Loma Linda University Medical Center

All Charges

Charge

Type

Price

INPATIENT MS-DRG 191: CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC

Facility IP

$14,104.20

Service Code	MS-DRG 191
Min. Negotiated Rate	$9,764.50
Max. Negotiated Rate	$14,104.20
Rate for Payer: EPIC Health Plan Medicare	$9,764.50
Rate for Payer: Humana Medicare	$9,764.50
Rate for Payer: IEHP Medicare Advantage	$9,764.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,522.11
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,303.27
Rate for Payer: Molina Healthcare of CA Medicare	$12,303.27
Rate for Payer: Multiplan WC	$14,104.20

INPATIENT MS-DRG 192: CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC

Facility IP

$10,642.61

Service Code	MS-DRG 192
Min. Negotiated Rate	$7,431.33
Max. Negotiated Rate	$10,642.61
Rate for Payer: EPIC Health Plan Medicare	$7,431.33
Rate for Payer: Humana Medicare	$7,431.33
Rate for Payer: IEHP Medicare Advantage	$7,431.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,768.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,363.48
Rate for Payer: Molina Healthcare of CA Medicare	$9,363.48
Rate for Payer: Multiplan WC	$10,642.61

INPATIENT MS-DRG 193: SIMPLE PNEUMONIA AND PLEURISY WITH MCC

Facility IP

$21,195.47

Service Code	MS-DRG 193
Min. Negotiated Rate	$15,142.48
Max. Negotiated Rate	$21,195.47
Rate for Payer: EPIC Health Plan Medicare	$15,142.48
Rate for Payer: Humana Medicare	$15,142.48
Rate for Payer: IEHP Medicare Advantage	$15,142.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,868.13
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,079.52
Rate for Payer: Molina Healthcare of CA Medicare	$19,079.52
Rate for Payer: Multiplan WC	$21,195.47

INPATIENT MS-DRG 194: SIMPLE PNEUMONIA AND PLEURISY WITH CC

Facility IP

$13,712.50

Service Code	MS-DRG 194
Min. Negotiated Rate	$9,462.73
Max. Negotiated Rate	$13,712.50
Rate for Payer: EPIC Health Plan Medicare	$9,462.73
Rate for Payer: Humana Medicare	$9,462.73
Rate for Payer: IEHP Medicare Advantage	$9,462.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,166.02
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,923.04
Rate for Payer: Molina Healthcare of CA Medicare	$11,923.04
Rate for Payer: Multiplan WC	$13,712.50

INPATIENT MS-DRG 195: SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC

Facility IP

$10,474.51

Service Code	MS-DRG 195
Min. Negotiated Rate	$7,248.91
Max. Negotiated Rate	$10,474.51
Rate for Payer: EPIC Health Plan Medicare	$7,248.91
Rate for Payer: Humana Medicare	$7,248.91
Rate for Payer: IEHP Medicare Advantage	$7,248.91
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,553.71
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,133.63
Rate for Payer: Molina Healthcare of CA Medicare	$9,133.63
Rate for Payer: Multiplan WC	$10,474.51

INPATIENT MS-DRG 196: INTERSTITIAL LUNG DISEASE WITH MCC

Facility IP

$28,360.18

Service Code	MS-DRG 196
Min. Negotiated Rate	$21,547.44
Max. Negotiated Rate	$28,360.18
Rate for Payer: EPIC Health Plan Medicare	$21,547.44
Rate for Payer: Humana Medicare	$21,547.44
Rate for Payer: IEHP Medicare Advantage	$21,547.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,425.98
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,149.77
Rate for Payer: Molina Healthcare of CA Medicare	$27,149.77
Rate for Payer: Multiplan WC	$28,360.18

INPATIENT MS-DRG 197: INTERSTITIAL LUNG DISEASE WITH CC

Facility IP

$16,052.87

Service Code	MS-DRG 197
Min. Negotiated Rate	$11,436.67
Max. Negotiated Rate	$16,052.87
Rate for Payer: EPIC Health Plan Medicare	$11,436.67
Rate for Payer: Humana Medicare	$11,436.67
Rate for Payer: IEHP Medicare Advantage	$11,436.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,495.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,410.20
Rate for Payer: Molina Healthcare of CA Medicare	$14,410.20
Rate for Payer: Multiplan WC	$16,052.87

INPATIENT MS-DRG 198: INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC

Facility IP

$11,602.26

Service Code	MS-DRG 198
Min. Negotiated Rate	$8,967.26
Max. Negotiated Rate	$11,602.26
Rate for Payer: EPIC Health Plan Medicare	$8,967.26
Rate for Payer: Humana Medicare	$8,967.26
Rate for Payer: IEHP Medicare Advantage	$8,967.26
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,581.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,298.75
Rate for Payer: Molina Healthcare of CA Medicare	$11,298.75
Rate for Payer: Multiplan WC	$11,602.26

INPATIENT MS-DRG 199: PNEUMOTHORAX WITH MCC

Facility IP

$28,701.28

Service Code	MS-DRG 199
Min. Negotiated Rate	$20,181.56
Max. Negotiated Rate	$28,701.28
Rate for Payer: EPIC Health Plan Medicare	$20,181.56
Rate for Payer: Humana Medicare	$20,181.56
Rate for Payer: IEHP Medicare Advantage	$20,181.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,814.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,428.77
Rate for Payer: Molina Healthcare of CA Medicare	$25,428.77
Rate for Payer: Multiplan WC	$28,701.28

INPATIENT MS-DRG 200: PNEUMOTHORAX WITH CC

Facility IP

$17,495.61

Service Code	MS-DRG 200
Min. Negotiated Rate	$12,331.89
Max. Negotiated Rate	$17,495.61
Rate for Payer: EPIC Health Plan Medicare	$12,331.89
Rate for Payer: Humana Medicare	$12,331.89
Rate for Payer: IEHP Medicare Advantage	$12,331.89
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,551.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,538.18
Rate for Payer: Molina Healthcare of CA Medicare	$15,538.18
Rate for Payer: Multiplan WC	$17,495.61

INPATIENT MS-DRG 201: PNEUMOTHORAX WITHOUT CC/MCC

Facility IP

$11,879.72

Service Code	MS-DRG 201
Min. Negotiated Rate	$8,155.37
Max. Negotiated Rate	$11,879.72
Rate for Payer: EPIC Health Plan Medicare	$8,155.37
Rate for Payer: Humana Medicare	$8,155.37
Rate for Payer: IEHP Medicare Advantage	$8,155.37
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,623.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,275.77
Rate for Payer: Molina Healthcare of CA Medicare	$10,275.77
Rate for Payer: Multiplan WC	$11,879.72

INPATIENT MS-DRG 202: BRONCHITIS AND ASTHMA WITH CC/MCC

Facility IP

$15,109.54

Service Code	MS-DRG 202
Min. Negotiated Rate	$10,986.26
Max. Negotiated Rate	$15,109.54
Rate for Payer: EPIC Health Plan Medicare	$10,986.26
Rate for Payer: Humana Medicare	$10,986.26
Rate for Payer: IEHP Medicare Advantage	$10,986.26
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,963.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,842.69
Rate for Payer: Molina Healthcare of CA Medicare	$13,842.69
Rate for Payer: Multiplan WC	$15,109.54

INPATIENT MS-DRG 203: BRONCHITIS AND ASTHMA WITHOUT CC/MCC

Facility IP

$10,887.43

Service Code	MS-DRG 203
Min. Negotiated Rate	$8,029.27
Max. Negotiated Rate	$10,887.43
Rate for Payer: EPIC Health Plan Medicare	$8,029.27
Rate for Payer: Humana Medicare	$8,029.27
Rate for Payer: IEHP Medicare Advantage	$8,029.27
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,474.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,116.88
Rate for Payer: Molina Healthcare of CA Medicare	$10,116.88
Rate for Payer: Multiplan WC	$10,887.43

INPATIENT MS-DRG 204: RESPIRATORY SIGNS AND SYMPTOMS

Facility IP

$13,209.83

Service Code	MS-DRG 204
Min. Negotiated Rate	$9,470.61
Max. Negotiated Rate	$13,209.83
Rate for Payer: EPIC Health Plan Medicare	$9,470.61
Rate for Payer: Humana Medicare	$9,470.61
Rate for Payer: IEHP Medicare Advantage	$9,470.61
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,175.32
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,932.97
Rate for Payer: Molina Healthcare of CA Medicare	$11,932.97
Rate for Payer: Multiplan WC	$13,209.83

INPATIENT MS-DRG 205: OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC

Facility IP

$29,066.86

Service Code	MS-DRG 205
Min. Negotiated Rate	$20,589.18
Max. Negotiated Rate	$29,066.86
Rate for Payer: EPIC Health Plan Medicare	$20,589.18
Rate for Payer: Humana Medicare	$20,589.18
Rate for Payer: IEHP Medicare Advantage	$20,589.18
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,295.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,942.37
Rate for Payer: Molina Healthcare of CA Medicare	$25,942.37
Rate for Payer: Multiplan WC	$29,066.86

INPATIENT MS-DRG 206: OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC

Facility IP

$14,580.76

Service Code	MS-DRG 206
Min. Negotiated Rate	$10,490.81
Max. Negotiated Rate	$14,580.76
Rate for Payer: EPIC Health Plan Medicare	$10,490.81
Rate for Payer: Humana Medicare	$10,490.81
Rate for Payer: IEHP Medicare Advantage	$10,490.81
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,379.16
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,218.42
Rate for Payer: Molina Healthcare of CA Medicare	$13,218.42
Rate for Payer: Multiplan WC	$14,580.76

INPATIENT MS-DRG 207: RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS

Facility IP

$107,158.95

Service Code	MS-DRG 207
Min. Negotiated Rate	$77,991.57
Max. Negotiated Rate	$107,158.95
Rate for Payer: EPIC Health Plan Medicare	$77,991.57
Rate for Payer: Humana Medicare	$77,991.57
Rate for Payer: IEHP Medicare Advantage	$77,991.57
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$92,030.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$98,269.38
Rate for Payer: Molina Healthcare of CA Medicare	$98,269.38
Rate for Payer: Multiplan WC	$107,158.95

INPATIENT MS-DRG 208: RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS

Facility IP

$42,435.01

Service Code	MS-DRG 208
Min. Negotiated Rate	$30,650.38
Max. Negotiated Rate	$42,435.01
Rate for Payer: EPIC Health Plan Medicare	$30,650.38
Rate for Payer: Humana Medicare	$30,650.38
Rate for Payer: IEHP Medicare Advantage	$30,650.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,167.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,619.48
Rate for Payer: Molina Healthcare of CA Medicare	$38,619.48
Rate for Payer: Multiplan WC	$42,435.01

INPATIENT MS-DRG 212: CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES

Facility IP

$153,074.02

Service Code	MS-DRG 212
Min. Negotiated Rate	$121,487.32
Max. Negotiated Rate	$153,074.02
Rate for Payer: EPIC Health Plan Medicare	$121,487.32
Rate for Payer: Humana Medicare	$121,487.32
Rate for Payer: IEHP Medicare Advantage	$121,487.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$143,355.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$153,074.02
Rate for Payer: Molina Healthcare of CA Medicare	$153,074.02

INPATIENT MS-DRG 215: OTHER HEART ASSIST SYSTEM IMPLANT

Facility IP

$168,153.66

Service Code	MS-DRG 215
Min. Negotiated Rate	$115,227.64
Max. Negotiated Rate	$168,153.66
Rate for Payer: EPIC Health Plan Medicare	$115,227.64
Rate for Payer: Humana Medicare	$115,227.64
Rate for Payer: IEHP Medicare Advantage	$115,227.64
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$135,968.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$145,186.83
Rate for Payer: Molina Healthcare of CA Medicare	$145,186.83
Rate for Payer: Multiplan WC	$168,153.66

INPATIENT MS-DRG 216: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC

Facility IP

$158,992.96

Service Code	MS-DRG 216
Min. Negotiated Rate	$28,410.00
Max. Negotiated Rate	$158,992.96
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: Cigna of CA HMO/PPO	$32,400.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$109,490.43
Rate for Payer: Humana Medicare	$109,490.43
Rate for Payer: IEHP Medicare Advantage	$109,490.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$129,198.71
Rate for Payer: Molina Healthcare of CA Medi-Cal	$137,957.94
Rate for Payer: Molina Healthcare of CA Medicare	$137,957.94
Rate for Payer: Multiplan WC	$158,992.96

INPATIENT MS-DRG 217: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC

Facility IP

$103,615.77

Service Code	MS-DRG 217
Min. Negotiated Rate	$28,410.00
Max. Negotiated Rate	$103,615.77
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: Cigna of CA HMO/PPO	$32,400.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$71,880.53
Rate for Payer: Humana Medicare	$71,880.53
Rate for Payer: IEHP Medicare Advantage	$71,880.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$84,819.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$90,569.47
Rate for Payer: Molina Healthcare of CA Medicare	$90,569.47
Rate for Payer: Multiplan WC	$103,615.77

INPATIENT MS-DRG 218: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility IP

$96,922.72

Service Code	MS-DRG 218
Min. Negotiated Rate	$28,410.00
Max. Negotiated Rate	$96,922.72
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: Cigna of CA HMO/PPO	$32,400.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$64,351.80
Rate for Payer: Humana Medicare	$64,351.80
Rate for Payer: IEHP Medicare Advantage	$64,351.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$75,935.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$81,083.27
Rate for Payer: Molina Healthcare of CA Medicare	$81,083.27
Rate for Payer: Multiplan WC	$96,922.72

INPATIENT MS-DRG 219: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility IP

$132,658.15

Service Code	MS-DRG 219
Min. Negotiated Rate	$28,410.00
Max. Negotiated Rate	$132,658.15
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: Cigna of CA HMO/PPO	$32,400.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$87,035.97
Rate for Payer: Humana Medicare	$87,035.97
Rate for Payer: IEHP Medicare Advantage	$87,035.97
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$102,702.44
Rate for Payer: Molina Healthcare of CA Medi-Cal	$109,665.32
Rate for Payer: Molina Healthcare of CA Medicare	$109,665.32
Rate for Payer: Multiplan WC	$132,658.15

INPATIENT MS-DRG 220: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC

Facility IP

$88,703.70

Service Code	MS-DRG 220
Min. Negotiated Rate	$28,410.00
Max. Negotiated Rate	$88,703.70
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: Cigna of CA HMO/PPO	$32,400.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$59,260.95
Rate for Payer: Humana Medicare	$59,260.95
Rate for Payer: IEHP Medicare Advantage	$59,260.95
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$69,927.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$74,668.80
Rate for Payer: Molina Healthcare of CA Medicare	$74,668.80
Rate for Payer: Multiplan WC	$88,703.70

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