Loma Linda University Medical Center

All Charges

Charge

Type

Price

INPATIENT MS-DRG 158: DENTAL AND ORAL DISEASES WITH CC

Facility IP

$15,163.40

Service Code	MS-DRG 158
Min. Negotiated Rate	$10,772.33
Max. Negotiated Rate	$15,163.40
Rate for Payer: EPIC Health Plan Medicare	$10,772.33
Rate for Payer: Humana Medicare	$10,772.33
Rate for Payer: IEHP Medicare Advantage	$10,772.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,711.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,573.14
Rate for Payer: Molina Healthcare of CA Medicare	$13,573.14
Rate for Payer: Multiplan WC	$15,163.40

INPATIENT MS-DRG 159: DENTAL AND ORAL DISEASES WITHOUT CC/MCC

Facility IP

$12,238.76

Service Code	MS-DRG 159
Min. Negotiated Rate	$7,807.43
Max. Negotiated Rate	$12,238.76
Rate for Payer: EPIC Health Plan Medicare	$7,807.43
Rate for Payer: Humana Medicare	$7,807.43
Rate for Payer: IEHP Medicare Advantage	$7,807.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,212.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,837.36
Rate for Payer: Molina Healthcare of CA Medicare	$9,837.36
Rate for Payer: Multiplan WC	$12,238.76

INPATIENT MS-DRG 163: MAJOR CHEST PROCEDURES WITH MCC

Facility IP

$79,051.74

Service Code	MS-DRG 163
Min. Negotiated Rate	$53,281.63
Max. Negotiated Rate	$79,051.74
Rate for Payer: EPIC Health Plan Medicare	$53,281.63
Rate for Payer: Humana Medicare	$53,281.63
Rate for Payer: IEHP Medicare Advantage	$53,281.63
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$62,872.32
Rate for Payer: Molina Healthcare of CA Medi-Cal	$67,134.85
Rate for Payer: Molina Healthcare of CA Medicare	$67,134.85
Rate for Payer: Multiplan WC	$79,051.74

INPATIENT MS-DRG 164: MAJOR CHEST PROCEDURES WITH CC

Facility IP

$42,151.02

Service Code	MS-DRG 164
Min. Negotiated Rate	$28,923.04
Max. Negotiated Rate	$42,151.02
Rate for Payer: EPIC Health Plan Medicare	$28,923.04
Rate for Payer: Humana Medicare	$28,923.04
Rate for Payer: IEHP Medicare Advantage	$28,923.04
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,129.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$36,443.03
Rate for Payer: Molina Healthcare of CA Medicare	$36,443.03
Rate for Payer: Multiplan WC	$42,151.02

INPATIENT MS-DRG 165: MAJOR CHEST PROCEDURES WITHOUT CC/MCC

Facility IP

$31,448.02

Service Code	MS-DRG 165
Min. Negotiated Rate	$21,333.49
Max. Negotiated Rate	$31,448.02
Rate for Payer: EPIC Health Plan Medicare	$21,333.49
Rate for Payer: Humana Medicare	$21,333.49
Rate for Payer: IEHP Medicare Advantage	$21,333.49
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,173.52
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,880.20
Rate for Payer: Molina Healthcare of CA Medicare	$26,880.20
Rate for Payer: Multiplan WC	$31,448.02

INPATIENT MS-DRG 166: OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC

Facility IP

$59,827.79

Service Code	MS-DRG 166
Min. Negotiated Rate	$45,897.02
Max. Negotiated Rate	$59,827.79
Rate for Payer: EPIC Health Plan Medicare	$45,897.02
Rate for Payer: Humana Medicare	$45,897.02
Rate for Payer: IEHP Medicare Advantage	$45,897.02
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$54,158.48
Rate for Payer: Molina Healthcare of CA Medi-Cal	$57,830.25
Rate for Payer: Molina Healthcare of CA Medicare	$57,830.25
Rate for Payer: Multiplan WC	$59,827.79

INPATIENT MS-DRG 167: OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC

Facility IP

$31,026.96

Service Code	MS-DRG 167
Min. Negotiated Rate	$20,696.14
Max. Negotiated Rate	$31,026.96
Rate for Payer: EPIC Health Plan Medicare	$20,696.14
Rate for Payer: Humana Medicare	$20,696.14
Rate for Payer: IEHP Medicare Advantage	$20,696.14
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,421.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,077.14
Rate for Payer: Molina Healthcare of CA Medicare	$26,077.14
Rate for Payer: Multiplan WC	$31,026.96

INPATIENT MS-DRG 168: OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility IP

$23,135.98

Service Code	MS-DRG 168
Min. Negotiated Rate	$15,470.17
Max. Negotiated Rate	$23,135.98
Rate for Payer: EPIC Health Plan Medicare	$15,470.17
Rate for Payer: Humana Medicare	$15,470.17
Rate for Payer: IEHP Medicare Advantage	$15,470.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,254.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,492.41
Rate for Payer: Molina Healthcare of CA Medicare	$19,492.41
Rate for Payer: Multiplan WC	$23,135.98

INPATIENT MS-DRG 173: ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM

Facility IP

$43,886.15

Service Code	MS-DRG 173
Min. Negotiated Rate	$34,830.28
Max. Negotiated Rate	$43,886.15
Rate for Payer: EPIC Health Plan Medicare	$34,830.28
Rate for Payer: Humana Medicare	$34,830.28
Rate for Payer: IEHP Medicare Advantage	$34,830.28
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$41,099.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,886.15
Rate for Payer: Molina Healthcare of CA Medicare	$43,886.15

INPATIENT MS-DRG 175: PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE

Facility IP

$22,796.52

Service Code	MS-DRG 175
Min. Negotiated Rate	$16,002.79
Max. Negotiated Rate	$22,796.52
Rate for Payer: EPIC Health Plan Medicare	$16,002.79
Rate for Payer: Humana Medicare	$16,002.79
Rate for Payer: IEHP Medicare Advantage	$16,002.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,883.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,163.52
Rate for Payer: Molina Healthcare of CA Medicare	$20,163.52
Rate for Payer: Multiplan WC	$22,796.52

INPATIENT MS-DRG 176: PULMONARY EMBOLISM WITHOUT MCC

Facility IP

$13,343.66

Service Code	MS-DRG 176
Min. Negotiated Rate	$9,388.39
Max. Negotiated Rate	$13,343.66
Rate for Payer: EPIC Health Plan Medicare	$9,388.39
Rate for Payer: Humana Medicare	$9,388.39
Rate for Payer: IEHP Medicare Advantage	$9,388.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,078.30
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,829.37
Rate for Payer: Molina Healthcare of CA Medicare	$11,829.37
Rate for Payer: Multiplan WC	$13,343.66

INPATIENT MS-DRG 177: RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC

Facility IP

$29,048.91

Service Code	MS-DRG 177
Min. Negotiated Rate	$19,306.61
Max. Negotiated Rate	$29,048.91
Rate for Payer: EPIC Health Plan Medicare	$19,306.61
Rate for Payer: Humana Medicare	$19,306.61
Rate for Payer: IEHP Medicare Advantage	$19,306.61
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,781.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,326.33
Rate for Payer: Molina Healthcare of CA Medicare	$24,326.33
Rate for Payer: Multiplan WC	$29,048.91

INPATIENT MS-DRG 178: RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC

Facility IP

$17,740.41

Service Code	MS-DRG 178
Min. Negotiated Rate	$11,315.06
Max. Negotiated Rate	$17,740.41
Rate for Payer: EPIC Health Plan Medicare	$11,315.06
Rate for Payer: Humana Medicare	$11,315.06
Rate for Payer: IEHP Medicare Advantage	$11,315.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,351.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,256.98
Rate for Payer: Molina Healthcare of CA Medicare	$14,256.98
Rate for Payer: Multiplan WC	$17,740.41

INPATIENT MS-DRG 179: RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC

Facility IP

$12,818.15

Service Code	MS-DRG 179
Min. Negotiated Rate	$8,799.49
Max. Negotiated Rate	$12,818.15
Rate for Payer: EPIC Health Plan Medicare	$8,799.49
Rate for Payer: Humana Medicare	$8,799.49
Rate for Payer: IEHP Medicare Advantage	$8,799.49
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,383.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,087.36
Rate for Payer: Molina Healthcare of CA Medicare	$11,087.36
Rate for Payer: Multiplan WC	$12,818.15

INPATIENT MS-DRG 180: RESPIRATORY NEOPLASMS WITH MCC

Facility IP

$27,645.34

Service Code	MS-DRG 180
Min. Negotiated Rate	$19,777.29
Max. Negotiated Rate	$27,645.34
Rate for Payer: EPIC Health Plan Medicare	$19,777.29
Rate for Payer: Humana Medicare	$19,777.29
Rate for Payer: IEHP Medicare Advantage	$19,777.29
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,337.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,919.39
Rate for Payer: Molina Healthcare of CA Medicare	$24,919.39
Rate for Payer: Multiplan WC	$27,645.34

INPATIENT MS-DRG 181: RESPIRATORY NEOPLASMS WITH CC

Facility IP

$18,502.59

Service Code	MS-DRG 181
Min. Negotiated Rate	$12,603.27
Max. Negotiated Rate	$18,502.59
Rate for Payer: EPIC Health Plan Medicare	$12,603.27
Rate for Payer: Humana Medicare	$12,603.27
Rate for Payer: IEHP Medicare Advantage	$12,603.27
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,871.86
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,880.12
Rate for Payer: Molina Healthcare of CA Medicare	$15,880.12
Rate for Payer: Multiplan WC	$18,502.59

INPATIENT MS-DRG 182: RESPIRATORY NEOPLASMS WITHOUT CC/MCC

Facility IP

$14,484.47

Service Code	MS-DRG 182
Min. Negotiated Rate	$9,199.23
Max. Negotiated Rate	$14,484.47
Rate for Payer: EPIC Health Plan Medicare	$9,199.23
Rate for Payer: Humana Medicare	$9,199.23
Rate for Payer: IEHP Medicare Advantage	$9,199.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,855.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,591.03
Rate for Payer: Molina Healthcare of CA Medicare	$11,591.03
Rate for Payer: Multiplan WC	$14,484.47

INPATIENT MS-DRG 183: MAJOR CHEST TRAUMA WITH MCC

Facility IP

$24,516.70

Service Code	MS-DRG 183
Min. Negotiated Rate	$17,933.97
Max. Negotiated Rate	$24,516.70
Rate for Payer: EPIC Health Plan Medicare	$17,933.97
Rate for Payer: Humana Medicare	$17,933.97
Rate for Payer: IEHP Medicare Advantage	$17,933.97
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,162.08
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,596.80
Rate for Payer: Molina Healthcare of CA Medicare	$22,596.80
Rate for Payer: Multiplan WC	$24,516.70

INPATIENT MS-DRG 184: MAJOR CHEST TRAUMA WITH CC

Facility IP

$17,058.21

Service Code	MS-DRG 184
Min. Negotiated Rate	$12,049.25
Max. Negotiated Rate	$17,058.21
Rate for Payer: EPIC Health Plan Medicare	$12,049.25
Rate for Payer: Humana Medicare	$12,049.25
Rate for Payer: IEHP Medicare Advantage	$12,049.25
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,218.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,182.06
Rate for Payer: Molina Healthcare of CA Medicare	$15,182.06
Rate for Payer: Multiplan WC	$17,058.21

INPATIENT MS-DRG 185: MAJOR CHEST TRAUMA WITHOUT CC/MCC

Facility IP

$12,322.00

Service Code	MS-DRG 185
Min. Negotiated Rate	$8,713.90
Max. Negotiated Rate	$12,322.00
Rate for Payer: EPIC Health Plan Medicare	$8,713.90
Rate for Payer: Humana Medicare	$8,713.90
Rate for Payer: IEHP Medicare Advantage	$8,713.90
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,282.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,979.51
Rate for Payer: Molina Healthcare of CA Medicare	$10,979.51
Rate for Payer: Multiplan WC	$12,322.00

INPATIENT MS-DRG 186: PLEURAL EFFUSION WITH MCC

Facility IP

$24,918.19

Service Code	MS-DRG 186
Min. Negotiated Rate	$17,681.72
Max. Negotiated Rate	$24,918.19
Rate for Payer: EPIC Health Plan Medicare	$17,681.72
Rate for Payer: Humana Medicare	$17,681.72
Rate for Payer: IEHP Medicare Advantage	$17,681.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,864.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,278.97
Rate for Payer: Molina Healthcare of CA Medicare	$22,278.97
Rate for Payer: Multiplan WC	$24,918.19

INPATIENT MS-DRG 187: PLEURAL EFFUSION WITH CC

Facility IP

$17,069.64

Service Code	MS-DRG 187
Min. Negotiated Rate	$11,423.17
Max. Negotiated Rate	$17,069.64
Rate for Payer: EPIC Health Plan Medicare	$11,423.17
Rate for Payer: Humana Medicare	$11,423.17
Rate for Payer: IEHP Medicare Advantage	$11,423.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,479.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,393.19
Rate for Payer: Molina Healthcare of CA Medicare	$14,393.19
Rate for Payer: Multiplan WC	$17,069.64

INPATIENT MS-DRG 188: PLEURAL EFFUSION WITHOUT CC/MCC

Facility IP

$11,816.07

Service Code	MS-DRG 188
Min. Negotiated Rate	$8,610.30
Max. Negotiated Rate	$11,816.07
Rate for Payer: EPIC Health Plan Medicare	$8,610.30
Rate for Payer: Humana Medicare	$8,610.30
Rate for Payer: IEHP Medicare Advantage	$8,610.30
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,160.15
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,848.98
Rate for Payer: Molina Healthcare of CA Medicare	$10,848.98
Rate for Payer: Multiplan WC	$11,816.07

INPATIENT MS-DRG 189: PULMONARY EDEMA AND RESPIRATORY FAILURE

Facility IP

$19,698.88

Service Code	MS-DRG 189
Min. Negotiated Rate	$14,077.27
Max. Negotiated Rate	$19,698.88
Rate for Payer: EPIC Health Plan Medicare	$14,077.27
Rate for Payer: Humana Medicare	$14,077.27
Rate for Payer: IEHP Medicare Advantage	$14,077.27
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,611.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,737.36
Rate for Payer: Molina Healthcare of CA Medicare	$17,737.36
Rate for Payer: Multiplan WC	$19,698.88

INPATIENT MS-DRG 190: CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC

Facility IP

$17,715.93

Service Code	MS-DRG 190
Min. Negotiated Rate	$12,613.40
Max. Negotiated Rate	$17,715.93
Rate for Payer: EPIC Health Plan Medicare	$12,613.40
Rate for Payer: Humana Medicare	$12,613.40
Rate for Payer: IEHP Medicare Advantage	$12,613.40
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,883.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,892.88
Rate for Payer: Molina Healthcare of CA Medicare	$15,892.88
Rate for Payer: Multiplan WC	$17,715.93

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