Loma Linda University Medical Center

All Charges

Charge

Type

Price

INPATIENT MS-DRG 557: TENDONITIS, MYOSITIS AND BURSITIS WITH MCC

Facility IP

$23,369.36

Service Code	MS-DRG 557
Min. Negotiated Rate	$17,734.66
Max. Negotiated Rate	$23,369.36
Rate for Payer: EPIC Health Plan Medicare	$17,734.66
Rate for Payer: Humana Medicare	$17,734.66
Rate for Payer: IEHP Medicare Advantage	$17,734.66
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,926.90
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,345.67
Rate for Payer: Molina Healthcare of CA Medicare	$22,345.67
Rate for Payer: Multiplan WC	$23,369.36

INPATIENT MS-DRG 558: TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC

Facility IP

$14,182.54

Service Code	MS-DRG 558
Min. Negotiated Rate	$10,095.56
Max. Negotiated Rate	$14,182.54
Rate for Payer: EPIC Health Plan Medicare	$10,095.56
Rate for Payer: Humana Medicare	$10,095.56
Rate for Payer: IEHP Medicare Advantage	$10,095.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,912.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,720.41
Rate for Payer: Molina Healthcare of CA Medicare	$12,720.41
Rate for Payer: Multiplan WC	$14,182.54

INPATIENT MS-DRG 559: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility IP

$29,132.15

Service Code	MS-DRG 559
Min. Negotiated Rate	$21,041.84
Max. Negotiated Rate	$29,132.15
Rate for Payer: EPIC Health Plan Medicare	$21,041.84
Rate for Payer: Humana Medicare	$21,041.84
Rate for Payer: IEHP Medicare Advantage	$21,041.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,829.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,512.72
Rate for Payer: Molina Healthcare of CA Medicare	$26,512.72
Rate for Payer: Multiplan WC	$29,132.15

INPATIENT MS-DRG 560: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC

Facility IP

$17,880.77

Service Code	MS-DRG 560
Min. Negotiated Rate	$12,952.34
Max. Negotiated Rate	$17,880.77
Rate for Payer: EPIC Health Plan Medicare	$12,952.34
Rate for Payer: Humana Medicare	$12,952.34
Rate for Payer: IEHP Medicare Advantage	$12,952.34
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,283.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,319.95
Rate for Payer: Molina Healthcare of CA Medicare	$16,319.95
Rate for Payer: Multiplan WC	$17,880.77

INPATIENT MS-DRG 561: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC

Facility IP

$12,896.48

Service Code	MS-DRG 561
Min. Negotiated Rate	$8,989.78
Max. Negotiated Rate	$12,896.48
Rate for Payer: EPIC Health Plan Medicare	$8,989.78
Rate for Payer: Humana Medicare	$8,989.78
Rate for Payer: IEHP Medicare Advantage	$8,989.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,607.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,327.12
Rate for Payer: Molina Healthcare of CA Medicare	$11,327.12
Rate for Payer: Multiplan WC	$12,896.48

INPATIENT MS-DRG 562: FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC

Facility IP

$23,873.67

Service Code	MS-DRG 562
Min. Negotiated Rate	$17,328.14
Max. Negotiated Rate	$23,873.67
Rate for Payer: EPIC Health Plan Medicare	$17,328.14
Rate for Payer: Humana Medicare	$17,328.14
Rate for Payer: IEHP Medicare Advantage	$17,328.14
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,447.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,833.46
Rate for Payer: Molina Healthcare of CA Medicare	$21,833.46
Rate for Payer: Multiplan WC	$23,873.67

INPATIENT MS-DRG 563: FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC

Facility IP

$14,055.24

Service Code	MS-DRG 563
Min. Negotiated Rate	$10,289.24
Max. Negotiated Rate	$14,055.24
Rate for Payer: EPIC Health Plan Medicare	$10,289.24
Rate for Payer: Humana Medicare	$10,289.24
Rate for Payer: IEHP Medicare Advantage	$10,289.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,141.30
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,964.44
Rate for Payer: Molina Healthcare of CA Medicare	$12,964.44
Rate for Payer: Multiplan WC	$14,055.24

INPATIENT MS-DRG 564: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC

Facility IP

$25,350.68

Service Code	MS-DRG 564
Min. Negotiated Rate	$17,792.08
Max. Negotiated Rate	$25,350.68
Rate for Payer: EPIC Health Plan Medicare	$17,792.08
Rate for Payer: Humana Medicare	$17,792.08
Rate for Payer: IEHP Medicare Advantage	$17,792.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,994.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,418.02
Rate for Payer: Molina Healthcare of CA Medicare	$22,418.02
Rate for Payer: Multiplan WC	$25,350.68

INPATIENT MS-DRG 565: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC

Facility IP

$16,114.88

Service Code	MS-DRG 565
Min. Negotiated Rate	$11,458.08
Max. Negotiated Rate	$16,114.88
Rate for Payer: EPIC Health Plan Medicare	$11,458.08
Rate for Payer: Humana Medicare	$11,458.08
Rate for Payer: IEHP Medicare Advantage	$11,458.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,520.53
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,437.18
Rate for Payer: Molina Healthcare of CA Medicare	$14,437.18
Rate for Payer: Multiplan WC	$16,114.88

INPATIENT MS-DRG 566: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC

Facility IP

$12,121.26

Service Code	MS-DRG 566
Min. Negotiated Rate	$8,655.36
Max. Negotiated Rate	$12,121.26
Rate for Payer: EPIC Health Plan Medicare	$8,655.36
Rate for Payer: Humana Medicare	$8,655.36
Rate for Payer: IEHP Medicare Advantage	$8,655.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,213.32
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,905.75
Rate for Payer: Molina Healthcare of CA Medicare	$10,905.75
Rate for Payer: Multiplan WC	$12,121.26

INPATIENT MS-DRG 570: SKIN DEBRIDEMENT WITH MCC

Facility IP

$47,608.62

Service Code	MS-DRG 570
Min. Negotiated Rate	$33,109.67
Max. Negotiated Rate	$47,608.62
Rate for Payer: EPIC Health Plan Medicare	$33,109.67
Rate for Payer: Humana Medicare	$33,109.67
Rate for Payer: IEHP Medicare Advantage	$33,109.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,069.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$41,718.18
Rate for Payer: Molina Healthcare of CA Medicare	$41,718.18
Rate for Payer: Multiplan WC	$47,608.62

INPATIENT MS-DRG 571: SKIN DEBRIDEMENT WITH CC

Facility IP

$26,906.02

Service Code	MS-DRG 571
Min. Negotiated Rate	$19,255.95
Max. Negotiated Rate	$26,906.02
Rate for Payer: EPIC Health Plan Medicare	$19,255.95
Rate for Payer: Humana Medicare	$19,255.95
Rate for Payer: IEHP Medicare Advantage	$19,255.95
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,722.02
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,262.50
Rate for Payer: Molina Healthcare of CA Medicare	$24,262.50
Rate for Payer: Multiplan WC	$26,906.02

INPATIENT MS-DRG 572: SKIN DEBRIDEMENT WITHOUT CC/MCC

Facility IP

$19,643.38

Service Code	MS-DRG 572
Min. Negotiated Rate	$13,036.78
Max. Negotiated Rate	$19,643.38
Rate for Payer: EPIC Health Plan Medicare	$13,036.78
Rate for Payer: Humana Medicare	$13,036.78
Rate for Payer: IEHP Medicare Advantage	$13,036.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,383.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,426.34
Rate for Payer: Molina Healthcare of CA Medicare	$16,426.34
Rate for Payer: Multiplan WC	$19,643.38

INPATIENT MS-DRG 573: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility IP

$95,809.66

Service Code	MS-DRG 573
Min. Negotiated Rate	$70,222.98
Max. Negotiated Rate	$95,809.66
Rate for Payer: EPIC Health Plan Medicare	$70,222.98
Rate for Payer: Humana Medicare	$70,222.98
Rate for Payer: IEHP Medicare Advantage	$70,222.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$82,863.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$88,480.95
Rate for Payer: Molina Healthcare of CA Medicare	$88,480.95
Rate for Payer: Multiplan WC	$95,809.66

INPATIENT MS-DRG 574: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility IP

$58,828.98

Service Code	MS-DRG 574
Min. Negotiated Rate	$38,555.22
Max. Negotiated Rate	$58,828.98
Rate for Payer: EPIC Health Plan Medicare	$38,555.22
Rate for Payer: Humana Medicare	$38,555.22
Rate for Payer: IEHP Medicare Advantage	$38,555.22
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$45,495.16
Rate for Payer: Molina Healthcare of CA Medi-Cal	$48,579.58
Rate for Payer: Molina Healthcare of CA Medicare	$48,579.58
Rate for Payer: Multiplan WC	$58,828.98

INPATIENT MS-DRG 575: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility IP

$33,450.56

Service Code	MS-DRG 575
Min. Negotiated Rate	$23,243.27
Max. Negotiated Rate	$33,450.56
Rate for Payer: EPIC Health Plan Medicare	$23,243.27
Rate for Payer: Humana Medicare	$23,243.27
Rate for Payer: IEHP Medicare Advantage	$23,243.27
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,427.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,286.52
Rate for Payer: Molina Healthcare of CA Medicare	$29,286.52
Rate for Payer: Multiplan WC	$33,450.56

INPATIENT MS-DRG 576: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility IP

$92,194.67

Service Code	MS-DRG 576
Min. Negotiated Rate	$64,198.65
Max. Negotiated Rate	$92,194.67
Rate for Payer: EPIC Health Plan Medicare	$64,198.65
Rate for Payer: Humana Medicare	$64,198.65
Rate for Payer: IEHP Medicare Advantage	$64,198.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$75,754.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$80,890.30
Rate for Payer: Molina Healthcare of CA Medicare	$80,890.30
Rate for Payer: Multiplan WC	$92,194.67

INPATIENT MS-DRG 577: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility IP

$42,738.56

Service Code	MS-DRG 577
Min. Negotiated Rate	$30,034.45
Max. Negotiated Rate	$42,738.56
Rate for Payer: EPIC Health Plan Medicare	$30,034.45
Rate for Payer: Humana Medicare	$30,034.45
Rate for Payer: IEHP Medicare Advantage	$30,034.45
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,440.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,843.41
Rate for Payer: Molina Healthcare of CA Medicare	$37,843.41
Rate for Payer: Multiplan WC	$42,738.56

INPATIENT MS-DRG 578: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility IP

$27,948.90

Service Code	MS-DRG 578
Min. Negotiated Rate	$18,339.33
Max. Negotiated Rate	$27,948.90
Rate for Payer: EPIC Health Plan Medicare	$18,339.33
Rate for Payer: Humana Medicare	$18,339.33
Rate for Payer: IEHP Medicare Advantage	$18,339.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,640.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,107.56
Rate for Payer: Molina Healthcare of CA Medicare	$23,107.56
Rate for Payer: Multiplan WC	$27,948.90

INPATIENT MS-DRG 579: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC

Facility IP

$51,437.41

Service Code	MS-DRG 579
Min. Negotiated Rate	$37,839.05
Max. Negotiated Rate	$51,437.41
Rate for Payer: EPIC Health Plan Medicare	$37,839.05
Rate for Payer: Humana Medicare	$37,839.05
Rate for Payer: IEHP Medicare Advantage	$37,839.05
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$44,650.08
Rate for Payer: Molina Healthcare of CA Medi-Cal	$47,677.20
Rate for Payer: Molina Healthcare of CA Medicare	$47,677.20
Rate for Payer: Multiplan WC	$51,437.41

INPATIENT MS-DRG 580: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC

Facility IP

$28,335.70

Service Code	MS-DRG 580
Min. Negotiated Rate	$19,871.88
Max. Negotiated Rate	$28,335.70
Rate for Payer: EPIC Health Plan Medicare	$19,871.88
Rate for Payer: Humana Medicare	$19,871.88
Rate for Payer: IEHP Medicare Advantage	$19,871.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,448.82
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,038.57
Rate for Payer: Molina Healthcare of CA Medicare	$25,038.57
Rate for Payer: Multiplan WC	$28,335.70

INPATIENT MS-DRG 581: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC

Facility IP

$23,036.43

Service Code	MS-DRG 581
Min. Negotiated Rate	$15,368.83
Max. Negotiated Rate	$23,036.43
Rate for Payer: EPIC Health Plan Medicare	$15,368.83
Rate for Payer: Humana Medicare	$15,368.83
Rate for Payer: IEHP Medicare Advantage	$15,368.83
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,135.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,364.73
Rate for Payer: Molina Healthcare of CA Medicare	$19,364.73
Rate for Payer: Multiplan WC	$23,036.43

INPATIENT MS-DRG 582: MASTECTOMY FOR MALIGNANCY WITH CC/MCC

Facility IP

$31,576.96

Service Code	MS-DRG 582
Min. Negotiated Rate	$19,812.20
Max. Negotiated Rate	$31,576.96
Rate for Payer: EPIC Health Plan Medicare	$19,812.20
Rate for Payer: Humana Medicare	$19,812.20
Rate for Payer: IEHP Medicare Advantage	$19,812.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,378.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,963.37
Rate for Payer: Molina Healthcare of CA Medicare	$24,963.37
Rate for Payer: Multiplan WC	$31,576.96

INPATIENT MS-DRG 583: MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC

Facility IP

$24,657.05

Service Code	MS-DRG 583
Min. Negotiated Rate	$17,341.67
Max. Negotiated Rate	$24,657.05
Rate for Payer: EPIC Health Plan Medicare	$17,341.67
Rate for Payer: Humana Medicare	$17,341.67
Rate for Payer: IEHP Medicare Advantage	$17,341.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,463.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,850.50
Rate for Payer: Molina Healthcare of CA Medicare	$21,850.50
Rate for Payer: Multiplan WC	$24,657.05

INPATIENT MS-DRG 584: BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC

Facility IP

$34,857.38

Service Code	MS-DRG 584
Min. Negotiated Rate	$22,259.11
Max. Negotiated Rate	$34,857.38
Rate for Payer: EPIC Health Plan Medicare	$22,259.11
Rate for Payer: Humana Medicare	$22,259.11
Rate for Payer: IEHP Medicare Advantage	$22,259.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,265.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,046.48
Rate for Payer: Molina Healthcare of CA Medicare	$28,046.48
Rate for Payer: Multiplan WC	$34,857.38

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