Loma Linda University Medical Center

All Charges

Charge

Type

Price

INPATIENT MS-DRG 689: KIDNEY AND URINARY TRACT INFECTIONS WITH MCC

Facility IP

$18,721.27

Service Code	MS-DRG 689
Min. Negotiated Rate	$13,428.67
Max. Negotiated Rate	$18,721.27
Rate for Payer: EPIC Health Plan Medicare	$13,428.67
Rate for Payer: Humana Medicare	$13,428.67
Rate for Payer: IEHP Medicare Advantage	$13,428.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,845.83
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,920.12
Rate for Payer: Molina Healthcare of CA Medicare	$16,920.12
Rate for Payer: Multiplan WC	$18,721.27

INPATIENT MS-DRG 690: KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC

Facility IP

$12,984.61

Service Code	MS-DRG 690
Min. Negotiated Rate	$9,290.44
Max. Negotiated Rate	$12,984.61
Rate for Payer: EPIC Health Plan Medicare	$9,290.44
Rate for Payer: Humana Medicare	$9,290.44
Rate for Payer: IEHP Medicare Advantage	$9,290.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,962.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,705.95
Rate for Payer: Molina Healthcare of CA Medicare	$11,705.95
Rate for Payer: Multiplan WC	$12,984.61

INPATIENT MS-DRG 693: URINARY STONES WITH MCC

Facility IP

$23,351.41

Service Code	MS-DRG 693
Min. Negotiated Rate	$16,152.56
Max. Negotiated Rate	$23,351.41
Rate for Payer: EPIC Health Plan Medicare	$16,152.56
Rate for Payer: Humana Medicare	$16,152.56
Rate for Payer: IEHP Medicare Advantage	$16,152.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,060.02
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,352.23
Rate for Payer: Molina Healthcare of CA Medicare	$20,352.23
Rate for Payer: Multiplan WC	$23,351.41

INPATIENT MS-DRG 694: URINARY STONES WITHOUT MCC

Facility IP

$13,009.09

Service Code	MS-DRG 694
Min. Negotiated Rate	$9,017.94
Max. Negotiated Rate	$13,009.09
Rate for Payer: EPIC Health Plan Medicare	$9,017.94
Rate for Payer: Humana Medicare	$9,017.94
Rate for Payer: IEHP Medicare Advantage	$9,017.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,641.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,362.60
Rate for Payer: Molina Healthcare of CA Medicare	$11,362.60
Rate for Payer: Multiplan WC	$13,009.09

INPATIENT MS-DRG 695: KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC

Facility IP

$18,740.86

Service Code	MS-DRG 695
Min. Negotiated Rate	$13,671.88
Max. Negotiated Rate	$18,740.86
Rate for Payer: EPIC Health Plan Medicare	$13,671.88
Rate for Payer: Humana Medicare	$13,671.88
Rate for Payer: IEHP Medicare Advantage	$13,671.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,132.82
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,226.57
Rate for Payer: Molina Healthcare of CA Medicare	$17,226.57
Rate for Payer: Multiplan WC	$18,740.86

INPATIENT MS-DRG 696: KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC

Facility IP

$11,310.12

Service Code	MS-DRG 696
Min. Negotiated Rate	$7,997.74
Max. Negotiated Rate	$11,310.12
Rate for Payer: EPIC Health Plan Medicare	$7,997.74
Rate for Payer: Humana Medicare	$7,997.74
Rate for Payer: IEHP Medicare Advantage	$7,997.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,437.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,077.15
Rate for Payer: Molina Healthcare of CA Medicare	$10,077.15
Rate for Payer: Multiplan WC	$11,310.12

INPATIENT MS-DRG 697: URETHRAL STRICTURE

Facility IP

$16,196.49

Service Code	MS-DRG 697
Min. Negotiated Rate	$12,738.40
Max. Negotiated Rate	$16,196.49
Rate for Payer: EPIC Health Plan Medicare	$12,738.40
Rate for Payer: Humana Medicare	$12,738.40
Rate for Payer: IEHP Medicare Advantage	$12,738.40
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,031.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,050.38
Rate for Payer: Molina Healthcare of CA Medicare	$16,050.38
Rate for Payer: Multiplan WC	$16,196.49

INPATIENT MS-DRG 698: OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC

Facility IP

$26,153.64

Service Code	MS-DRG 698
Min. Negotiated Rate	$18,833.67
Max. Negotiated Rate	$26,153.64
Rate for Payer: EPIC Health Plan Medicare	$18,833.67
Rate for Payer: Humana Medicare	$18,833.67
Rate for Payer: IEHP Medicare Advantage	$18,833.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,223.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,730.42
Rate for Payer: Molina Healthcare of CA Medicare	$23,730.42
Rate for Payer: Multiplan WC	$26,153.64

INPATIENT MS-DRG 699: OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC

Facility IP

$16,518.01

Service Code	MS-DRG 699
Min. Negotiated Rate	$11,699.05
Max. Negotiated Rate	$16,518.01
Rate for Payer: EPIC Health Plan Medicare	$11,699.05
Rate for Payer: Humana Medicare	$11,699.05
Rate for Payer: IEHP Medicare Advantage	$11,699.05
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,804.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,740.80
Rate for Payer: Molina Healthcare of CA Medicare	$14,740.80
Rate for Payer: Multiplan WC	$16,518.01

INPATIENT MS-DRG 700: OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC

Facility IP

$12,090.25

Service Code	MS-DRG 700
Min. Negotiated Rate	$8,180.16
Max. Negotiated Rate	$12,090.25
Rate for Payer: EPIC Health Plan Medicare	$8,180.16
Rate for Payer: Humana Medicare	$8,180.16
Rate for Payer: IEHP Medicare Advantage	$8,180.16
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,652.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,307.00
Rate for Payer: Molina Healthcare of CA Medicare	$10,307.00
Rate for Payer: Multiplan WC	$12,090.25

INPATIENT MS-DRG 707: MAJOR MALE PELVIC PROCEDURES WITH CC/MCC

Facility IP

$32,564.35

Service Code	MS-DRG 707
Min. Negotiated Rate	$22,296.25
Max. Negotiated Rate	$32,564.35
Rate for Payer: EPIC Health Plan Medicare	$22,296.25
Rate for Payer: Humana Medicare	$22,296.25
Rate for Payer: IEHP Medicare Advantage	$22,296.25
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,309.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,093.28
Rate for Payer: Molina Healthcare of CA Medicare	$28,093.28
Rate for Payer: Multiplan WC	$32,564.35

INPATIENT MS-DRG 708: MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC

Facility IP

$24,231.09

Service Code	MS-DRG 708
Min. Negotiated Rate	$16,627.74
Max. Negotiated Rate	$24,231.09
Rate for Payer: EPIC Health Plan Medicare	$16,627.74
Rate for Payer: Humana Medicare	$16,627.74
Rate for Payer: IEHP Medicare Advantage	$16,627.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,620.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,950.95
Rate for Payer: Molina Healthcare of CA Medicare	$20,950.95
Rate for Payer: Multiplan WC	$24,231.09

INPATIENT MS-DRG 709: PENIS PROCEDURES WITH CC/MCC

Facility IP

$39,365.11

Service Code	MS-DRG 709
Min. Negotiated Rate	$24,648.55
Max. Negotiated Rate	$39,365.11
Rate for Payer: EPIC Health Plan Medicare	$24,648.55
Rate for Payer: Humana Medicare	$24,648.55
Rate for Payer: IEHP Medicare Advantage	$24,648.55
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,085.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,057.17
Rate for Payer: Molina Healthcare of CA Medicare	$31,057.17
Rate for Payer: Multiplan WC	$39,365.11

INPATIENT MS-DRG 710: PENIS PROCEDURES WITHOUT CC/MCC

Facility IP

$23,524.41

Service Code	MS-DRG 710
Min. Negotiated Rate	$14,812.55
Max. Negotiated Rate	$23,524.41
Rate for Payer: EPIC Health Plan Medicare	$14,812.55
Rate for Payer: Humana Medicare	$14,812.55
Rate for Payer: IEHP Medicare Advantage	$14,812.55
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,478.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,663.81
Rate for Payer: Molina Healthcare of CA Medicare	$18,663.81
Rate for Payer: Multiplan WC	$23,524.41

INPATIENT MS-DRG 711: TESTES PROCEDURES WITH CC/MCC

Facility IP

$33,349.37

Service Code	MS-DRG 711
Min. Negotiated Rate	$24,109.18
Max. Negotiated Rate	$33,349.37
Rate for Payer: EPIC Health Plan Medicare	$24,109.18
Rate for Payer: Humana Medicare	$24,109.18
Rate for Payer: IEHP Medicare Advantage	$24,109.18
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,448.83
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,377.57
Rate for Payer: Molina Healthcare of CA Medicare	$30,377.57
Rate for Payer: Multiplan WC	$33,349.37

INPATIENT MS-DRG 712: TESTES PROCEDURES WITHOUT CC/MCC

Facility IP

$20,263.57

Service Code	MS-DRG 712
Min. Negotiated Rate	$13,586.30
Max. Negotiated Rate	$20,263.57
Rate for Payer: EPIC Health Plan Medicare	$13,586.30
Rate for Payer: Humana Medicare	$13,586.30
Rate for Payer: IEHP Medicare Advantage	$13,586.30
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,031.83
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,118.74
Rate for Payer: Molina Healthcare of CA Medicare	$17,118.74
Rate for Payer: Multiplan WC	$20,263.57

INPATIENT MS-DRG 713: TRANSURETHRAL PROSTATECTOMY WITH CC/MCC

Facility IP

$24,185.39

Service Code	MS-DRG 713
Min. Negotiated Rate	$16,539.92
Max. Negotiated Rate	$24,185.39
Rate for Payer: EPIC Health Plan Medicare	$16,539.92
Rate for Payer: Humana Medicare	$16,539.92
Rate for Payer: IEHP Medicare Advantage	$16,539.92
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,517.11
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,840.30
Rate for Payer: Molina Healthcare of CA Medicare	$20,840.30
Rate for Payer: Multiplan WC	$24,185.39

INPATIENT MS-DRG 714: TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC

Facility IP

$15,638.33

Service Code	MS-DRG 714
Min. Negotiated Rate	$10,997.52
Max. Negotiated Rate	$15,638.33
Rate for Payer: EPIC Health Plan Medicare	$10,997.52
Rate for Payer: Humana Medicare	$10,997.52
Rate for Payer: IEHP Medicare Advantage	$10,997.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,977.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,856.88
Rate for Payer: Molina Healthcare of CA Medicare	$13,856.88
Rate for Payer: Multiplan WC	$15,638.33

INPATIENT MS-DRG 715: OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC

Facility IP

$36,447.00

Service Code	MS-DRG 715
Min. Negotiated Rate	$25,061.83
Max. Negotiated Rate	$36,447.00
Rate for Payer: EPIC Health Plan Medicare	$25,061.83
Rate for Payer: Humana Medicare	$25,061.83
Rate for Payer: IEHP Medicare Advantage	$25,061.83
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,572.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,577.91
Rate for Payer: Molina Healthcare of CA Medicare	$31,577.91
Rate for Payer: Multiplan WC	$36,447.00

INPATIENT MS-DRG 716: OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC

Facility IP

$21,450.07

Service Code	MS-DRG 716
Min. Negotiated Rate	$16,218.99
Max. Negotiated Rate	$21,450.07
Rate for Payer: EPIC Health Plan Medicare	$16,218.99
Rate for Payer: Humana Medicare	$16,218.99
Rate for Payer: IEHP Medicare Advantage	$16,218.99
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,138.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,435.93
Rate for Payer: Molina Healthcare of CA Medicare	$20,435.93
Rate for Payer: Multiplan WC	$21,450.07

INPATIENT MS-DRG 717: OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC

Facility IP

$28,892.23

Service Code	MS-DRG 717
Min. Negotiated Rate	$20,627.45
Max. Negotiated Rate	$28,892.23
Rate for Payer: EPIC Health Plan Medicare	$20,627.45
Rate for Payer: Humana Medicare	$20,627.45
Rate for Payer: IEHP Medicare Advantage	$20,627.45
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,340.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,990.59
Rate for Payer: Molina Healthcare of CA Medicare	$25,990.59
Rate for Payer: Multiplan WC	$28,892.23

INPATIENT MS-DRG 718: OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC

Facility IP

$20,710.75

Service Code	MS-DRG 718
Min. Negotiated Rate	$13,444.41
Max. Negotiated Rate	$20,710.75
Rate for Payer: EPIC Health Plan Medicare	$13,444.41
Rate for Payer: Humana Medicare	$13,444.41
Rate for Payer: IEHP Medicare Advantage	$13,444.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,864.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,939.96
Rate for Payer: Molina Healthcare of CA Medicare	$16,939.96
Rate for Payer: Multiplan WC	$20,710.75

INPATIENT MS-DRG 722: MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC

Facility IP

$27,707.36

Service Code	MS-DRG 722
Min. Negotiated Rate	$21,315.47
Max. Negotiated Rate	$27,707.36
Rate for Payer: EPIC Health Plan Medicare	$21,315.47
Rate for Payer: Humana Medicare	$21,315.47
Rate for Payer: IEHP Medicare Advantage	$21,315.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,152.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,857.49
Rate for Payer: Molina Healthcare of CA Medicare	$26,857.49
Rate for Payer: Multiplan WC	$27,707.36

INPATIENT MS-DRG 723: MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC

Facility IP

$18,807.78

Service Code	MS-DRG 723
Min. Negotiated Rate	$12,751.90
Max. Negotiated Rate	$18,807.78
Rate for Payer: EPIC Health Plan Medicare	$12,751.90
Rate for Payer: Humana Medicare	$12,751.90
Rate for Payer: IEHP Medicare Advantage	$12,751.90
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,047.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,067.39
Rate for Payer: Molina Healthcare of CA Medicare	$16,067.39
Rate for Payer: Multiplan WC	$18,807.78

INPATIENT MS-DRG 724: MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility IP

$12,486.84

Service Code	MS-DRG 724
Min. Negotiated Rate	$9,319.72
Max. Negotiated Rate	$12,486.84
Rate for Payer: EPIC Health Plan Medicare	$9,319.72
Rate for Payer: Humana Medicare	$9,319.72
Rate for Payer: IEHP Medicare Advantage	$9,319.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,997.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,742.85
Rate for Payer: Molina Healthcare of CA Medicare	$11,742.85
Rate for Payer: Multiplan WC	$12,486.84

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