Loma Linda University Medical Center

All Charges

Charge

Type

Price

INPATIENT MS-DRG 001: HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC

Facility IP

$459,359.21

Service Code	MS-DRG 001
Min. Negotiated Rate	$305,346.84
Max. Negotiated Rate	$459,359.21
Rate for Payer: EPIC Health Plan Medicare	$305,346.84
Rate for Payer: Humana Medicare	$305,346.84
Rate for Payer: IEHP Medicare Advantage	$305,346.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$360,309.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$384,737.02
Rate for Payer: Molina Healthcare of CA Medicare	$384,737.02
Rate for Payer: Multiplan WC	$459,359.21

INPATIENT MS-DRG 002: HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC

Facility IP

$219,888.11

Service Code	MS-DRG 002
Min. Negotiated Rate	$138,078.46
Max. Negotiated Rate	$219,888.11
Rate for Payer: EPIC Health Plan Medicare	$138,078.46
Rate for Payer: Humana Medicare	$138,078.46
Rate for Payer: IEHP Medicare Advantage	$138,078.46
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$162,932.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$173,978.86
Rate for Payer: Molina Healthcare of CA Medicare	$173,978.86
Rate for Payer: Multiplan WC	$219,888.11

INPATIENT MS-DRG 003: ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES

Facility IP

$330,280.16

Service Code	MS-DRG 003
Min. Negotiated Rate	$240,280.57
Max. Negotiated Rate	$330,280.16
Rate for Payer: EPIC Health Plan Medicare	$240,280.57
Rate for Payer: Humana Medicare	$240,280.57
Rate for Payer: IEHP Medicare Advantage	$240,280.57
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$283,531.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$302,753.52
Rate for Payer: Molina Healthcare of CA Medicare	$302,753.52
Rate for Payer: Multiplan WC	$330,280.16

INPATIENT MS-DRG 004: TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES

Facility IP

$224,108.60

Service Code	MS-DRG 004
Min. Negotiated Rate	$165,733.01
Max. Negotiated Rate	$224,108.60
Rate for Payer: EPIC Health Plan Medicare	$165,733.01
Rate for Payer: Humana Medicare	$165,733.01
Rate for Payer: IEHP Medicare Advantage	$165,733.01
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$195,564.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$208,823.59
Rate for Payer: Molina Healthcare of CA Medicare	$208,823.59
Rate for Payer: Multiplan WC	$224,108.60

INPATIENT MS-DRG 005: LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT

Facility IP

$186,168.27

Service Code	MS-DRG 005
Min. Negotiated Rate	$116,750.04
Max. Negotiated Rate	$186,168.27
Rate for Payer: EPIC Health Plan Medicare	$116,750.04
Rate for Payer: Humana Medicare	$116,750.04
Rate for Payer: IEHP Medicare Advantage	$116,750.04
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$137,765.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$147,105.05
Rate for Payer: Molina Healthcare of CA Medicare	$147,105.05
Rate for Payer: Multiplan WC	$186,168.27

INPATIENT MS-DRG 006: LIVER TRANSPLANT WITHOUT MCC

Facility IP

$78,490.32

Service Code	MS-DRG 006
Min. Negotiated Rate	$54,670.05
Max. Negotiated Rate	$78,490.32
Rate for Payer: EPIC Health Plan Medicare	$54,670.05
Rate for Payer: Humana Medicare	$54,670.05
Rate for Payer: IEHP Medicare Advantage	$54,670.05
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$64,510.66
Rate for Payer: Molina Healthcare of CA Medi-Cal	$68,884.26
Rate for Payer: Molina Healthcare of CA Medicare	$68,884.26
Rate for Payer: Multiplan WC	$78,490.32

INPATIENT MS-DRG 007: LUNG TRANSPLANT

Facility IP

$199,229.58

Service Code	MS-DRG 007
Min. Negotiated Rate	$138,329.58
Max. Negotiated Rate	$199,229.58
Rate for Payer: EPIC Health Plan Medicare	$138,329.58
Rate for Payer: Humana Medicare	$138,329.58
Rate for Payer: IEHP Medicare Advantage	$138,329.58
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$163,228.90
Rate for Payer: Molina Healthcare of CA Medi-Cal	$174,295.27
Rate for Payer: Molina Healthcare of CA Medicare	$174,295.27
Rate for Payer: Multiplan WC	$199,229.58

INPATIENT MS-DRG 008: SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT

Facility IP

$91,249.70

Service Code	MS-DRG 008
Min. Negotiated Rate	$59,453.48
Max. Negotiated Rate	$91,249.70
Rate for Payer: EPIC Health Plan Medicare	$59,453.48
Rate for Payer: Humana Medicare	$59,453.48
Rate for Payer: IEHP Medicare Advantage	$59,453.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$70,155.11
Rate for Payer: Molina Healthcare of CA Medi-Cal	$74,911.38
Rate for Payer: Molina Healthcare of CA Medicare	$74,911.38
Rate for Payer: Multiplan WC	$91,249.70

INPATIENT MS-DRG 010: PANCREAS TRANSPLANT

Facility IP

$68,553.68

Service Code	MS-DRG 010
Min. Negotiated Rate	$54,407.68
Max. Negotiated Rate	$68,553.68
Rate for Payer: EPIC Health Plan Medicare	$54,407.68
Rate for Payer: Humana Medicare	$54,407.68
Rate for Payer: IEHP Medicare Advantage	$54,407.68
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$64,201.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$68,553.68
Rate for Payer: Molina Healthcare of CA Medicare	$68,553.68
Rate for Payer: Multiplan WC	$67,677.97

INPATIENT MS-DRG 011: TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC

Facility IP

$84,298.79

Service Code	MS-DRG 011
Min. Negotiated Rate	$58,266.66
Max. Negotiated Rate	$84,298.79
Rate for Payer: EPIC Health Plan Medicare	$58,266.66
Rate for Payer: Humana Medicare	$58,266.66
Rate for Payer: IEHP Medicare Advantage	$58,266.66
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$68,754.66
Rate for Payer: Molina Healthcare of CA Medi-Cal	$73,415.99
Rate for Payer: Molina Healthcare of CA Medicare	$73,415.99
Rate for Payer: Multiplan WC	$84,298.79

INPATIENT MS-DRG 012: TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC

Facility IP

$63,805.10

Service Code	MS-DRG 012
Min. Negotiated Rate	$45,301.37
Max. Negotiated Rate	$63,805.10
Rate for Payer: EPIC Health Plan Medicare	$45,301.37
Rate for Payer: Humana Medicare	$45,301.37
Rate for Payer: IEHP Medicare Advantage	$45,301.37
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$53,455.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$57,079.73
Rate for Payer: Molina Healthcare of CA Medicare	$57,079.73
Rate for Payer: Multiplan WC	$63,805.10

INPATIENT MS-DRG 013: TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC

Facility IP

$46,159.35

Service Code	MS-DRG 013
Min. Negotiated Rate	$30,446.58
Max. Negotiated Rate	$46,159.35
Rate for Payer: EPIC Health Plan Medicare	$30,446.58
Rate for Payer: Humana Medicare	$30,446.58
Rate for Payer: IEHP Medicare Advantage	$30,446.58
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,926.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,362.69
Rate for Payer: Molina Healthcare of CA Medicare	$38,362.69
Rate for Payer: Multiplan WC	$46,159.35

INPATIENT MS-DRG 014: ALLOGENEIC BONE MARROW TRANSPLANT

Facility IP

$182,675.67

Service Code	MS-DRG 014
Min. Negotiated Rate	$129,259.27
Max. Negotiated Rate	$182,675.67
Rate for Payer: EPIC Health Plan Medicare	$129,259.27
Rate for Payer: Humana Medicare	$129,259.27
Rate for Payer: IEHP Medicare Advantage	$129,259.27
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$152,525.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$162,866.68
Rate for Payer: Molina Healthcare of CA Medicare	$162,866.68
Rate for Payer: Multiplan WC	$182,675.67

INPATIENT MS-DRG 016: AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC

Facility IP

$99,300.62

Service Code	MS-DRG 016
Min. Negotiated Rate	$69,760.18
Max. Negotiated Rate	$99,300.62
Rate for Payer: EPIC Health Plan Medicare	$69,760.18
Rate for Payer: Humana Medicare	$69,760.18
Rate for Payer: IEHP Medicare Advantage	$69,760.18
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$82,317.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$87,897.83
Rate for Payer: Molina Healthcare of CA Medicare	$87,897.83
Rate for Payer: Multiplan WC	$99,300.62

INPATIENT MS-DRG 017: AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC

Facility IP

$87,897.83

Service Code	MS-DRG 017
Min. Negotiated Rate	$69,760.18
Max. Negotiated Rate	$87,897.83
Rate for Payer: EPIC Health Plan Medicare	$69,760.18
Rate for Payer: Humana Medicare	$69,760.18
Rate for Payer: IEHP Medicare Advantage	$69,760.18
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$82,317.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$87,897.83
Rate for Payer: Molina Healthcare of CA Medicare	$87,897.83
Rate for Payer: Multiplan WC	$71,322.34

INPATIENT MS-DRG 018: CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES

Facility IP

$589,908.75

Service Code	MS-DRG 018
Min. Negotiated Rate	$415,069.80
Max. Negotiated Rate	$589,908.75
Rate for Payer: EPIC Health Plan Medicare	$415,069.80
Rate for Payer: Humana Medicare	$415,069.80
Rate for Payer: IEHP Medicare Advantage	$415,069.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$489,782.36
Rate for Payer: Molina Healthcare of CA Medi-Cal	$522,987.95
Rate for Payer: Molina Healthcare of CA Medicare	$522,987.95
Rate for Payer: Multiplan WC	$589,908.75

INPATIENT MS-DRG 019: SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS

Facility IP

$116,440.43

Service Code	MS-DRG 019
Min. Negotiated Rate	$90,214.79
Max. Negotiated Rate	$116,440.43
Rate for Payer: EPIC Health Plan Medicare	$90,214.79
Rate for Payer: Humana Medicare	$90,214.79
Rate for Payer: IEHP Medicare Advantage	$90,214.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$106,453.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$113,670.64
Rate for Payer: Molina Healthcare of CA Medicare	$113,670.64
Rate for Payer: Multiplan WC	$116,440.43

INPATIENT MS-DRG 020: INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC

Facility IP

$151,834.77

Service Code	MS-DRG 020
Min. Negotiated Rate	$95,382.21
Max. Negotiated Rate	$151,834.77
Rate for Payer: EPIC Health Plan Medicare	$95,382.21
Rate for Payer: Humana Medicare	$95,382.21
Rate for Payer: IEHP Medicare Advantage	$95,382.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$112,551.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$120,181.58
Rate for Payer: Molina Healthcare of CA Medicare	$120,181.58
Rate for Payer: Multiplan WC	$151,834.77

INPATIENT MS-DRG 021: INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC

Facility IP

$110,803.33

Service Code	MS-DRG 021
Min. Negotiated Rate	$69,359.32
Max. Negotiated Rate	$110,803.33
Rate for Payer: EPIC Health Plan Medicare	$69,359.32
Rate for Payer: Humana Medicare	$69,359.32
Rate for Payer: IEHP Medicare Advantage	$69,359.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$81,844.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$87,392.74
Rate for Payer: Molina Healthcare of CA Medicare	$87,392.74
Rate for Payer: Multiplan WC	$110,803.33

INPATIENT MS-DRG 022: INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC

Facility IP

$71,133.03

Service Code	MS-DRG 022
Min. Negotiated Rate	$44,375.75
Max. Negotiated Rate	$71,133.03
Rate for Payer: EPIC Health Plan Medicare	$44,375.75
Rate for Payer: Humana Medicare	$44,375.75
Rate for Payer: IEHP Medicare Advantage	$44,375.75
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$52,363.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$55,913.44
Rate for Payer: Molina Healthcare of CA Medicare	$55,913.44
Rate for Payer: Multiplan WC	$71,133.03

INPATIENT MS-DRG 023: CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR

Facility IP

$93,539.47

Service Code	MS-DRG 023
Min. Negotiated Rate	$64,037.62
Max. Negotiated Rate	$93,539.47
Rate for Payer: EPIC Health Plan Medicare	$64,037.62
Rate for Payer: Humana Medicare	$64,037.62
Rate for Payer: IEHP Medicare Advantage	$64,037.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$75,564.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$80,687.40
Rate for Payer: Molina Healthcare of CA Medicare	$80,687.40
Rate for Payer: Multiplan WC	$93,539.47

INPATIENT MS-DRG 024: CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC

Facility IP

$64,446.51

Service Code	MS-DRG 024
Min. Negotiated Rate	$42,867.97
Max. Negotiated Rate	$64,446.51
Rate for Payer: EPIC Health Plan Medicare	$42,867.97
Rate for Payer: Humana Medicare	$42,867.97
Rate for Payer: IEHP Medicare Advantage	$42,867.97
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$50,584.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$54,013.64
Rate for Payer: Molina Healthcare of CA Medicare	$54,013.64
Rate for Payer: Multiplan WC	$64,446.51

INPATIENT MS-DRG 025: CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC

Facility IP

$74,103.36

Service Code	MS-DRG 025
Min. Negotiated Rate	$49,930.53
Max. Negotiated Rate	$74,103.36
Rate for Payer: EPIC Health Plan Medicare	$49,930.53
Rate for Payer: Humana Medicare	$49,930.53
Rate for Payer: IEHP Medicare Advantage	$49,930.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$58,918.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$62,912.47
Rate for Payer: Molina Healthcare of CA Medicare	$62,912.47
Rate for Payer: Multiplan WC	$74,103.36

INPATIENT MS-DRG 026: CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC

Facility IP

$49,345.12

Service Code	MS-DRG 026
Min. Negotiated Rate	$33,457.64
Max. Negotiated Rate	$49,345.12
Rate for Payer: EPIC Health Plan Medicare	$33,457.64
Rate for Payer: Humana Medicare	$33,457.64
Rate for Payer: IEHP Medicare Advantage	$33,457.64
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,480.02
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,156.63
Rate for Payer: Molina Healthcare of CA Medicare	$42,156.63
Rate for Payer: Multiplan WC	$49,345.12

INPATIENT MS-DRG 027: CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC

Facility IP

$40,726.24

Service Code	MS-DRG 027
Min. Negotiated Rate	$27,599.93
Max. Negotiated Rate	$40,726.24
Rate for Payer: EPIC Health Plan Medicare	$27,599.93
Rate for Payer: Humana Medicare	$27,599.93
Rate for Payer: IEHP Medicare Advantage	$27,599.93
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,567.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,775.91
Rate for Payer: Molina Healthcare of CA Medicare	$34,775.91
Rate for Payer: Multiplan WC	$40,726.24

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