Loma Linda University Medical Center

All Charges

Charge

Type

Price

INPATIENT MS-DRG 087: TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC

Facility IP

$14,238.03

Service Code	MS-DRG 087
Min. Negotiated Rate	$10,183.39
Max. Negotiated Rate	$14,238.03
Rate for Payer: EPIC Health Plan Medicare	$10,183.39
Rate for Payer: Humana Medicare	$10,183.39
Rate for Payer: IEHP Medicare Advantage	$10,183.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,016.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,831.07
Rate for Payer: Molina Healthcare of CA Medicare	$12,831.07
Rate for Payer: Multiplan WC	$14,238.03

INPATIENT MS-DRG 088: CONCUSSION WITH MCC

Facility IP

$25,726.05

Service Code	MS-DRG 088
Min. Negotiated Rate	$17,475.65
Max. Negotiated Rate	$25,726.05
Rate for Payer: EPIC Health Plan Medicare	$17,475.65
Rate for Payer: Humana Medicare	$17,475.65
Rate for Payer: IEHP Medicare Advantage	$17,475.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,621.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,019.32
Rate for Payer: Molina Healthcare of CA Medicare	$22,019.32
Rate for Payer: Multiplan WC	$25,726.05

INPATIENT MS-DRG 089: CONCUSSION WITH CC

Facility IP

$19,057.48

Service Code	MS-DRG 089
Min. Negotiated Rate	$13,152.77
Max. Negotiated Rate	$19,057.48
Rate for Payer: EPIC Health Plan Medicare	$13,152.77
Rate for Payer: Humana Medicare	$13,152.77
Rate for Payer: IEHP Medicare Advantage	$13,152.77
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,520.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,572.49
Rate for Payer: Molina Healthcare of CA Medicare	$16,572.49
Rate for Payer: Multiplan WC	$19,057.48

INPATIENT MS-DRG 090: CONCUSSION WITHOUT CC/MCC

Facility IP

$13,520.63

Service Code	MS-DRG 090
Min. Negotiated Rate	$10,730.66
Max. Negotiated Rate	$13,520.63
Rate for Payer: EPIC Health Plan Medicare	$10,730.66
Rate for Payer: Humana Medicare	$10,730.66
Rate for Payer: IEHP Medicare Advantage	$10,730.66
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,662.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,520.63
Rate for Payer: Molina Healthcare of CA Medicare	$13,520.63
Rate for Payer: Multiplan WC	$13,433.43

INPATIENT MS-DRG 091: OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC

Facility IP

$28,192.08

Service Code	MS-DRG 091
Min. Negotiated Rate	$20,351.59
Max. Negotiated Rate	$28,192.08
Rate for Payer: EPIC Health Plan Medicare	$20,351.59
Rate for Payer: Humana Medicare	$20,351.59
Rate for Payer: IEHP Medicare Advantage	$20,351.59
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,014.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,643.00
Rate for Payer: Molina Healthcare of CA Medicare	$25,643.00
Rate for Payer: Multiplan WC	$28,192.08

INPATIENT MS-DRG 092: OTHER DISORDERS OF NERVOUS SYSTEM WITH CC

Facility IP

$16,227.50

Service Code	MS-DRG 092
Min. Negotiated Rate	$11,758.73
Max. Negotiated Rate	$16,227.50
Rate for Payer: EPIC Health Plan Medicare	$11,758.73
Rate for Payer: Humana Medicare	$11,758.73
Rate for Payer: IEHP Medicare Advantage	$11,758.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,875.30
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,816.00
Rate for Payer: Molina Healthcare of CA Medicare	$14,816.00
Rate for Payer: Multiplan WC	$16,227.50

INPATIENT MS-DRG 093: OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility IP

$12,481.94

Service Code	MS-DRG 093
Min. Negotiated Rate	$8,924.47
Max. Negotiated Rate	$12,481.94
Rate for Payer: EPIC Health Plan Medicare	$8,924.47
Rate for Payer: Humana Medicare	$8,924.47
Rate for Payer: IEHP Medicare Advantage	$8,924.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,530.87
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,244.83
Rate for Payer: Molina Healthcare of CA Medicare	$11,244.83
Rate for Payer: Multiplan WC	$12,481.94

INPATIENT MS-DRG 094: BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC

Facility IP

$58,321.41

Service Code	MS-DRG 094
Min. Negotiated Rate	$40,997.61
Max. Negotiated Rate	$58,321.41
Rate for Payer: EPIC Health Plan Medicare	$40,997.61
Rate for Payer: Humana Medicare	$40,997.61
Rate for Payer: IEHP Medicare Advantage	$40,997.61
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$48,377.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$51,656.99
Rate for Payer: Molina Healthcare of CA Medicare	$51,656.99
Rate for Payer: Multiplan WC	$58,321.41

INPATIENT MS-DRG 095: BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC

Facility IP

$41,728.32

Service Code	MS-DRG 095
Min. Negotiated Rate	$27,051.55
Max. Negotiated Rate	$41,728.32
Rate for Payer: EPIC Health Plan Medicare	$27,051.55
Rate for Payer: Humana Medicare	$27,051.55
Rate for Payer: IEHP Medicare Advantage	$27,051.55
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,920.83
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,084.95
Rate for Payer: Molina Healthcare of CA Medicare	$34,084.95
Rate for Payer: Multiplan WC	$41,728.32

INPATIENT MS-DRG 096: BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility IP

$37,280.98

Service Code	MS-DRG 096
Min. Negotiated Rate	$24,748.78
Max. Negotiated Rate	$37,280.98
Rate for Payer: EPIC Health Plan Medicare	$24,748.78
Rate for Payer: Humana Medicare	$24,748.78
Rate for Payer: IEHP Medicare Advantage	$24,748.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,203.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,183.46
Rate for Payer: Molina Healthcare of CA Medicare	$31,183.46
Rate for Payer: Multiplan WC	$37,280.98

INPATIENT MS-DRG 097: NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC

Facility IP

$63,457.48

Service Code	MS-DRG 097
Min. Negotiated Rate	$41,157.50
Max. Negotiated Rate	$63,457.48
Rate for Payer: EPIC Health Plan Medicare	$41,157.50
Rate for Payer: Humana Medicare	$41,157.50
Rate for Payer: IEHP Medicare Advantage	$41,157.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$48,565.85
Rate for Payer: Molina Healthcare of CA Medi-Cal	$51,858.45
Rate for Payer: Molina Healthcare of CA Medicare	$51,858.45
Rate for Payer: Multiplan WC	$63,457.48

INPATIENT MS-DRG 098: NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC

Facility IP

$34,015.24

Service Code	MS-DRG 098
Min. Negotiated Rate	$24,465.02
Max. Negotiated Rate	$34,015.24
Rate for Payer: EPIC Health Plan Medicare	$24,465.02
Rate for Payer: Humana Medicare	$24,465.02
Rate for Payer: IEHP Medicare Advantage	$24,465.02
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,868.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,825.93
Rate for Payer: Molina Healthcare of CA Medicare	$30,825.93
Rate for Payer: Multiplan WC	$34,015.24

INPATIENT MS-DRG 099: NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC

Facility IP

$22,824.26

Service Code	MS-DRG 099
Min. Negotiated Rate	$15,070.44
Max. Negotiated Rate	$22,824.26
Rate for Payer: EPIC Health Plan Medicare	$15,070.44
Rate for Payer: Humana Medicare	$15,070.44
Rate for Payer: IEHP Medicare Advantage	$15,070.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,783.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,988.75
Rate for Payer: Molina Healthcare of CA Medicare	$18,988.75
Rate for Payer: Multiplan WC	$22,824.26

INPATIENT MS-DRG 100: SEIZURES WITH MCC

Facility IP

$31,351.74

Service Code	MS-DRG 100
Min. Negotiated Rate	$22,528.23
Max. Negotiated Rate	$31,351.74
Rate for Payer: EPIC Health Plan Medicare	$22,528.23
Rate for Payer: Humana Medicare	$22,528.23
Rate for Payer: IEHP Medicare Advantage	$22,528.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,583.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,385.57
Rate for Payer: Molina Healthcare of CA Medicare	$28,385.57
Rate for Payer: Multiplan WC	$31,351.74

INPATIENT MS-DRG 101: SEIZURES WITHOUT MCC

Facility IP

$14,712.96

Service Code	MS-DRG 101
Min. Negotiated Rate	$10,446.89
Max. Negotiated Rate	$14,712.96
Rate for Payer: EPIC Health Plan Medicare	$10,446.89
Rate for Payer: Humana Medicare	$10,446.89
Rate for Payer: IEHP Medicare Advantage	$10,446.89
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,327.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,163.08
Rate for Payer: Molina Healthcare of CA Medicare	$13,163.08
Rate for Payer: Multiplan WC	$14,712.96

INPATIENT MS-DRG 102: HEADACHES WITH MCC

Facility IP

$18,766.97

Service Code	MS-DRG 102
Min. Negotiated Rate	$13,791.24
Max. Negotiated Rate	$18,766.97
Rate for Payer: EPIC Health Plan Medicare	$13,791.24
Rate for Payer: Humana Medicare	$13,791.24
Rate for Payer: IEHP Medicare Advantage	$13,791.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,273.66
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,376.96
Rate for Payer: Molina Healthcare of CA Medicare	$17,376.96
Rate for Payer: Multiplan WC	$18,766.97

INPATIENT MS-DRG 103: HEADACHES WITHOUT MCC

Facility IP

$13,586.84

Service Code	MS-DRG 103
Min. Negotiated Rate	$9,690.17
Max. Negotiated Rate	$13,586.84
Rate for Payer: EPIC Health Plan Medicare	$9,690.17
Rate for Payer: Humana Medicare	$9,690.17
Rate for Payer: IEHP Medicare Advantage	$9,690.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,434.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,209.61
Rate for Payer: Molina Healthcare of CA Medicare	$12,209.61
Rate for Payer: Multiplan WC	$13,586.84

INPATIENT MS-DRG 113: ORBITAL PROCEDURES WITH CC/MCC

Facility IP

$36,644.48

Service Code	MS-DRG 113
Min. Negotiated Rate	$28,437.70
Max. Negotiated Rate	$36,644.48
Rate for Payer: EPIC Health Plan Medicare	$28,437.70
Rate for Payer: Humana Medicare	$28,437.70
Rate for Payer: IEHP Medicare Advantage	$28,437.70
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,556.49
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,831.50
Rate for Payer: Molina Healthcare of CA Medicare	$35,831.50
Rate for Payer: Multiplan WC	$36,644.48

INPATIENT MS-DRG 114: ORBITAL PROCEDURES WITHOUT CC/MCC

Facility IP

$21,262.38

Service Code	MS-DRG 114
Min. Negotiated Rate	$14,075.01
Max. Negotiated Rate	$21,262.38
Rate for Payer: EPIC Health Plan Medicare	$14,075.01
Rate for Payer: Humana Medicare	$14,075.01
Rate for Payer: IEHP Medicare Advantage	$14,075.01
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,608.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,734.51
Rate for Payer: Molina Healthcare of CA Medicare	$17,734.51
Rate for Payer: Multiplan WC	$21,262.38

INPATIENT MS-DRG 115: EXTRAOCULAR PROCEDURES EXCEPT ORBIT

Facility IP

$24,792.51

Service Code	MS-DRG 115
Min. Negotiated Rate	$17,820.22
Max. Negotiated Rate	$24,792.51
Rate for Payer: EPIC Health Plan Medicare	$17,820.22
Rate for Payer: Humana Medicare	$17,820.22
Rate for Payer: IEHP Medicare Advantage	$17,820.22
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,027.86
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,453.48
Rate for Payer: Molina Healthcare of CA Medicare	$22,453.48
Rate for Payer: Multiplan WC	$24,792.51

INPATIENT MS-DRG 116: INTRAOCULAR PROCEDURES WITH CC/MCC

Facility IP

$30,788.68

Service Code	MS-DRG 116
Min. Negotiated Rate	$20,820.01
Max. Negotiated Rate	$30,788.68
Rate for Payer: EPIC Health Plan Medicare	$20,820.01
Rate for Payer: Humana Medicare	$20,820.01
Rate for Payer: IEHP Medicare Advantage	$20,820.01
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,567.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,233.21
Rate for Payer: Molina Healthcare of CA Medicare	$26,233.21
Rate for Payer: Multiplan WC	$30,788.68

INPATIENT MS-DRG 117: INTRAOCULAR PROCEDURES WITHOUT CC/MCC

Facility IP

$17,260.61

Service Code	MS-DRG 117
Min. Negotiated Rate	$13,698.90
Max. Negotiated Rate	$17,260.61
Rate for Payer: EPIC Health Plan Medicare	$13,698.90
Rate for Payer: Humana Medicare	$13,698.90
Rate for Payer: IEHP Medicare Advantage	$13,698.90
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,164.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,260.61
Rate for Payer: Molina Healthcare of CA Medicare	$17,260.61
Rate for Payer: Multiplan WC	$16,203.02

INPATIENT MS-DRG 121: ACUTE MAJOR EYE INFECTIONS WITH CC/MCC

Facility IP

$19,997.55

Service Code	MS-DRG 121
Min. Negotiated Rate	$14,631.26
Max. Negotiated Rate	$19,997.55
Rate for Payer: EPIC Health Plan Medicare	$14,631.26
Rate for Payer: Humana Medicare	$14,631.26
Rate for Payer: IEHP Medicare Advantage	$14,631.26
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,264.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,435.39
Rate for Payer: Molina Healthcare of CA Medicare	$18,435.39
Rate for Payer: Multiplan WC	$19,997.55

INPATIENT MS-DRG 122: ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC

Facility IP

$11,274.22

Service Code	MS-DRG 122
Min. Negotiated Rate	$8,587.78
Max. Negotiated Rate	$11,274.22
Rate for Payer: EPIC Health Plan Medicare	$8,587.78
Rate for Payer: Humana Medicare	$8,587.78
Rate for Payer: IEHP Medicare Advantage	$8,587.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,133.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,820.60
Rate for Payer: Molina Healthcare of CA Medicare	$10,820.60
Rate for Payer: Multiplan WC	$11,274.22

INPATIENT MS-DRG 123: NEUROLOGICAL EYE DISORDERS

Facility IP

$12,955.24

Service Code	MS-DRG 123
Min. Negotiated Rate	$9,257.78
Max. Negotiated Rate	$12,955.24
Rate for Payer: EPIC Health Plan Medicare	$9,257.78
Rate for Payer: Humana Medicare	$9,257.78
Rate for Payer: IEHP Medicare Advantage	$9,257.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,924.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,664.80
Rate for Payer: Molina Healthcare of CA Medicare	$11,664.80
Rate for Payer: Multiplan WC	$12,955.24

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