Loma Linda University Medical Center

All Charges

Charge

Type

Price

INPATIENT MS-DRG 407: PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC

Facility IP

$36,324.60

Service Code	MS-DRG 407
Min. Negotiated Rate	$24,425.62
Max. Negotiated Rate	$36,324.60
Rate for Payer: EPIC Health Plan Medicare	$24,425.62
Rate for Payer: Humana Medicare	$24,425.62
Rate for Payer: IEHP Medicare Advantage	$24,425.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,822.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,776.28
Rate for Payer: Molina Healthcare of CA Medicare	$30,776.28
Rate for Payer: Multiplan WC	$36,324.60

INPATIENT MS-DRG 408: BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC

Facility IP

$59,888.18

Service Code	MS-DRG 408
Min. Negotiated Rate	$42,118.02
Max. Negotiated Rate	$59,888.18
Rate for Payer: EPIC Health Plan Medicare	$42,118.02
Rate for Payer: Humana Medicare	$42,118.02
Rate for Payer: IEHP Medicare Advantage	$42,118.02
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$49,699.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$53,068.71
Rate for Payer: Molina Healthcare of CA Medicare	$53,068.71
Rate for Payer: Multiplan WC	$59,888.18

INPATIENT MS-DRG 409: BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC

Facility IP

$34,785.57

Service Code	MS-DRG 409
Min. Negotiated Rate	$22,244.47
Max. Negotiated Rate	$34,785.57
Rate for Payer: EPIC Health Plan Medicare	$22,244.47
Rate for Payer: Humana Medicare	$22,244.47
Rate for Payer: IEHP Medicare Advantage	$22,244.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,248.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,028.03
Rate for Payer: Molina Healthcare of CA Medicare	$28,028.03
Rate for Payer: Multiplan WC	$34,785.57

INPATIENT MS-DRG 410: BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC

Facility IP

$27,707.36

Service Code	MS-DRG 410
Min. Negotiated Rate	$17,829.25
Max. Negotiated Rate	$27,707.36
Rate for Payer: EPIC Health Plan Medicare	$17,829.25
Rate for Payer: Humana Medicare	$17,829.25
Rate for Payer: IEHP Medicare Advantage	$17,829.25
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,038.52
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,464.86
Rate for Payer: Molina Healthcare of CA Medicare	$22,464.86
Rate for Payer: Multiplan WC	$27,707.36

INPATIENT MS-DRG 411: CHOLECYSTECTOMY WITH C.D.E. WITH MCC

Facility IP

$55,134.01

Service Code	MS-DRG 411
Min. Negotiated Rate	$34,440.65
Max. Negotiated Rate	$55,134.01
Rate for Payer: EPIC Health Plan Medicare	$34,440.65
Rate for Payer: Humana Medicare	$34,440.65
Rate for Payer: IEHP Medicare Advantage	$34,440.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,639.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,395.22
Rate for Payer: Molina Healthcare of CA Medicare	$43,395.22
Rate for Payer: Multiplan WC	$55,134.01

INPATIENT MS-DRG 412: CHOLECYSTECTOMY WITH C.D.E. WITH CC

Facility IP

$37,467.04

Service Code	MS-DRG 412
Min. Negotiated Rate	$23,469.59
Max. Negotiated Rate	$37,467.04
Rate for Payer: EPIC Health Plan Medicare	$23,469.59
Rate for Payer: Humana Medicare	$23,469.59
Rate for Payer: IEHP Medicare Advantage	$23,469.59
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,694.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,571.68
Rate for Payer: Molina Healthcare of CA Medicare	$29,571.68
Rate for Payer: Multiplan WC	$37,467.04

INPATIENT MS-DRG 413: CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC

Facility IP

$26,445.78

Service Code	MS-DRG 413
Min. Negotiated Rate	$17,203.16
Max. Negotiated Rate	$26,445.78
Rate for Payer: EPIC Health Plan Medicare	$17,203.16
Rate for Payer: Humana Medicare	$17,203.16
Rate for Payer: IEHP Medicare Advantage	$17,203.16
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,299.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,675.98
Rate for Payer: Molina Healthcare of CA Medicare	$21,675.98
Rate for Payer: Multiplan WC	$26,445.78

INPATIENT MS-DRG 414: CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC

Facility IP

$57,688.17

Service Code	MS-DRG 414
Min. Negotiated Rate	$39,899.72
Max. Negotiated Rate	$57,688.17
Rate for Payer: EPIC Health Plan Medicare	$39,899.72
Rate for Payer: Humana Medicare	$39,899.72
Rate for Payer: IEHP Medicare Advantage	$39,899.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$47,081.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$50,273.65
Rate for Payer: Molina Healthcare of CA Medicare	$50,273.65
Rate for Payer: Multiplan WC	$57,688.17

INPATIENT MS-DRG 415: CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC

Facility IP

$32,641.06

Service Code	MS-DRG 415
Min. Negotiated Rate	$22,452.78
Max. Negotiated Rate	$32,641.06
Rate for Payer: EPIC Health Plan Medicare	$22,452.78
Rate for Payer: Humana Medicare	$22,452.78
Rate for Payer: IEHP Medicare Advantage	$22,452.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,494.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,290.50
Rate for Payer: Molina Healthcare of CA Medicare	$28,290.50
Rate for Payer: Multiplan WC	$32,641.06

INPATIENT MS-DRG 416: CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC

Facility IP

$22,463.58

Service Code	MS-DRG 416
Min. Negotiated Rate	$15,284.38
Max. Negotiated Rate	$22,463.58
Rate for Payer: EPIC Health Plan Medicare	$15,284.38
Rate for Payer: Humana Medicare	$15,284.38
Rate for Payer: IEHP Medicare Advantage	$15,284.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,035.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,258.32
Rate for Payer: Molina Healthcare of CA Medicare	$19,258.32
Rate for Payer: Multiplan WC	$22,463.58

INPATIENT MS-DRG 417: LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC

Facility IP

$38,805.31

Service Code	MS-DRG 417
Min. Negotiated Rate	$14,580.00
Max. Negotiated Rate	$38,805.31
Rate for Payer: Cigna of CA HMO/PPO	$14,580.00
Rate for Payer: EPIC Health Plan Medicare	$26,303.85
Rate for Payer: Humana Medicare	$26,303.85
Rate for Payer: IEHP Medicare Advantage	$26,303.85
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,038.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$33,142.85
Rate for Payer: Molina Healthcare of CA Medicare	$33,142.85
Rate for Payer: Multiplan WC	$38,805.31

INPATIENT MS-DRG 418: LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC

Facility IP

$27,108.40

Service Code	MS-DRG 418
Min. Negotiated Rate	$14,580.00
Max. Negotiated Rate	$27,108.40
Rate for Payer: Cigna of CA HMO/PPO	$14,580.00
Rate for Payer: EPIC Health Plan Medicare	$18,611.84
Rate for Payer: Humana Medicare	$18,611.84
Rate for Payer: IEHP Medicare Advantage	$18,611.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,961.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,450.92
Rate for Payer: Molina Healthcare of CA Medicare	$23,450.92
Rate for Payer: Multiplan WC	$27,108.40

INPATIENT MS-DRG 419: LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC

Facility IP

$21,298.29

Service Code	MS-DRG 419
Min. Negotiated Rate	$14,580.00
Max. Negotiated Rate	$21,298.29
Rate for Payer: Cigna of CA HMO/PPO	$14,580.00
Rate for Payer: EPIC Health Plan Medicare	$14,991.59
Rate for Payer: Humana Medicare	$14,991.59
Rate for Payer: IEHP Medicare Advantage	$14,991.59
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,690.08
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,889.40
Rate for Payer: Molina Healthcare of CA Medicare	$18,889.40
Rate for Payer: Multiplan WC	$21,298.29

INPATIENT MS-DRG 420: HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC

Facility IP

$53,224.51

Service Code	MS-DRG 420
Min. Negotiated Rate	$36,246.83
Max. Negotiated Rate	$53,224.51
Rate for Payer: EPIC Health Plan Medicare	$36,246.83
Rate for Payer: Humana Medicare	$36,246.83
Rate for Payer: IEHP Medicare Advantage	$36,246.83
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,771.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$45,671.01
Rate for Payer: Molina Healthcare of CA Medicare	$45,671.01
Rate for Payer: Multiplan WC	$53,224.51

INPATIENT MS-DRG 421: HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC

Facility IP

$29,566.27

Service Code	MS-DRG 421
Min. Negotiated Rate	$19,455.25
Max. Negotiated Rate	$29,566.27
Rate for Payer: EPIC Health Plan Medicare	$19,455.25
Rate for Payer: Humana Medicare	$19,455.25
Rate for Payer: IEHP Medicare Advantage	$19,455.25
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,957.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,513.62
Rate for Payer: Molina Healthcare of CA Medicare	$24,513.62
Rate for Payer: Multiplan WC	$29,566.27

INPATIENT MS-DRG 422: HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC

Facility IP

$22,613.73

Service Code	MS-DRG 422
Min. Negotiated Rate	$16,092.88
Max. Negotiated Rate	$22,613.73
Rate for Payer: EPIC Health Plan Medicare	$16,092.88
Rate for Payer: Humana Medicare	$16,092.88
Rate for Payer: IEHP Medicare Advantage	$16,092.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,989.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,277.03
Rate for Payer: Molina Healthcare of CA Medicare	$20,277.03
Rate for Payer: Multiplan WC	$22,613.73

INPATIENT MS-DRG 423: OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC

Facility IP

$64,170.68

Service Code	MS-DRG 423
Min. Negotiated Rate	$44,242.87
Max. Negotiated Rate	$64,170.68
Rate for Payer: EPIC Health Plan Medicare	$44,242.87
Rate for Payer: Humana Medicare	$44,242.87
Rate for Payer: IEHP Medicare Advantage	$44,242.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$52,206.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$55,746.02
Rate for Payer: Molina Healthcare of CA Medicare	$55,746.02
Rate for Payer: Multiplan WC	$64,170.68

INPATIENT MS-DRG 424: OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC

Facility IP

$38,656.81

Service Code	MS-DRG 424
Min. Negotiated Rate	$24,208.28
Max. Negotiated Rate	$38,656.81
Rate for Payer: EPIC Health Plan Medicare	$24,208.28
Rate for Payer: Humana Medicare	$24,208.28
Rate for Payer: IEHP Medicare Advantage	$24,208.28
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,565.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,502.43
Rate for Payer: Molina Healthcare of CA Medicare	$30,502.43
Rate for Payer: Multiplan WC	$38,656.81

INPATIENT MS-DRG 425: OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC

Facility IP

$23,348.15

Service Code	MS-DRG 425
Min. Negotiated Rate	$18,242.50
Max. Negotiated Rate	$23,348.15
Rate for Payer: EPIC Health Plan Medicare	$18,242.50
Rate for Payer: Humana Medicare	$18,242.50
Rate for Payer: IEHP Medicare Advantage	$18,242.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,526.15
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,985.55
Rate for Payer: Molina Healthcare of CA Medicare	$22,985.55
Rate for Payer: Multiplan WC	$23,348.15

INPATIENT MS-DRG 432: CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC

Facility IP

$30,816.42

Service Code	MS-DRG 432
Min. Negotiated Rate	$21,779.40
Max. Negotiated Rate	$30,816.42
Rate for Payer: EPIC Health Plan Medicare	$21,779.40
Rate for Payer: Humana Medicare	$21,779.40
Rate for Payer: IEHP Medicare Advantage	$21,779.40
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,699.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,442.04
Rate for Payer: Molina Healthcare of CA Medicare	$27,442.04
Rate for Payer: Multiplan WC	$30,816.42

INPATIENT MS-DRG 433: CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC

Facility IP

$16,970.08

Service Code	MS-DRG 433
Min. Negotiated Rate	$11,813.90
Max. Negotiated Rate	$16,970.08
Rate for Payer: EPIC Health Plan Medicare	$11,813.90
Rate for Payer: Humana Medicare	$11,813.90
Rate for Payer: IEHP Medicare Advantage	$11,813.90
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,940.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,885.51
Rate for Payer: Molina Healthcare of CA Medicare	$14,885.51
Rate for Payer: Multiplan WC	$16,970.08

INPATIENT MS-DRG 434: CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC

Facility IP

$10,244.39

Service Code	MS-DRG 434
Min. Negotiated Rate	$7,743.24
Max. Negotiated Rate	$10,244.39
Rate for Payer: EPIC Health Plan Medicare	$7,743.24
Rate for Payer: Humana Medicare	$7,743.24
Rate for Payer: IEHP Medicare Advantage	$7,743.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,137.02
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,756.48
Rate for Payer: Molina Healthcare of CA Medicare	$9,756.48
Rate for Payer: Multiplan WC	$10,244.39

INPATIENT MS-DRG 435: MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC

Facility IP

$28,531.54

Service Code	MS-DRG 435
Min. Negotiated Rate	$20,021.64
Max. Negotiated Rate	$28,531.54
Rate for Payer: EPIC Health Plan Medicare	$20,021.64
Rate for Payer: Humana Medicare	$20,021.64
Rate for Payer: IEHP Medicare Advantage	$20,021.64
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,625.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,227.27
Rate for Payer: Molina Healthcare of CA Medicare	$25,227.27
Rate for Payer: Multiplan WC	$28,531.54

INPATIENT MS-DRG 436: MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC

Facility IP

$17,959.11

Service Code	MS-DRG 436
Min. Negotiated Rate	$12,598.75
Max. Negotiated Rate	$17,959.11
Rate for Payer: EPIC Health Plan Medicare	$12,598.75
Rate for Payer: Humana Medicare	$12,598.75
Rate for Payer: IEHP Medicare Advantage	$12,598.75
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,866.52
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,874.42
Rate for Payer: Molina Healthcare of CA Medicare	$15,874.42
Rate for Payer: Multiplan WC	$17,959.11

INPATIENT MS-DRG 437: MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC

Facility IP

$13,805.53

Service Code	MS-DRG 437
Min. Negotiated Rate	$9,562.93
Max. Negotiated Rate	$13,805.53
Rate for Payer: EPIC Health Plan Medicare	$9,562.93
Rate for Payer: Humana Medicare	$9,562.93
Rate for Payer: IEHP Medicare Advantage	$9,562.93
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,284.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,049.29
Rate for Payer: Molina Healthcare of CA Medicare	$12,049.29
Rate for Payer: Multiplan WC	$13,805.53

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