Loma Linda University Medical Center

All Charges

Charge

Type

Price

INPATIENT MS-DRG 585: BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC

Facility IP

$30,047.72

Service Code	MS-DRG 585
Min. Negotiated Rate	$19,166.98
Max. Negotiated Rate	$30,047.72
Rate for Payer: EPIC Health Plan Medicare	$19,166.98
Rate for Payer: Humana Medicare	$19,166.98
Rate for Payer: IEHP Medicare Advantage	$19,166.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,617.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,150.39
Rate for Payer: Molina Healthcare of CA Medicare	$24,150.39
Rate for Payer: Multiplan WC	$30,047.72

INPATIENT MS-DRG 592: SKIN ULCERS WITH MCC

Facility IP

$29,912.22

Service Code	MS-DRG 592
Min. Negotiated Rate	$23,739.86
Max. Negotiated Rate	$29,912.22
Rate for Payer: EPIC Health Plan Medicare	$23,739.86
Rate for Payer: Humana Medicare	$23,739.86
Rate for Payer: IEHP Medicare Advantage	$23,739.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,013.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,912.22
Rate for Payer: Molina Healthcare of CA Medicare	$29,912.22
Rate for Payer: Multiplan WC	$29,115.82

INPATIENT MS-DRG 593: SKIN ULCERS WITH CC

Facility IP

$18,799.61

Service Code	MS-DRG 593
Min. Negotiated Rate	$13,828.39
Max. Negotiated Rate	$18,799.61
Rate for Payer: EPIC Health Plan Medicare	$13,828.39
Rate for Payer: Humana Medicare	$13,828.39
Rate for Payer: IEHP Medicare Advantage	$13,828.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,317.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,423.77
Rate for Payer: Molina Healthcare of CA Medicare	$17,423.77
Rate for Payer: Multiplan WC	$18,799.61

INPATIENT MS-DRG 594: SKIN ULCERS WITHOUT CC/MCC

Facility IP

$12,630.46

Service Code	MS-DRG 594
Min. Negotiated Rate	$9,070.86
Max. Negotiated Rate	$12,630.46
Rate for Payer: EPIC Health Plan Medicare	$9,070.86
Rate for Payer: Humana Medicare	$9,070.86
Rate for Payer: IEHP Medicare Advantage	$9,070.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,703.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,429.28
Rate for Payer: Molina Healthcare of CA Medicare	$11,429.28
Rate for Payer: Multiplan WC	$12,630.46

INPATIENT MS-DRG 595: MAJOR SKIN DISORDERS WITH MCC

Facility IP

$34,948.78

Service Code	MS-DRG 595
Min. Negotiated Rate	$24,695.86
Max. Negotiated Rate	$34,948.78
Rate for Payer: EPIC Health Plan Medicare	$24,695.86
Rate for Payer: Humana Medicare	$24,695.86
Rate for Payer: IEHP Medicare Advantage	$24,695.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,141.11
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,116.78
Rate for Payer: Molina Healthcare of CA Medicare	$31,116.78
Rate for Payer: Multiplan WC	$34,948.78

INPATIENT MS-DRG 596: MAJOR SKIN DISORDERS WITHOUT MCC

Facility IP

$17,818.75

Service Code	MS-DRG 596
Min. Negotiated Rate	$11,566.19
Max. Negotiated Rate	$17,818.75
Rate for Payer: EPIC Health Plan Medicare	$11,566.19
Rate for Payer: Humana Medicare	$11,566.19
Rate for Payer: IEHP Medicare Advantage	$11,566.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,648.10
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,573.40
Rate for Payer: Molina Healthcare of CA Medicare	$14,573.40
Rate for Payer: Multiplan WC	$17,818.75

INPATIENT MS-DRG 597: MALIGNANT BREAST DISORDERS WITH MCC

Facility IP

$27,483.77

Service Code	MS-DRG 597
Min. Negotiated Rate	$18,226.73
Max. Negotiated Rate	$27,483.77
Rate for Payer: EPIC Health Plan Medicare	$18,226.73
Rate for Payer: Humana Medicare	$18,226.73
Rate for Payer: IEHP Medicare Advantage	$18,226.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,507.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,965.68
Rate for Payer: Molina Healthcare of CA Medicare	$22,965.68
Rate for Payer: Multiplan WC	$27,483.77

INPATIENT MS-DRG 598: MALIGNANT BREAST DISORDERS WITH CC

Facility IP

$17,431.96

Service Code	MS-DRG 598
Min. Negotiated Rate	$13,703.42
Max. Negotiated Rate	$17,431.96
Rate for Payer: EPIC Health Plan Medicare	$13,703.42
Rate for Payer: Humana Medicare	$13,703.42
Rate for Payer: IEHP Medicare Advantage	$13,703.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,170.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,266.31
Rate for Payer: Molina Healthcare of CA Medicare	$17,266.31
Rate for Payer: Multiplan WC	$17,431.96

INPATIENT MS-DRG 599: MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility IP

$12,201.23

Service Code	MS-DRG 599
Min. Negotiated Rate	$7,780.40
Max. Negotiated Rate	$12,201.23
Rate for Payer: EPIC Health Plan Medicare	$7,780.40
Rate for Payer: Humana Medicare	$7,780.40
Rate for Payer: IEHP Medicare Advantage	$7,780.40
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,180.87
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,803.30
Rate for Payer: Molina Healthcare of CA Medicare	$9,803.30
Rate for Payer: Multiplan WC	$12,201.23

INPATIENT MS-DRG 600: NON-MALIGNANT BREAST DISORDERS WITH CC/MCC

Facility IP

$16,991.30

Service Code	MS-DRG 600
Min. Negotiated Rate	$11,751.98
Max. Negotiated Rate	$16,991.30
Rate for Payer: EPIC Health Plan Medicare	$11,751.98
Rate for Payer: Humana Medicare	$11,751.98
Rate for Payer: IEHP Medicare Advantage	$11,751.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,867.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,807.49
Rate for Payer: Molina Healthcare of CA Medicare	$14,807.49
Rate for Payer: Multiplan WC	$16,991.30

INPATIENT MS-DRG 601: NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility IP

$11,488.02

Service Code	MS-DRG 601
Min. Negotiated Rate	$7,337.86
Max. Negotiated Rate	$11,488.02
Rate for Payer: EPIC Health Plan Medicare	$7,337.86
Rate for Payer: Humana Medicare	$7,337.86
Rate for Payer: IEHP Medicare Advantage	$7,337.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,658.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,245.70
Rate for Payer: Molina Healthcare of CA Medicare	$9,245.70
Rate for Payer: Multiplan WC	$11,488.02

INPATIENT MS-DRG 602: CELLULITIS WITH MCC

Facility IP

$23,521.15

Service Code	MS-DRG 602
Min. Negotiated Rate	$16,954.31
Max. Negotiated Rate	$23,521.15
Rate for Payer: EPIC Health Plan Medicare	$16,954.31
Rate for Payer: Humana Medicare	$16,954.31
Rate for Payer: IEHP Medicare Advantage	$16,954.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,006.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,362.43
Rate for Payer: Molina Healthcare of CA Medicare	$21,362.43
Rate for Payer: Multiplan WC	$23,521.15

INPATIENT MS-DRG 603: CELLULITIS WITHOUT MCC

Facility IP

$14,391.44

Service Code	MS-DRG 603
Min. Negotiated Rate	$10,166.50
Max. Negotiated Rate	$14,391.44
Rate for Payer: EPIC Health Plan Medicare	$10,166.50
Rate for Payer: Humana Medicare	$10,166.50
Rate for Payer: IEHP Medicare Advantage	$10,166.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,996.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,809.79
Rate for Payer: Molina Healthcare of CA Medicare	$12,809.79
Rate for Payer: Multiplan WC	$14,391.44

INPATIENT MS-DRG 604: TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC

Facility IP

$24,630.94

Service Code	MS-DRG 604
Min. Negotiated Rate	$17,164.88
Max. Negotiated Rate	$24,630.94
Rate for Payer: EPIC Health Plan Medicare	$17,164.88
Rate for Payer: Humana Medicare	$17,164.88
Rate for Payer: IEHP Medicare Advantage	$17,164.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,254.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,627.75
Rate for Payer: Molina Healthcare of CA Medicare	$21,627.75
Rate for Payer: Multiplan WC	$24,630.94

INPATIENT MS-DRG 605: TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC

Facility IP

$14,858.21

Service Code	MS-DRG 605
Min. Negotiated Rate	$10,437.87
Max. Negotiated Rate	$14,858.21
Rate for Payer: EPIC Health Plan Medicare	$10,437.87
Rate for Payer: Humana Medicare	$10,437.87
Rate for Payer: IEHP Medicare Advantage	$10,437.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,316.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,151.72
Rate for Payer: Molina Healthcare of CA Medicare	$13,151.72
Rate for Payer: Multiplan WC	$14,858.21

INPATIENT MS-DRG 606: MINOR SKIN DISORDERS WITH MCC

Facility IP

$25,050.38

Service Code	MS-DRG 606
Min. Negotiated Rate	$18,061.20
Max. Negotiated Rate	$25,050.38
Rate for Payer: EPIC Health Plan Medicare	$18,061.20
Rate for Payer: Humana Medicare	$18,061.20
Rate for Payer: IEHP Medicare Advantage	$18,061.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,312.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,757.11
Rate for Payer: Molina Healthcare of CA Medicare	$22,757.11
Rate for Payer: Multiplan WC	$25,050.38

INPATIENT MS-DRG 607: MINOR SKIN DISORDERS WITHOUT MCC

Facility IP

$13,843.07

Service Code	MS-DRG 607
Min. Negotiated Rate	$10,265.60
Max. Negotiated Rate	$13,843.07
Rate for Payer: EPIC Health Plan Medicare	$10,265.60
Rate for Payer: Humana Medicare	$10,265.60
Rate for Payer: IEHP Medicare Advantage	$10,265.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,113.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,934.66
Rate for Payer: Molina Healthcare of CA Medicare	$12,934.66
Rate for Payer: Multiplan WC	$13,843.07

INPATIENT MS-DRG 614: ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC

Facility IP

$38,351.60

Service Code	MS-DRG 614
Min. Negotiated Rate	$25,567.42
Max. Negotiated Rate	$38,351.60
Rate for Payer: EPIC Health Plan Medicare	$25,567.42
Rate for Payer: Humana Medicare	$25,567.42
Rate for Payer: IEHP Medicare Advantage	$25,567.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,169.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,214.95
Rate for Payer: Molina Healthcare of CA Medicare	$32,214.95
Rate for Payer: Multiplan WC	$38,351.60

INPATIENT MS-DRG 615: ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC

Facility IP

$24,085.83

Service Code	MS-DRG 615
Min. Negotiated Rate	$16,769.62
Max. Negotiated Rate	$24,085.83
Rate for Payer: EPIC Health Plan Medicare	$16,769.62
Rate for Payer: Humana Medicare	$16,769.62
Rate for Payer: IEHP Medicare Advantage	$16,769.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,788.15
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,129.72
Rate for Payer: Molina Healthcare of CA Medicare	$21,129.72
Rate for Payer: Multiplan WC	$24,085.83

INPATIENT MS-DRG 616: AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC

Facility IP

$61,438.63

Service Code	MS-DRG 616
Min. Negotiated Rate	$44,769.87
Max. Negotiated Rate	$61,438.63
Rate for Payer: EPIC Health Plan Medicare	$44,769.87
Rate for Payer: Humana Medicare	$44,769.87
Rate for Payer: IEHP Medicare Advantage	$44,769.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$52,828.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$56,410.04
Rate for Payer: Molina Healthcare of CA Medicare	$56,410.04
Rate for Payer: Multiplan WC	$61,438.63

INPATIENT MS-DRG 617: AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC

Facility IP

$31,727.11

Service Code	MS-DRG 617
Min. Negotiated Rate	$22,550.75
Max. Negotiated Rate	$31,727.11
Rate for Payer: EPIC Health Plan Medicare	$22,550.75
Rate for Payer: Humana Medicare	$22,550.75
Rate for Payer: IEHP Medicare Advantage	$22,550.75
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,609.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,413.94
Rate for Payer: Molina Healthcare of CA Medicare	$28,413.94
Rate for Payer: Multiplan WC	$31,727.11

INPATIENT MS-DRG 618: AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC

Facility IP

$19,142.35

Service Code	MS-DRG 618
Min. Negotiated Rate	$13,283.39
Max. Negotiated Rate	$19,142.35
Rate for Payer: EPIC Health Plan Medicare	$13,283.39
Rate for Payer: Humana Medicare	$13,283.39
Rate for Payer: IEHP Medicare Advantage	$13,283.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,674.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,737.07
Rate for Payer: Molina Healthcare of CA Medicare	$16,737.07
Rate for Payer: Multiplan WC	$19,142.35

INPATIENT MS-DRG 619: O.R. PROCEDURES FOR OBESITY WITH MCC

Facility IP

$47,194.08

Service Code	MS-DRG 619
Min. Negotiated Rate	$11,586.00
Max. Negotiated Rate	$47,194.08
Rate for Payer: Cigna of CA HMO/PPO	$16,000.00
Rate for Payer: EPIC Health Plan Medicare	$29,509.71
Rate for Payer: Humana Medicare	$29,509.71
Rate for Payer: IEHP Medicare Advantage	$29,509.71
Rate for Payer: Kaiser Permanente of CA Commercial	$11,586.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,821.46
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,182.23
Rate for Payer: Molina Healthcare of CA Medicare	$37,182.23
Rate for Payer: Multiplan WC	$47,194.08
Rate for Payer: United Healthcare All Other HMO/non HMO	$21,886.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$18,363.00

INPATIENT MS-DRG 620: O.R. PROCEDURES FOR OBESITY WITH CC

Facility IP

$27,509.88

Service Code	MS-DRG 620
Min. Negotiated Rate	$11,586.00
Max. Negotiated Rate	$27,509.88
Rate for Payer: Cigna of CA HMO/PPO	$16,000.00
Rate for Payer: EPIC Health Plan Medicare	$18,471.08
Rate for Payer: Humana Medicare	$18,471.08
Rate for Payer: IEHP Medicare Advantage	$18,471.08
Rate for Payer: Kaiser Permanente of CA Commercial	$11,586.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,795.87
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,273.56
Rate for Payer: Molina Healthcare of CA Medicare	$23,273.56
Rate for Payer: Multiplan WC	$27,509.88
Rate for Payer: United Healthcare All Other HMO/non HMO	$21,886.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$18,363.00

INPATIENT MS-DRG 621: O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC

Facility IP

$25,378.42

Service Code	MS-DRG 621
Min. Negotiated Rate	$11,586.00
Max. Negotiated Rate	$25,378.42
Rate for Payer: Cigna of CA HMO/PPO	$16,000.00
Rate for Payer: EPIC Health Plan Medicare	$17,289.84
Rate for Payer: Humana Medicare	$17,289.84
Rate for Payer: IEHP Medicare Advantage	$17,289.84
Rate for Payer: Kaiser Permanente of CA Commercial	$11,586.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,402.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,785.20
Rate for Payer: Molina Healthcare of CA Medicare	$21,785.20
Rate for Payer: Multiplan WC	$25,378.42
Rate for Payer: United Healthcare All Other HMO/non HMO	$21,886.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$18,363.00

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