Loma Linda University Medical Center

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Type

Price

INPATIENT MS-DRG 522: HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC

Facility IP

$35,462.88

Service Code	MS-DRG 522
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$35,462.88
Rate for Payer: EPIC Health Plan Medicare	$23,988.69
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$23,988.69
Rate for Payer: IEHP Medicare Advantage	$23,988.69
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,306.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,225.75
Rate for Payer: Molina Healthcare of CA Medicare	$30,225.75
Rate for Payer: Multiplan WC	$35,462.88

INPATIENT MS-DRG 533: FRACTURES OF FEMUR WITH MCC

Facility IP

$23,404.10

Service Code	MS-DRG 533
Min. Negotiated Rate	$18,574.68
Max. Negotiated Rate	$23,404.10
Rate for Payer: EPIC Health Plan Medicare	$18,574.68
Rate for Payer: Humana Medicare	$18,574.68
Rate for Payer: IEHP Medicare Advantage	$18,574.68
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,918.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,404.10
Rate for Payer: Molina Healthcare of CA Medicare	$23,404.10
Rate for Payer: Multiplan WC	$23,277.97

INPATIENT MS-DRG 534: FRACTURES OF FEMUR WITHOUT MCC

Facility IP

$12,989.51

Service Code	MS-DRG 534
Min. Negotiated Rate	$9,325.35
Max. Negotiated Rate	$12,989.51
Rate for Payer: EPIC Health Plan Medicare	$9,325.35
Rate for Payer: Humana Medicare	$9,325.35
Rate for Payer: IEHP Medicare Advantage	$9,325.35
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,003.91
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,749.94
Rate for Payer: Molina Healthcare of CA Medicare	$11,749.94
Rate for Payer: Multiplan WC	$12,989.51

INPATIENT MS-DRG 535: FRACTURES OF HIP AND PELVIS WITH MCC

Facility IP

$21,045.32

Service Code	MS-DRG 535
Min. Negotiated Rate	$14,805.81
Max. Negotiated Rate	$21,045.32
Rate for Payer: EPIC Health Plan Medicare	$14,805.81
Rate for Payer: Humana Medicare	$14,805.81
Rate for Payer: IEHP Medicare Advantage	$14,805.81
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,470.86
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,655.32
Rate for Payer: Molina Healthcare of CA Medicare	$18,655.32
Rate for Payer: Multiplan WC	$21,045.32

INPATIENT MS-DRG 536: FRACTURES OF HIP AND PELVIS WITHOUT MCC

Facility IP

$12,682.68

Service Code	MS-DRG 536
Min. Negotiated Rate	$9,067.48
Max. Negotiated Rate	$12,682.68
Rate for Payer: EPIC Health Plan Medicare	$9,067.48
Rate for Payer: Humana Medicare	$9,067.48
Rate for Payer: IEHP Medicare Advantage	$9,067.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,699.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,425.02
Rate for Payer: Molina Healthcare of CA Medicare	$11,425.02
Rate for Payer: Multiplan WC	$12,682.68

INPATIENT MS-DRG 537: SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC

Facility IP

$16,212.82

Service Code	MS-DRG 537
Min. Negotiated Rate	$11,093.24
Max. Negotiated Rate	$16,212.82
Rate for Payer: EPIC Health Plan Medicare	$11,093.24
Rate for Payer: Humana Medicare	$11,093.24
Rate for Payer: IEHP Medicare Advantage	$11,093.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,090.02
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,977.48
Rate for Payer: Molina Healthcare of CA Medicare	$13,977.48
Rate for Payer: Multiplan WC	$16,212.82

INPATIENT MS-DRG 538: SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC

Facility IP

$11,362.36

Service Code	MS-DRG 538
Min. Negotiated Rate	$8,189.16
Max. Negotiated Rate	$11,362.36
Rate for Payer: EPIC Health Plan Medicare	$8,189.16
Rate for Payer: Humana Medicare	$8,189.16
Rate for Payer: IEHP Medicare Advantage	$8,189.16
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,663.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,318.34
Rate for Payer: Molina Healthcare of CA Medicare	$10,318.34
Rate for Payer: Multiplan WC	$11,362.36

INPATIENT MS-DRG 539: OSTEOMYELITIS WITH MCC

Facility IP

$32,574.14

Service Code	MS-DRG 539
Min. Negotiated Rate	$22,549.62
Max. Negotiated Rate	$32,574.14
Rate for Payer: EPIC Health Plan Medicare	$22,549.62
Rate for Payer: Humana Medicare	$22,549.62
Rate for Payer: IEHP Medicare Advantage	$22,549.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,608.55
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,412.52
Rate for Payer: Molina Healthcare of CA Medicare	$28,412.52
Rate for Payer: Multiplan WC	$32,574.14

INPATIENT MS-DRG 540: OSTEOMYELITIS WITH CC

Facility IP

$21,977.23

Service Code	MS-DRG 540
Min. Negotiated Rate	$14,822.69
Max. Negotiated Rate	$21,977.23
Rate for Payer: EPIC Health Plan Medicare	$14,822.69
Rate for Payer: Humana Medicare	$14,822.69
Rate for Payer: IEHP Medicare Advantage	$14,822.69
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,490.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,676.59
Rate for Payer: Molina Healthcare of CA Medicare	$18,676.59
Rate for Payer: Multiplan WC	$21,977.23

INPATIENT MS-DRG 541: OSTEOMYELITIS WITHOUT CC/MCC

Facility IP

$13,350.19

Service Code	MS-DRG 541
Min. Negotiated Rate	$9,864.72
Max. Negotiated Rate	$13,350.19
Rate for Payer: EPIC Health Plan Medicare	$9,864.72
Rate for Payer: Humana Medicare	$9,864.72
Rate for Payer: IEHP Medicare Advantage	$9,864.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,640.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,429.55
Rate for Payer: Molina Healthcare of CA Medicare	$12,429.55
Rate for Payer: Multiplan WC	$13,350.19

INPATIENT MS-DRG 542: PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC

Facility IP

$29,833.92

Service Code	MS-DRG 542
Min. Negotiated Rate	$20,740.07
Max. Negotiated Rate	$29,833.92
Rate for Payer: EPIC Health Plan Medicare	$20,740.07
Rate for Payer: Humana Medicare	$20,740.07
Rate for Payer: IEHP Medicare Advantage	$20,740.07
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,473.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,132.49
Rate for Payer: Molina Healthcare of CA Medicare	$26,132.49
Rate for Payer: Multiplan WC	$29,833.92

INPATIENT MS-DRG 543: PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC

Facility IP

$17,773.05

Service Code	MS-DRG 543
Min. Negotiated Rate	$12,486.15
Max. Negotiated Rate	$17,773.05
Rate for Payer: EPIC Health Plan Medicare	$12,486.15
Rate for Payer: Humana Medicare	$12,486.15
Rate for Payer: IEHP Medicare Advantage	$12,486.15
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,733.66
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,732.55
Rate for Payer: Molina Healthcare of CA Medicare	$15,732.55
Rate for Payer: Multiplan WC	$17,773.05

INPATIENT MS-DRG 544: PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC

Facility IP

$12,699.01

Service Code	MS-DRG 544
Min. Negotiated Rate	$8,846.77
Max. Negotiated Rate	$12,699.01
Rate for Payer: EPIC Health Plan Medicare	$8,846.77
Rate for Payer: Humana Medicare	$8,846.77
Rate for Payer: IEHP Medicare Advantage	$8,846.77
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,439.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,146.93
Rate for Payer: Molina Healthcare of CA Medicare	$11,146.93
Rate for Payer: Multiplan WC	$12,699.01

INPATIENT MS-DRG 545: CONNECTIVE TISSUE DISORDERS WITH MCC

Facility IP

$40,941.68

Service Code	MS-DRG 545
Min. Negotiated Rate	$28,278.94
Max. Negotiated Rate	$40,941.68
Rate for Payer: EPIC Health Plan Medicare	$28,278.94
Rate for Payer: Humana Medicare	$28,278.94
Rate for Payer: IEHP Medicare Advantage	$28,278.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,369.15
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,631.46
Rate for Payer: Molina Healthcare of CA Medicare	$35,631.46
Rate for Payer: Multiplan WC	$40,941.68

INPATIENT MS-DRG 546: CONNECTIVE TISSUE DISORDERS WITH CC

Facility IP

$19,676.03

Service Code	MS-DRG 546
Min. Negotiated Rate	$13,709.04
Max. Negotiated Rate	$19,676.03
Rate for Payer: EPIC Health Plan Medicare	$13,709.04
Rate for Payer: Humana Medicare	$13,709.04
Rate for Payer: IEHP Medicare Advantage	$13,709.04
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,176.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,273.39
Rate for Payer: Molina Healthcare of CA Medicare	$17,273.39
Rate for Payer: Multiplan WC	$19,676.03

INPATIENT MS-DRG 547: CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility IP

$14,930.02

Service Code	MS-DRG 547
Min. Negotiated Rate	$9,475.12
Max. Negotiated Rate	$14,930.02
Rate for Payer: EPIC Health Plan Medicare	$9,475.12
Rate for Payer: Humana Medicare	$9,475.12
Rate for Payer: IEHP Medicare Advantage	$9,475.12
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,180.64
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,938.65
Rate for Payer: Molina Healthcare of CA Medicare	$11,938.65
Rate for Payer: Multiplan WC	$14,930.02

INPATIENT MS-DRG 548: SEPTIC ARTHRITIS WITH MCC

Facility IP

$31,660.19

Service Code	MS-DRG 548
Min. Negotiated Rate	$22,160.02
Max. Negotiated Rate	$31,660.19
Rate for Payer: EPIC Health Plan Medicare	$22,160.02
Rate for Payer: Humana Medicare	$22,160.02
Rate for Payer: IEHP Medicare Advantage	$22,160.02
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,148.82
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,921.63
Rate for Payer: Molina Healthcare of CA Medicare	$27,921.63
Rate for Payer: Multiplan WC	$31,660.19

INPATIENT MS-DRG 549: SEPTIC ARTHRITIS WITH CC

Facility IP

$19,775.59

Service Code	MS-DRG 549
Min. Negotiated Rate	$13,786.74
Max. Negotiated Rate	$19,775.59
Rate for Payer: EPIC Health Plan Medicare	$13,786.74
Rate for Payer: Humana Medicare	$13,786.74
Rate for Payer: IEHP Medicare Advantage	$13,786.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,268.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,371.29
Rate for Payer: Molina Healthcare of CA Medicare	$17,371.29
Rate for Payer: Multiplan WC	$19,775.59

INPATIENT MS-DRG 550: SEPTIC ARTHRITIS WITHOUT CC/MCC

Facility IP

$17,108.81

Service Code	MS-DRG 550
Min. Negotiated Rate	$10,828.62
Max. Negotiated Rate	$17,108.81
Rate for Payer: EPIC Health Plan Medicare	$10,828.62
Rate for Payer: Humana Medicare	$10,828.62
Rate for Payer: IEHP Medicare Advantage	$10,828.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,777.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,644.06
Rate for Payer: Molina Healthcare of CA Medicare	$13,644.06
Rate for Payer: Multiplan WC	$17,108.81

INPATIENT MS-DRG 551: MEDICAL BACK PROBLEMS WITH MCC

Facility IP

$27,310.77

Service Code	MS-DRG 551
Min. Negotiated Rate	$19,368.54
Max. Negotiated Rate	$27,310.77
Rate for Payer: EPIC Health Plan Medicare	$19,368.54
Rate for Payer: Humana Medicare	$19,368.54
Rate for Payer: IEHP Medicare Advantage	$19,368.54
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,854.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,404.36
Rate for Payer: Molina Healthcare of CA Medicare	$24,404.36
Rate for Payer: Multiplan WC	$27,310.77

INPATIENT MS-DRG 552: MEDICAL BACK PROBLEMS WITHOUT MCC

Facility IP

$15,675.86

Service Code	MS-DRG 552
Min. Negotiated Rate	$11,085.36
Max. Negotiated Rate	$15,675.86
Rate for Payer: EPIC Health Plan Medicare	$11,085.36
Rate for Payer: Humana Medicare	$11,085.36
Rate for Payer: IEHP Medicare Advantage	$11,085.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,080.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,967.55
Rate for Payer: Molina Healthcare of CA Medicare	$13,967.55
Rate for Payer: Multiplan WC	$15,675.86

INPATIENT MS-DRG 553: BONE DISEASES AND ARTHROPATHIES WITH MCC

Facility IP

$21,639.39

Service Code	MS-DRG 553
Min. Negotiated Rate	$15,422.89
Max. Negotiated Rate	$21,639.39
Rate for Payer: EPIC Health Plan Medicare	$15,422.89
Rate for Payer: Humana Medicare	$15,422.89
Rate for Payer: IEHP Medicare Advantage	$15,422.89
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,199.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,432.84
Rate for Payer: Molina Healthcare of CA Medicare	$19,432.84
Rate for Payer: Multiplan WC	$21,639.39

INPATIENT MS-DRG 554: BONE DISEASES AND ARTHROPATHIES WITHOUT MCC

Facility IP

$13,386.09

Service Code	MS-DRG 554
Min. Negotiated Rate	$9,458.22
Max. Negotiated Rate	$13,386.09
Rate for Payer: EPIC Health Plan Medicare	$9,458.22
Rate for Payer: Humana Medicare	$9,458.22
Rate for Payer: IEHP Medicare Advantage	$9,458.22
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,160.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,917.36
Rate for Payer: Molina Healthcare of CA Medicare	$11,917.36
Rate for Payer: Multiplan WC	$13,386.09

INPATIENT MS-DRG 555: SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility IP

$21,725.88

Service Code	MS-DRG 555
Min. Negotiated Rate	$15,957.74
Max. Negotiated Rate	$21,725.88
Rate for Payer: EPIC Health Plan Medicare	$15,957.74
Rate for Payer: Humana Medicare	$15,957.74
Rate for Payer: IEHP Medicare Advantage	$15,957.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,830.13
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,106.75
Rate for Payer: Molina Healthcare of CA Medicare	$20,106.75
Rate for Payer: Multiplan WC	$21,725.88

INPATIENT MS-DRG 556: SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC

Facility IP

$13,186.99

Service Code	MS-DRG 556
Min. Negotiated Rate	$9,487.50
Max. Negotiated Rate	$13,186.99
Rate for Payer: EPIC Health Plan Medicare	$9,487.50
Rate for Payer: Humana Medicare	$9,487.50
Rate for Payer: IEHP Medicare Advantage	$9,487.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,195.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,954.25
Rate for Payer: Molina Healthcare of CA Medicare	$11,954.25
Rate for Payer: Multiplan WC	$13,186.99

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