Loma Linda University Medical Center

All Charges

Charge

Type

Price

INPATIENT MS-DRG 657: KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC

Facility IP

$30,649.95

Service Code	MS-DRG 657
Min. Negotiated Rate	$20,970.90
Max. Negotiated Rate	$30,649.95
Rate for Payer: EPIC Health Plan Medicare	$20,970.90
Rate for Payer: Humana Medicare	$20,970.90
Rate for Payer: IEHP Medicare Advantage	$20,970.90
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,745.66
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,423.33
Rate for Payer: Molina Healthcare of CA Medicare	$26,423.33
Rate for Payer: Multiplan WC	$30,649.95

INPATIENT MS-DRG 658: KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC

Facility IP

$25,770.11

Service Code	MS-DRG 658
Min. Negotiated Rate	$16,874.35
Max. Negotiated Rate	$25,770.11
Rate for Payer: EPIC Health Plan Medicare	$16,874.35
Rate for Payer: Humana Medicare	$16,874.35
Rate for Payer: IEHP Medicare Advantage	$16,874.35
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,911.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,261.68
Rate for Payer: Molina Healthcare of CA Medicare	$21,261.68
Rate for Payer: Multiplan WC	$25,770.11

INPATIENT MS-DRG 659: KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC

Facility IP

$42,056.37

Service Code	MS-DRG 659
Min. Negotiated Rate	$29,356.55
Max. Negotiated Rate	$42,056.37
Rate for Payer: EPIC Health Plan Medicare	$29,356.55
Rate for Payer: Humana Medicare	$29,356.55
Rate for Payer: IEHP Medicare Advantage	$29,356.55
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,640.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$36,989.25
Rate for Payer: Molina Healthcare of CA Medicare	$36,989.25
Rate for Payer: Multiplan WC	$42,056.37

INPATIENT MS-DRG 660: KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC

Facility IP

$23,031.53

Service Code	MS-DRG 660
Min. Negotiated Rate	$15,359.82
Max. Negotiated Rate	$23,031.53
Rate for Payer: EPIC Health Plan Medicare	$15,359.82
Rate for Payer: Humana Medicare	$15,359.82
Rate for Payer: IEHP Medicare Advantage	$15,359.82
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,124.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,353.37
Rate for Payer: Molina Healthcare of CA Medicare	$19,353.37
Rate for Payer: Multiplan WC	$23,031.53

INPATIENT MS-DRG 661: KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC

Facility IP

$17,591.90

Service Code	MS-DRG 661
Min. Negotiated Rate	$12,009.83
Max. Negotiated Rate	$17,591.90
Rate for Payer: EPIC Health Plan Medicare	$12,009.83
Rate for Payer: Humana Medicare	$12,009.83
Rate for Payer: IEHP Medicare Advantage	$12,009.83
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,171.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,132.39
Rate for Payer: Molina Healthcare of CA Medicare	$15,132.39
Rate for Payer: Multiplan WC	$17,591.90

INPATIENT MS-DRG 662: MINOR BLADDER PROCEDURES WITH MCC

Facility IP

$49,593.18

Service Code	MS-DRG 662
Min. Negotiated Rate	$33,948.57
Max. Negotiated Rate	$49,593.18
Rate for Payer: EPIC Health Plan Medicare	$33,948.57
Rate for Payer: Humana Medicare	$33,948.57
Rate for Payer: IEHP Medicare Advantage	$33,948.57
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,059.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,775.20
Rate for Payer: Molina Healthcare of CA Medicare	$42,775.20
Rate for Payer: Multiplan WC	$49,593.18

INPATIENT MS-DRG 663: MINOR BLADDER PROCEDURES WITH CC

Facility IP

$24,888.81

Service Code	MS-DRG 663
Min. Negotiated Rate	$16,633.37
Max. Negotiated Rate	$24,888.81
Rate for Payer: EPIC Health Plan Medicare	$16,633.37
Rate for Payer: Humana Medicare	$16,633.37
Rate for Payer: IEHP Medicare Advantage	$16,633.37
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,627.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,958.05
Rate for Payer: Molina Healthcare of CA Medicare	$20,958.05
Rate for Payer: Multiplan WC	$24,888.81

INPATIENT MS-DRG 664: MINOR BLADDER PROCEDURES WITHOUT CC/MCC

Facility IP

$18,388.34

Service Code	MS-DRG 664
Min. Negotiated Rate	$12,158.48
Max. Negotiated Rate	$18,388.34
Rate for Payer: EPIC Health Plan Medicare	$12,158.48
Rate for Payer: Humana Medicare	$12,158.48
Rate for Payer: IEHP Medicare Advantage	$12,158.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,347.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,319.68
Rate for Payer: Molina Healthcare of CA Medicare	$15,319.68
Rate for Payer: Multiplan WC	$18,388.34

INPATIENT MS-DRG 665: PROSTATECTOMY WITH MCC

Facility IP

$49,945.71

Service Code	MS-DRG 665
Min. Negotiated Rate	$34,989.03
Max. Negotiated Rate	$49,945.71
Rate for Payer: EPIC Health Plan Medicare	$34,989.03
Rate for Payer: Humana Medicare	$34,989.03
Rate for Payer: IEHP Medicare Advantage	$34,989.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$41,287.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$44,086.18
Rate for Payer: Molina Healthcare of CA Medicare	$44,086.18
Rate for Payer: Multiplan WC	$49,945.71

INPATIENT MS-DRG 666: PROSTATECTOMY WITH CC

Facility IP

$28,102.31

Service Code	MS-DRG 666
Min. Negotiated Rate	$19,543.08
Max. Negotiated Rate	$28,102.31
Rate for Payer: EPIC Health Plan Medicare	$19,543.08
Rate for Payer: Humana Medicare	$19,543.08
Rate for Payer: IEHP Medicare Advantage	$19,543.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,060.83
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,624.28
Rate for Payer: Molina Healthcare of CA Medicare	$24,624.28
Rate for Payer: Multiplan WC	$28,102.31

INPATIENT MS-DRG 667: PROSTATECTOMY WITHOUT CC/MCC

Facility IP

$16,057.77

Service Code	MS-DRG 667
Min. Negotiated Rate	$12,023.34
Max. Negotiated Rate	$16,057.77
Rate for Payer: EPIC Health Plan Medicare	$12,023.34
Rate for Payer: Humana Medicare	$12,023.34
Rate for Payer: IEHP Medicare Advantage	$12,023.34
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,187.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,149.41
Rate for Payer: Molina Healthcare of CA Medicare	$15,149.41
Rate for Payer: Multiplan WC	$16,057.77

INPATIENT MS-DRG 668: TRANSURETHRAL PROCEDURES WITH MCC

Facility IP

$46,071.22

Service Code	MS-DRG 668
Min. Negotiated Rate	$31,936.33
Max. Negotiated Rate	$46,071.22
Rate for Payer: EPIC Health Plan Medicare	$31,936.33
Rate for Payer: Humana Medicare	$31,936.33
Rate for Payer: IEHP Medicare Advantage	$31,936.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,684.87
Rate for Payer: Molina Healthcare of CA Medi-Cal	$40,239.78
Rate for Payer: Molina Healthcare of CA Medicare	$40,239.78
Rate for Payer: Multiplan WC	$46,071.22

INPATIENT MS-DRG 669: TRANSURETHRAL PROCEDURES WITH CC

Facility IP

$25,691.78

Service Code	MS-DRG 669
Min. Negotiated Rate	$17,484.67
Max. Negotiated Rate	$25,691.78
Rate for Payer: EPIC Health Plan Medicare	$17,484.67
Rate for Payer: Humana Medicare	$17,484.67
Rate for Payer: IEHP Medicare Advantage	$17,484.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,631.91
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,030.68
Rate for Payer: Molina Healthcare of CA Medicare	$22,030.68
Rate for Payer: Multiplan WC	$25,691.78

INPATIENT MS-DRG 670: TRANSURETHRAL PROCEDURES WITHOUT CC/MCC

Facility IP

$16,116.52

Service Code	MS-DRG 670
Min. Negotiated Rate	$11,043.68
Max. Negotiated Rate	$16,116.52
Rate for Payer: EPIC Health Plan Medicare	$11,043.68
Rate for Payer: Humana Medicare	$11,043.68
Rate for Payer: IEHP Medicare Advantage	$11,043.68
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,031.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,915.04
Rate for Payer: Molina Healthcare of CA Medicare	$13,915.04
Rate for Payer: Multiplan WC	$16,116.52

INPATIENT MS-DRG 671: URETHRAL PROCEDURES WITH CC/MCC

Facility IP

$29,891.05

Service Code	MS-DRG 671
Min. Negotiated Rate	$19,481.13
Max. Negotiated Rate	$29,891.05
Rate for Payer: EPIC Health Plan Medicare	$19,481.13
Rate for Payer: Humana Medicare	$19,481.13
Rate for Payer: IEHP Medicare Advantage	$19,481.13
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,987.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,546.22
Rate for Payer: Molina Healthcare of CA Medicare	$24,546.22
Rate for Payer: Multiplan WC	$29,891.05

INPATIENT MS-DRG 672: URETHRAL PROCEDURES WITHOUT CC/MCC

Facility IP

$17,001.10

Service Code	MS-DRG 672
Min. Negotiated Rate	$10,761.05
Max. Negotiated Rate	$17,001.10
Rate for Payer: EPIC Health Plan Medicare	$10,761.05
Rate for Payer: Humana Medicare	$10,761.05
Rate for Payer: IEHP Medicare Advantage	$10,761.05
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,698.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,558.92
Rate for Payer: Molina Healthcare of CA Medicare	$13,558.92
Rate for Payer: Multiplan WC	$17,001.10

INPATIENT MS-DRG 673: OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC

Facility IP

$57,023.93

Service Code	MS-DRG 673
Min. Negotiated Rate	$41,845.53
Max. Negotiated Rate	$57,023.93
Rate for Payer: EPIC Health Plan Medicare	$41,845.53
Rate for Payer: Humana Medicare	$41,845.53
Rate for Payer: IEHP Medicare Advantage	$41,845.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$49,377.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$52,725.37
Rate for Payer: Molina Healthcare of CA Medicare	$52,725.37
Rate for Payer: Multiplan WC	$57,023.93

INPATIENT MS-DRG 674: OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC

Facility IP

$38,687.81

Service Code	MS-DRG 674
Min. Negotiated Rate	$27,029.02
Max. Negotiated Rate	$38,687.81
Rate for Payer: EPIC Health Plan Medicare	$27,029.02
Rate for Payer: Humana Medicare	$27,029.02
Rate for Payer: IEHP Medicare Advantage	$27,029.02
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,894.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,056.57
Rate for Payer: Molina Healthcare of CA Medicare	$34,056.57
Rate for Payer: Multiplan WC	$38,687.81

INPATIENT MS-DRG 675: OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC

Facility IP

$27,522.94

Service Code	MS-DRG 675
Min. Negotiated Rate	$18,069.09
Max. Negotiated Rate	$27,522.94
Rate for Payer: EPIC Health Plan Medicare	$18,069.09
Rate for Payer: Humana Medicare	$18,069.09
Rate for Payer: IEHP Medicare Advantage	$18,069.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,321.53
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,767.05
Rate for Payer: Molina Healthcare of CA Medicare	$22,767.05
Rate for Payer: Multiplan WC	$27,522.94

INPATIENT MS-DRG 682: RENAL FAILURE WITH MCC

Facility IP

$24,262.10

Service Code	MS-DRG 682
Min. Negotiated Rate	$17,104.06
Max. Negotiated Rate	$24,262.10
Rate for Payer: EPIC Health Plan Medicare	$17,104.06
Rate for Payer: Humana Medicare	$17,104.06
Rate for Payer: IEHP Medicare Advantage	$17,104.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,182.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,551.12
Rate for Payer: Molina Healthcare of CA Medicare	$21,551.12
Rate for Payer: Multiplan WC	$24,262.10

INPATIENT MS-DRG 683: RENAL FAILURE WITH CC

Facility IP

$14,605.24

Service Code	MS-DRG 683
Min. Negotiated Rate	$10,347.80
Max. Negotiated Rate	$14,605.24
Rate for Payer: EPIC Health Plan Medicare	$10,347.80
Rate for Payer: Humana Medicare	$10,347.80
Rate for Payer: IEHP Medicare Advantage	$10,347.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,210.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,038.23
Rate for Payer: Molina Healthcare of CA Medicare	$13,038.23
Rate for Payer: Multiplan WC	$14,605.24

INPATIENT MS-DRG 684: RENAL FAILURE WITHOUT CC/MCC

Facility IP

$9,870.66

Service Code	MS-DRG 684
Min. Negotiated Rate	$7,056.36
Max. Negotiated Rate	$9,870.66
Rate for Payer: EPIC Health Plan Medicare	$7,056.36
Rate for Payer: Humana Medicare	$7,056.36
Rate for Payer: IEHP Medicare Advantage	$7,056.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,326.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,891.01
Rate for Payer: Molina Healthcare of CA Medicare	$8,891.01
Rate for Payer: Multiplan WC	$9,870.66

INPATIENT MS-DRG 686: KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC

Facility IP

$27,708.99

Service Code	MS-DRG 686
Min. Negotiated Rate	$20,916.85
Max. Negotiated Rate	$27,708.99
Rate for Payer: EPIC Health Plan Medicare	$20,916.85
Rate for Payer: Humana Medicare	$20,916.85
Rate for Payer: IEHP Medicare Advantage	$20,916.85
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,681.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,355.23
Rate for Payer: Molina Healthcare of CA Medicare	$26,355.23
Rate for Payer: Multiplan WC	$27,708.99

INPATIENT MS-DRG 687: KIDNEY AND URINARY TRACT NEOPLASMS WITH CC

Facility IP

$16,970.08

Service Code	MS-DRG 687
Min. Negotiated Rate	$11,974.93
Max. Negotiated Rate	$16,970.08
Rate for Payer: EPIC Health Plan Medicare	$11,974.93
Rate for Payer: Humana Medicare	$11,974.93
Rate for Payer: IEHP Medicare Advantage	$11,974.93
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,130.42
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,088.41
Rate for Payer: Molina Healthcare of CA Medicare	$15,088.41
Rate for Payer: Multiplan WC	$16,970.08

INPATIENT MS-DRG 688: KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC

Facility IP

$14,140.11

Service Code	MS-DRG 688
Min. Negotiated Rate	$8,997.67
Max. Negotiated Rate	$14,140.11
Rate for Payer: EPIC Health Plan Medicare	$8,997.67
Rate for Payer: Humana Medicare	$8,997.67
Rate for Payer: IEHP Medicare Advantage	$8,997.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,617.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,337.06
Rate for Payer: Molina Healthcare of CA Medicare	$11,337.06
Rate for Payer: Multiplan WC	$14,140.11

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