Loma Linda University Medical Center

All Charges

Charge

Type

Price

INPATIENT MS-DRG 725: BENIGN PROSTATIC HYPERTROPHY WITH MCC

Facility IP

$20,389.23

Service Code	MS-DRG 725
Min. Negotiated Rate	$14,177.48
Max. Negotiated Rate	$20,389.23
Rate for Payer: EPIC Health Plan Medicare	$14,177.48
Rate for Payer: Humana Medicare	$14,177.48
Rate for Payer: IEHP Medicare Advantage	$14,177.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,729.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,863.62
Rate for Payer: Molina Healthcare of CA Medicare	$17,863.62
Rate for Payer: Multiplan WC	$20,389.23

INPATIENT MS-DRG 726: BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC

Facility IP

$12,592.92

Service Code	MS-DRG 726
Min. Negotiated Rate	$8,434.64
Max. Negotiated Rate	$12,592.92
Rate for Payer: EPIC Health Plan Medicare	$8,434.64
Rate for Payer: Humana Medicare	$8,434.64
Rate for Payer: IEHP Medicare Advantage	$8,434.64
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,952.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,627.65
Rate for Payer: Molina Healthcare of CA Medicare	$10,627.65
Rate for Payer: Multiplan WC	$12,592.92

INPATIENT MS-DRG 727: INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC

Facility IP

$23,449.33

Service Code	MS-DRG 727
Min. Negotiated Rate	$18,457.57
Max. Negotiated Rate	$23,449.33
Rate for Payer: EPIC Health Plan Medicare	$18,457.57
Rate for Payer: Humana Medicare	$18,457.57
Rate for Payer: IEHP Medicare Advantage	$18,457.57
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,779.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,256.54
Rate for Payer: Molina Healthcare of CA Medicare	$23,256.54
Rate for Payer: Multiplan WC	$23,449.33

INPATIENT MS-DRG 728: INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC

Facility IP

$13,410.57

Service Code	MS-DRG 728
Min. Negotiated Rate	$9,213.87
Max. Negotiated Rate	$13,410.57
Rate for Payer: EPIC Health Plan Medicare	$9,213.87
Rate for Payer: Humana Medicare	$9,213.87
Rate for Payer: IEHP Medicare Advantage	$9,213.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,872.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,609.48
Rate for Payer: Molina Healthcare of CA Medicare	$11,609.48
Rate for Payer: Multiplan WC	$13,410.57

INPATIENT MS-DRG 729: OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC

Facility IP

$17,590.26

Service Code	MS-DRG 729
Min. Negotiated Rate	$11,508.74
Max. Negotiated Rate	$17,590.26
Rate for Payer: EPIC Health Plan Medicare	$11,508.74
Rate for Payer: Humana Medicare	$11,508.74
Rate for Payer: IEHP Medicare Advantage	$11,508.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,580.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,501.01
Rate for Payer: Molina Healthcare of CA Medicare	$14,501.01
Rate for Payer: Multiplan WC	$17,590.26

INPATIENT MS-DRG 730: OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility IP

$10,703.00

Service Code	MS-DRG 730
Min. Negotiated Rate	$7,203.87
Max. Negotiated Rate	$10,703.00
Rate for Payer: EPIC Health Plan Medicare	$7,203.87
Rate for Payer: Humana Medicare	$7,203.87
Rate for Payer: IEHP Medicare Advantage	$7,203.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,500.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,076.88
Rate for Payer: Molina Healthcare of CA Medicare	$9,076.88
Rate for Payer: Multiplan WC	$10,703.00

INPATIENT MS-DRG 734: PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC

Facility IP

$35,663.62

Service Code	MS-DRG 734
Min. Negotiated Rate	$24,680.10
Max. Negotiated Rate	$35,663.62
Rate for Payer: EPIC Health Plan Medicare	$24,680.10
Rate for Payer: Humana Medicare	$24,680.10
Rate for Payer: IEHP Medicare Advantage	$24,680.10
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,122.52
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,096.93
Rate for Payer: Molina Healthcare of CA Medicare	$31,096.93
Rate for Payer: Multiplan WC	$35,663.62

INPATIENT MS-DRG 735: PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC

Facility IP

$20,762.98

Service Code	MS-DRG 735
Min. Negotiated Rate	$14,394.81
Max. Negotiated Rate	$20,762.98
Rate for Payer: EPIC Health Plan Medicare	$14,394.81
Rate for Payer: Humana Medicare	$14,394.81
Rate for Payer: IEHP Medicare Advantage	$14,394.81
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,985.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,137.46
Rate for Payer: Molina Healthcare of CA Medicare	$18,137.46
Rate for Payer: Multiplan WC	$20,762.98

INPATIENT MS-DRG 736: UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC

Facility IP

$69,610.31

Service Code	MS-DRG 736
Min. Negotiated Rate	$43,976.01
Max. Negotiated Rate	$69,610.31
Rate for Payer: EPIC Health Plan Medicare	$43,976.01
Rate for Payer: Humana Medicare	$43,976.01
Rate for Payer: IEHP Medicare Advantage	$43,976.01
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$51,891.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$55,409.77
Rate for Payer: Molina Healthcare of CA Medicare	$55,409.77
Rate for Payer: Multiplan WC	$69,610.31

INPATIENT MS-DRG 737: UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC

Facility IP

$33,024.59

Service Code	MS-DRG 737
Min. Negotiated Rate	$22,430.26
Max. Negotiated Rate	$33,024.59
Rate for Payer: EPIC Health Plan Medicare	$22,430.26
Rate for Payer: Humana Medicare	$22,430.26
Rate for Payer: IEHP Medicare Advantage	$22,430.26
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,467.71
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,262.13
Rate for Payer: Molina Healthcare of CA Medicare	$28,262.13
Rate for Payer: Multiplan WC	$33,024.59

INPATIENT MS-DRG 738: UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility IP

$22,910.75

Service Code	MS-DRG 738
Min. Negotiated Rate	$15,570.39
Max. Negotiated Rate	$22,910.75
Rate for Payer: EPIC Health Plan Medicare	$15,570.39
Rate for Payer: Humana Medicare	$15,570.39
Rate for Payer: IEHP Medicare Advantage	$15,570.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,373.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,618.69
Rate for Payer: Molina Healthcare of CA Medicare	$19,618.69
Rate for Payer: Multiplan WC	$22,910.75

INPATIENT MS-DRG 739: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC

Facility IP

$63,687.59

Service Code	MS-DRG 739
Min. Negotiated Rate	$40,925.54
Max. Negotiated Rate	$63,687.59
Rate for Payer: EPIC Health Plan Medicare	$40,925.54
Rate for Payer: Humana Medicare	$40,925.54
Rate for Payer: IEHP Medicare Advantage	$40,925.54
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$48,292.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$51,566.18
Rate for Payer: Molina Healthcare of CA Medicare	$51,566.18
Rate for Payer: Multiplan WC	$63,687.59

INPATIENT MS-DRG 740: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC

Facility IP

$29,416.12

Service Code	MS-DRG 740
Min. Negotiated Rate	$20,326.81
Max. Negotiated Rate	$29,416.12
Rate for Payer: EPIC Health Plan Medicare	$20,326.81
Rate for Payer: Humana Medicare	$20,326.81
Rate for Payer: IEHP Medicare Advantage	$20,326.81
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,985.64
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,611.78
Rate for Payer: Molina Healthcare of CA Medicare	$25,611.78
Rate for Payer: Multiplan WC	$29,416.12

INPATIENT MS-DRG 741: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility IP

$21,427.22

Service Code	MS-DRG 741
Min. Negotiated Rate	$14,835.08
Max. Negotiated Rate	$21,427.22
Rate for Payer: EPIC Health Plan Medicare	$14,835.08
Rate for Payer: Humana Medicare	$14,835.08
Rate for Payer: IEHP Medicare Advantage	$14,835.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,505.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,692.20
Rate for Payer: Molina Healthcare of CA Medicare	$18,692.20
Rate for Payer: Multiplan WC	$21,427.22

INPATIENT MS-DRG 742: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC

Facility IP

$29,411.22

Service Code	MS-DRG 742
Min. Negotiated Rate	$20,269.38
Max. Negotiated Rate	$29,411.22
Rate for Payer: EPIC Health Plan Medicare	$20,269.38
Rate for Payer: Humana Medicare	$20,269.38
Rate for Payer: IEHP Medicare Advantage	$20,269.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,917.87
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,539.42
Rate for Payer: Molina Healthcare of CA Medicare	$25,539.42
Rate for Payer: Multiplan WC	$29,411.22

INPATIENT MS-DRG 743: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC

Facility IP

$19,104.81

Service Code	MS-DRG 743
Min. Negotiated Rate	$13,289.03
Max. Negotiated Rate	$19,104.81
Rate for Payer: EPIC Health Plan Medicare	$13,289.03
Rate for Payer: Humana Medicare	$13,289.03
Rate for Payer: IEHP Medicare Advantage	$13,289.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,681.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,744.18
Rate for Payer: Molina Healthcare of CA Medicare	$16,744.18
Rate for Payer: Multiplan WC	$19,104.81

INPATIENT MS-DRG 744: D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC

Facility IP

$30,981.26

Service Code	MS-DRG 744
Min. Negotiated Rate	$21,401.06
Max. Negotiated Rate	$30,981.26
Rate for Payer: EPIC Health Plan Medicare	$21,401.06
Rate for Payer: Humana Medicare	$21,401.06
Rate for Payer: IEHP Medicare Advantage	$21,401.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,253.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,965.34
Rate for Payer: Molina Healthcare of CA Medicare	$26,965.34
Rate for Payer: Multiplan WC	$30,981.26

INPATIENT MS-DRG 745: D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC

Facility IP

$18,781.66

Service Code	MS-DRG 745
Min. Negotiated Rate	$11,869.08
Max. Negotiated Rate	$18,781.66
Rate for Payer: EPIC Health Plan Medicare	$11,869.08
Rate for Payer: Humana Medicare	$11,869.08
Rate for Payer: IEHP Medicare Advantage	$11,869.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,005.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,955.04
Rate for Payer: Molina Healthcare of CA Medicare	$14,955.04
Rate for Payer: Multiplan WC	$18,781.66

INPATIENT MS-DRG 746: VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC

Facility IP

$25,515.52

Service Code	MS-DRG 746
Min. Negotiated Rate	$19,078.03
Max. Negotiated Rate	$25,515.52
Rate for Payer: EPIC Health Plan Medicare	$19,078.03
Rate for Payer: Humana Medicare	$19,078.03
Rate for Payer: IEHP Medicare Advantage	$19,078.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,512.08
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,038.32
Rate for Payer: Molina Healthcare of CA Medicare	$24,038.32
Rate for Payer: Multiplan WC	$25,515.52

INPATIENT MS-DRG 747: VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC

Facility IP

$15,971.27

Service Code	MS-DRG 747
Min. Negotiated Rate	$10,194.65
Max. Negotiated Rate	$15,971.27
Rate for Payer: EPIC Health Plan Medicare	$10,194.65
Rate for Payer: Humana Medicare	$10,194.65
Rate for Payer: IEHP Medicare Advantage	$10,194.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,029.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,845.26
Rate for Payer: Molina Healthcare of CA Medicare	$12,845.26
Rate for Payer: Multiplan WC	$15,971.27

INPATIENT MS-DRG 748: FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

Facility IP

$23,129.45

Service Code	MS-DRG 748
Min. Negotiated Rate	$16,024.19
Max. Negotiated Rate	$23,129.45
Rate for Payer: EPIC Health Plan Medicare	$16,024.19
Rate for Payer: Humana Medicare	$16,024.19
Rate for Payer: IEHP Medicare Advantage	$16,024.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,908.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,190.48
Rate for Payer: Molina Healthcare of CA Medicare	$20,190.48
Rate for Payer: Multiplan WC	$23,129.45

INPATIENT MS-DRG 749: OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC

Facility IP

$41,228.91

Service Code	MS-DRG 749
Min. Negotiated Rate	$28,549.19
Max. Negotiated Rate	$41,228.91
Rate for Payer: EPIC Health Plan Medicare	$28,549.19
Rate for Payer: Humana Medicare	$28,549.19
Rate for Payer: IEHP Medicare Advantage	$28,549.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,688.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,971.98
Rate for Payer: Molina Healthcare of CA Medicare	$35,971.98
Rate for Payer: Multiplan WC	$41,228.91

INPATIENT MS-DRG 750: OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility IP

$23,289.40

Service Code	MS-DRG 750
Min. Negotiated Rate	$15,518.60
Max. Negotiated Rate	$23,289.40
Rate for Payer: EPIC Health Plan Medicare	$15,518.60
Rate for Payer: Humana Medicare	$15,518.60
Rate for Payer: IEHP Medicare Advantage	$15,518.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,311.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,553.44
Rate for Payer: Molina Healthcare of CA Medicare	$19,553.44
Rate for Payer: Multiplan WC	$23,289.40

INPATIENT MS-DRG 754: MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC

Facility IP

$28,347.13

Service Code	MS-DRG 754
Min. Negotiated Rate	$21,064.36
Max. Negotiated Rate	$28,347.13
Rate for Payer: EPIC Health Plan Medicare	$21,064.36
Rate for Payer: Humana Medicare	$21,064.36
Rate for Payer: IEHP Medicare Advantage	$21,064.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,855.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,541.09
Rate for Payer: Molina Healthcare of CA Medicare	$26,541.09
Rate for Payer: Multiplan WC	$28,347.13

INPATIENT MS-DRG 755: MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC

Facility IP

$17,644.13

Service Code	MS-DRG 755
Min. Negotiated Rate	$12,418.59
Max. Negotiated Rate	$17,644.13
Rate for Payer: EPIC Health Plan Medicare	$12,418.59
Rate for Payer: Humana Medicare	$12,418.59
Rate for Payer: IEHP Medicare Advantage	$12,418.59
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,653.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,647.42
Rate for Payer: Molina Healthcare of CA Medicare	$15,647.42
Rate for Payer: Multiplan WC	$17,644.13

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