Loma Linda University Medical Center

All Charges

Charge

Type

Price

INPATIENT MS-DRG 622: SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC

Facility IP

$59,098.26

Service Code	MS-DRG 622
Min. Negotiated Rate	$43,282.37
Max. Negotiated Rate	$59,098.26
Rate for Payer: EPIC Health Plan Medicare	$43,282.37
Rate for Payer: Humana Medicare	$43,282.37
Rate for Payer: IEHP Medicare Advantage	$43,282.37
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$51,073.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$54,535.79
Rate for Payer: Molina Healthcare of CA Medicare	$54,535.79
Rate for Payer: Multiplan WC	$59,098.26

INPATIENT MS-DRG 623: SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC

Facility IP

$30,757.66

Service Code	MS-DRG 623
Min. Negotiated Rate	$21,164.58
Max. Negotiated Rate	$30,757.66
Rate for Payer: EPIC Health Plan Medicare	$21,164.58
Rate for Payer: Humana Medicare	$21,164.58
Rate for Payer: IEHP Medicare Advantage	$21,164.58
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,974.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,667.37
Rate for Payer: Molina Healthcare of CA Medicare	$26,667.37
Rate for Payer: Multiplan WC	$30,757.66

INPATIENT MS-DRG 624: SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC

Facility IP

$16,141.00

Service Code	MS-DRG 624
Min. Negotiated Rate	$12,754.14
Max. Negotiated Rate	$16,141.00
Rate for Payer: EPIC Health Plan Medicare	$12,754.14
Rate for Payer: Humana Medicare	$12,754.14
Rate for Payer: IEHP Medicare Advantage	$12,754.14
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,049.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,070.22
Rate for Payer: Molina Healthcare of CA Medicare	$16,070.22
Rate for Payer: Multiplan WC	$16,141.00

INPATIENT MS-DRG 625: THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC

Facility IP

$46,957.43

Service Code	MS-DRG 625
Min. Negotiated Rate	$33,098.41
Max. Negotiated Rate	$46,957.43
Rate for Payer: EPIC Health Plan Medicare	$33,098.41
Rate for Payer: Humana Medicare	$33,098.41
Rate for Payer: IEHP Medicare Advantage	$33,098.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,056.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$41,704.00
Rate for Payer: Molina Healthcare of CA Medicare	$41,704.00
Rate for Payer: Multiplan WC	$46,957.43

INPATIENT MS-DRG 626: THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC

Facility IP

$26,426.20

Service Code	MS-DRG 626
Min. Negotiated Rate	$17,003.86
Max. Negotiated Rate	$26,426.20
Rate for Payer: EPIC Health Plan Medicare	$17,003.86
Rate for Payer: Humana Medicare	$17,003.86
Rate for Payer: IEHP Medicare Advantage	$17,003.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,064.55
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,424.86
Rate for Payer: Molina Healthcare of CA Medicare	$21,424.86
Rate for Payer: Multiplan WC	$26,426.20

INPATIENT MS-DRG 627: THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC

Facility IP

$20,823.36

Service Code	MS-DRG 627
Min. Negotiated Rate	$14,122.29
Max. Negotiated Rate	$20,823.36
Rate for Payer: EPIC Health Plan Medicare	$14,122.29
Rate for Payer: Humana Medicare	$14,122.29
Rate for Payer: IEHP Medicare Advantage	$14,122.29
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,664.30
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,794.09
Rate for Payer: Molina Healthcare of CA Medicare	$17,794.09
Rate for Payer: Multiplan WC	$20,823.36

INPATIENT MS-DRG 628: OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC

Facility IP

$59,485.06

Service Code	MS-DRG 628
Min. Negotiated Rate	$45,409.47
Max. Negotiated Rate	$59,485.06
Rate for Payer: EPIC Health Plan Medicare	$45,409.47
Rate for Payer: Humana Medicare	$45,409.47
Rate for Payer: IEHP Medicare Advantage	$45,409.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$53,583.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$57,215.93
Rate for Payer: Molina Healthcare of CA Medicare	$57,215.93
Rate for Payer: Multiplan WC	$59,485.06

INPATIENT MS-DRG 629: OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC

Facility IP

$36,620.00

Service Code	MS-DRG 629
Min. Negotiated Rate	$25,684.52
Max. Negotiated Rate	$36,620.00
Rate for Payer: EPIC Health Plan Medicare	$25,684.52
Rate for Payer: Humana Medicare	$25,684.52
Rate for Payer: IEHP Medicare Advantage	$25,684.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,307.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,362.50
Rate for Payer: Molina Healthcare of CA Medicare	$32,362.50
Rate for Payer: Multiplan WC	$36,620.00

INPATIENT MS-DRG 630: OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC

Facility IP

$22,917.29

Service Code	MS-DRG 630
Min. Negotiated Rate	$15,927.35
Max. Negotiated Rate	$22,917.29
Rate for Payer: EPIC Health Plan Medicare	$15,927.35
Rate for Payer: Humana Medicare	$15,927.35
Rate for Payer: IEHP Medicare Advantage	$15,927.35
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,794.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,068.46
Rate for Payer: Molina Healthcare of CA Medicare	$20,068.46
Rate for Payer: Multiplan WC	$22,917.29

INPATIENT MS-DRG 637: DIABETES WITH MCC

Facility IP

$22,778.56

Service Code	MS-DRG 637
Min. Negotiated Rate	$16,524.15
Max. Negotiated Rate	$22,778.56
Rate for Payer: EPIC Health Plan Medicare	$16,524.15
Rate for Payer: Humana Medicare	$16,524.15
Rate for Payer: IEHP Medicare Advantage	$16,524.15
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,498.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,820.43
Rate for Payer: Molina Healthcare of CA Medicare	$20,820.43
Rate for Payer: Multiplan WC	$22,778.56

INPATIENT MS-DRG 638: DIABETES WITH CC

Facility IP

$14,296.78

Service Code	MS-DRG 638
Min. Negotiated Rate	$10,332.03
Max. Negotiated Rate	$14,296.78
Rate for Payer: EPIC Health Plan Medicare	$10,332.03
Rate for Payer: Humana Medicare	$10,332.03
Rate for Payer: IEHP Medicare Advantage	$10,332.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,191.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,018.36
Rate for Payer: Molina Healthcare of CA Medicare	$13,018.36
Rate for Payer: Multiplan WC	$14,296.78

INPATIENT MS-DRG 639: DIABETES WITHOUT CC/MCC

Facility IP

$9,805.37

Service Code	MS-DRG 639
Min. Negotiated Rate	$7,214.00
Max. Negotiated Rate	$9,805.37
Rate for Payer: EPIC Health Plan Medicare	$7,214.00
Rate for Payer: Humana Medicare	$7,214.00
Rate for Payer: IEHP Medicare Advantage	$7,214.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,512.52
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,089.64
Rate for Payer: Molina Healthcare of CA Medicare	$9,089.64
Rate for Payer: Multiplan WC	$9,805.37

INPATIENT MS-DRG 640: MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC

Facility IP

$20,650.36

Service Code	MS-DRG 640
Min. Negotiated Rate	$15,014.13
Max. Negotiated Rate	$20,650.36
Rate for Payer: EPIC Health Plan Medicare	$15,014.13
Rate for Payer: Humana Medicare	$15,014.13
Rate for Payer: IEHP Medicare Advantage	$15,014.13
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,716.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,917.80
Rate for Payer: Molina Healthcare of CA Medicare	$18,917.80
Rate for Payer: Multiplan WC	$20,650.36

INPATIENT MS-DRG 641: MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC

Facility IP

$12,570.07

Service Code	MS-DRG 641
Min. Negotiated Rate	$9,003.29
Max. Negotiated Rate	$12,570.07
Rate for Payer: EPIC Health Plan Medicare	$9,003.29
Rate for Payer: Humana Medicare	$9,003.29
Rate for Payer: IEHP Medicare Advantage	$9,003.29
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,623.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,344.15
Rate for Payer: Molina Healthcare of CA Medicare	$11,344.15
Rate for Payer: Multiplan WC	$12,570.07

INPATIENT MS-DRG 642: INBORN AND OTHER DISORDERS OF METABOLISM

Facility IP

$22,902.60

Service Code	MS-DRG 642
Min. Negotiated Rate	$14,880.13
Max. Negotiated Rate	$22,902.60
Rate for Payer: EPIC Health Plan Medicare	$14,880.13
Rate for Payer: Humana Medicare	$14,880.13
Rate for Payer: IEHP Medicare Advantage	$14,880.13
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,558.55
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,748.96
Rate for Payer: Molina Healthcare of CA Medicare	$18,748.96
Rate for Payer: Multiplan WC	$22,902.60

INPATIENT MS-DRG 643: ENDOCRINE DISORDERS WITH MCC

Facility IP

$26,826.05

Service Code	MS-DRG 643
Min. Negotiated Rate	$18,728.94
Max. Negotiated Rate	$26,826.05
Rate for Payer: EPIC Health Plan Medicare	$18,728.94
Rate for Payer: Humana Medicare	$18,728.94
Rate for Payer: IEHP Medicare Advantage	$18,728.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,100.15
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,598.46
Rate for Payer: Molina Healthcare of CA Medicare	$23,598.46
Rate for Payer: Multiplan WC	$26,826.05

INPATIENT MS-DRG 644: ENDOCRINE DISORDERS WITH CC

Facility IP

$16,632.25

Service Code	MS-DRG 644
Min. Negotiated Rate	$12,159.60
Max. Negotiated Rate	$16,632.25
Rate for Payer: EPIC Health Plan Medicare	$12,159.60
Rate for Payer: Humana Medicare	$12,159.60
Rate for Payer: IEHP Medicare Advantage	$12,159.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,348.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,321.10
Rate for Payer: Molina Healthcare of CA Medicare	$15,321.10
Rate for Payer: Multiplan WC	$16,632.25

INPATIENT MS-DRG 645: ENDOCRINE DISORDERS WITHOUT CC/MCC

Facility IP

$12,119.62

Service Code	MS-DRG 645
Min. Negotiated Rate	$8,772.45
Max. Negotiated Rate	$12,119.62
Rate for Payer: EPIC Health Plan Medicare	$8,772.45
Rate for Payer: Humana Medicare	$8,772.45
Rate for Payer: IEHP Medicare Advantage	$8,772.45
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,351.49
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,053.29
Rate for Payer: Molina Healthcare of CA Medicare	$11,053.29
Rate for Payer: Multiplan WC	$12,119.62

INPATIENT MS-DRG 650: KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC

Facility IP

$75,790.90

Service Code	MS-DRG 650
Min. Negotiated Rate	$50,848.26
Max. Negotiated Rate	$75,790.90
Rate for Payer: EPIC Health Plan Medicare	$50,848.26
Rate for Payer: Humana Medicare	$50,848.26
Rate for Payer: IEHP Medicare Advantage	$50,848.26
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$60,000.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$64,068.81
Rate for Payer: Molina Healthcare of CA Medicare	$64,068.81
Rate for Payer: Multiplan WC	$75,790.90

INPATIENT MS-DRG 651: KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC

Facility IP

$57,875.86

Service Code	MS-DRG 651
Min. Negotiated Rate	$39,147.51
Max. Negotiated Rate	$57,875.86
Rate for Payer: EPIC Health Plan Medicare	$39,147.51
Rate for Payer: Humana Medicare	$39,147.51
Rate for Payer: IEHP Medicare Advantage	$39,147.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$46,194.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$49,325.86
Rate for Payer: Molina Healthcare of CA Medicare	$49,325.86
Rate for Payer: Multiplan WC	$57,875.86

INPATIENT MS-DRG 652: KIDNEY TRANSPLANT

Facility IP

$50,350.46

Service Code	MS-DRG 652
Min. Negotiated Rate	$34,035.28
Max. Negotiated Rate	$50,350.46
Rate for Payer: EPIC Health Plan Medicare	$34,035.28
Rate for Payer: Humana Medicare	$34,035.28
Rate for Payer: IEHP Medicare Advantage	$34,035.28
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,161.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,884.45
Rate for Payer: Molina Healthcare of CA Medicare	$42,884.45
Rate for Payer: Multiplan WC	$50,350.46

INPATIENT MS-DRG 653: MAJOR BLADDER PROCEDURES WITH MCC

Facility IP

$90,688.28

Service Code	MS-DRG 653
Min. Negotiated Rate	$61,163.95
Max. Negotiated Rate	$90,688.28
Rate for Payer: EPIC Health Plan Medicare	$61,163.95
Rate for Payer: Humana Medicare	$61,163.95
Rate for Payer: IEHP Medicare Advantage	$61,163.95
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$72,173.46
Rate for Payer: Molina Healthcare of CA Medi-Cal	$77,066.58
Rate for Payer: Molina Healthcare of CA Medicare	$77,066.58
Rate for Payer: Multiplan WC	$90,688.28

INPATIENT MS-DRG 654: MAJOR BLADDER PROCEDURES WITH CC

Facility IP

$46,391.10

Service Code	MS-DRG 654
Min. Negotiated Rate	$31,029.87
Max. Negotiated Rate	$46,391.10
Rate for Payer: EPIC Health Plan Medicare	$31,029.87
Rate for Payer: Humana Medicare	$31,029.87
Rate for Payer: IEHP Medicare Advantage	$31,029.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,615.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$39,097.64
Rate for Payer: Molina Healthcare of CA Medicare	$39,097.64
Rate for Payer: Multiplan WC	$46,391.10

INPATIENT MS-DRG 655: MAJOR BLADDER PROCEDURES WITHOUT CC/MCC

Facility IP

$35,231.13

Service Code	MS-DRG 655
Min. Negotiated Rate	$23,939.16
Max. Negotiated Rate	$35,231.13
Rate for Payer: EPIC Health Plan Medicare	$23,939.16
Rate for Payer: Humana Medicare	$23,939.16
Rate for Payer: IEHP Medicare Advantage	$23,939.16
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,248.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,163.34
Rate for Payer: Molina Healthcare of CA Medicare	$30,163.34
Rate for Payer: Multiplan WC	$35,231.13

INPATIENT MS-DRG 656: KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC

Facility IP

$53,944.24

Service Code	MS-DRG 656
Min. Negotiated Rate	$35,535.17
Max. Negotiated Rate	$53,944.24
Rate for Payer: EPIC Health Plan Medicare	$35,535.17
Rate for Payer: Humana Medicare	$35,535.17
Rate for Payer: IEHP Medicare Advantage	$35,535.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$41,931.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$44,774.31
Rate for Payer: Molina Healthcare of CA Medicare	$44,774.31
Rate for Payer: Multiplan WC	$53,944.24

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