES WITH MCC

Facility

$52,299.13

Service Code	MS-DRG 500
Min. Negotiated Rate	$36,719.78
Max. Negotiated Rate	$52,299.13
Rate for Payer: EPIC Health Plan Medicare	$36,719.78
Rate for Payer: Humana Medicare	$36,719.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,719.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$43,329.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,266.92
Rate for Payer: Molina Healthcare of CA Medicare	$46,266.92
Rate for Payer: Multiplan WC	$52,299.13

INPATIENT MS-DRG 501: SOFT TISSUE PROCEDURES WITH CC

Facility

$28,688.23

Service Code	MS-DRG 501
Min. Negotiated Rate	$19,749.14
Max. Negotiated Rate	$28,688.23
Rate for Payer: EPIC Health Plan Medicare	$19,749.14
Rate for Payer: Humana Medicare	$19,749.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,749.14
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,303.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,883.92
Rate for Payer: Molina Healthcare of CA Medicare	$24,883.92
Rate for Payer: Multiplan WC	$28,688.23

INPATIENT MS-DRG 502: SOFT TISSUE PROCEDURES WITHOUT CC/MCC

Facility

$22,432.56

Service Code	MS-DRG 502
Min. Negotiated Rate	$15,774.20
Max. Negotiated Rate	$22,432.56
Rate for Payer: EPIC Health Plan Medicare	$15,774.20
Rate for Payer: Humana Medicare	$15,774.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,774.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,613.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,875.49
Rate for Payer: Molina Healthcare of CA Medicare	$19,875.49
Rate for Payer: Multiplan WC	$22,432.56

INPATIENT MS-DRG 503: FOOT PROCEDURES WITH MCC

Facility

$41,344.79

Service Code	MS-DRG 503
Min. Negotiated Rate	$30,403.78
Max. Negotiated Rate	$41,344.79
Rate for Payer: EPIC Health Plan Medicare	$30,403.78
Rate for Payer: Humana Medicare	$30,403.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,403.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,876.46
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,308.76
Rate for Payer: Molina Healthcare of CA Medicare	$38,308.76
Rate for Payer: Multiplan WC	$41,344.79

INPATIENT MS-DRG 504: FOOT PROCEDURES WITH CC

Facility

$28,965.67

Service Code	MS-DRG 504
Min. Negotiated Rate	$19,652.29
Max. Negotiated Rate	$28,965.67
Rate for Payer: EPIC Health Plan Medicare	$19,652.29
Rate for Payer: Humana Medicare	$19,652.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,652.29
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,189.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,761.89
Rate for Payer: Molina Healthcare of CA Medicare	$24,761.89
Rate for Payer: Multiplan WC	$28,965.67

INPATIENT MS-DRG 505: FOOT PROCEDURES WITHOUT CC/MCC

Facility

$28,835.11

Service Code	MS-DRG 505
Min. Negotiated Rate	$19,411.33
Max. Negotiated Rate	$28,835.11
Rate for Payer: EPIC Health Plan Medicare	$19,411.33
Rate for Payer: Humana Medicare	$19,411.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,411.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,905.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,458.28
Rate for Payer: Molina Healthcare of CA Medicare	$24,458.28
Rate for Payer: Multiplan WC	$28,835.11

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