Loma Linda University Medical Center

All Charges

Charge

Type

Price

INPATIENT MS-DRG 756: MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility IP

$16,268.30

Service Code	MS-DRG 756
Min. Negotiated Rate	$11,348.85
Max. Negotiated Rate	$16,268.30
Rate for Payer: EPIC Health Plan Medicare	$11,348.85
Rate for Payer: Humana Medicare	$11,348.85
Rate for Payer: IEHP Medicare Advantage	$11,348.85
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,391.64
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,299.55
Rate for Payer: Molina Healthcare of CA Medicare	$14,299.55
Rate for Payer: Multiplan WC	$16,268.30

INPATIENT MS-DRG 757: INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC

Facility IP

$22,395.03

Service Code	MS-DRG 757
Min. Negotiated Rate	$17,000.47
Max. Negotiated Rate	$22,395.03
Rate for Payer: EPIC Health Plan Medicare	$17,000.47
Rate for Payer: Humana Medicare	$17,000.47
Rate for Payer: IEHP Medicare Advantage	$17,000.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,060.55
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,420.59
Rate for Payer: Molina Healthcare of CA Medicare	$21,420.59
Rate for Payer: Multiplan WC	$22,395.03

INPATIENT MS-DRG 758: INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC

Facility IP

$15,594.26

Service Code	MS-DRG 758
Min. Negotiated Rate	$11,381.50
Max. Negotiated Rate	$15,594.26
Rate for Payer: EPIC Health Plan Medicare	$11,381.50
Rate for Payer: Humana Medicare	$11,381.50
Rate for Payer: IEHP Medicare Advantage	$11,381.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,430.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,340.69
Rate for Payer: Molina Healthcare of CA Medicare	$14,340.69
Rate for Payer: Multiplan WC	$15,594.26

INPATIENT MS-DRG 759: INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility IP

$10,125.25

Service Code	MS-DRG 759
Min. Negotiated Rate	$7,480.89
Max. Negotiated Rate	$10,125.25
Rate for Payer: EPIC Health Plan Medicare	$7,480.89
Rate for Payer: Humana Medicare	$7,480.89
Rate for Payer: IEHP Medicare Advantage	$7,480.89
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,827.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,425.92
Rate for Payer: Molina Healthcare of CA Medicare	$9,425.92
Rate for Payer: Multiplan WC	$10,125.25

INPATIENT MS-DRG 760: MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC

Facility IP

$15,775.42

Service Code	MS-DRG 760
Min. Negotiated Rate	$11,413.03
Max. Negotiated Rate	$15,775.42
Rate for Payer: EPIC Health Plan Medicare	$11,413.03
Rate for Payer: Humana Medicare	$11,413.03
Rate for Payer: IEHP Medicare Advantage	$11,413.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,467.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,380.42
Rate for Payer: Molina Healthcare of CA Medicare	$14,380.42
Rate for Payer: Multiplan WC	$15,775.42

INPATIENT MS-DRG 761: MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC

Facility IP

$9,232.52

Service Code	MS-DRG 761
Min. Negotiated Rate	$7,023.71
Max. Negotiated Rate	$9,232.52
Rate for Payer: EPIC Health Plan Medicare	$7,023.71
Rate for Payer: Humana Medicare	$7,023.71
Rate for Payer: IEHP Medicare Advantage	$7,023.71
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,287.98
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,849.87
Rate for Payer: Molina Healthcare of CA Medicare	$8,849.87
Rate for Payer: Multiplan WC	$9,232.52

INPATIENT MS-DRG 768: VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C

Facility IP

$18,716.38

Service Code	MS-DRG 768
Min. Negotiated Rate	$6,819.00
Max. Negotiated Rate	$18,716.38
Rate for Payer: EPIC Health Plan Medicare	$13,920.73
Rate for Payer: Humana Medicare	$13,920.73
Rate for Payer: IEHP Medicare Advantage	$13,920.73
Rate for Payer: Kaiser Permanente of CA Commercial	$9,224.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,426.46
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,540.12
Rate for Payer: Molina Healthcare of CA Medicare	$17,540.12
Rate for Payer: Multiplan WC	$18,716.38
Rate for Payer: United Healthcare All Other HMO/non HMO	$8,090.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$6,819.00

INPATIENT MS-DRG 769: POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES

Facility IP

$27,113.30

Service Code	MS-DRG 769
Min. Negotiated Rate	$17,589.39
Max. Negotiated Rate	$27,113.30
Rate for Payer: EPIC Health Plan Medicare	$17,589.39
Rate for Payer: Humana Medicare	$17,589.39
Rate for Payer: IEHP Medicare Advantage	$17,589.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,755.48
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,162.63
Rate for Payer: Molina Healthcare of CA Medicare	$22,162.63
Rate for Payer: Multiplan WC	$27,113.30

INPATIENT MS-DRG 770: ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility IP

$14,130.32

Service Code	MS-DRG 770
Min. Negotiated Rate	$9,198.10
Max. Negotiated Rate	$14,130.32
Rate for Payer: EPIC Health Plan Medicare	$9,198.10
Rate for Payer: Humana Medicare	$9,198.10
Rate for Payer: IEHP Medicare Advantage	$9,198.10
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,853.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,589.61
Rate for Payer: Molina Healthcare of CA Medicare	$11,589.61
Rate for Payer: Multiplan WC	$14,130.32

INPATIENT MS-DRG 776: POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES

Facility IP

$11,377.04

Service Code	MS-DRG 776
Min. Negotiated Rate	$8,274.75
Max. Negotiated Rate	$11,377.04
Rate for Payer: EPIC Health Plan Medicare	$8,274.75
Rate for Payer: Humana Medicare	$8,274.75
Rate for Payer: IEHP Medicare Advantage	$8,274.75
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,764.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,426.18
Rate for Payer: Molina Healthcare of CA Medicare	$10,426.18
Rate for Payer: Multiplan WC	$11,377.04

INPATIENT MS-DRG 779: ABORTION WITHOUT D&C

Facility IP

$16,624.09

Service Code	MS-DRG 779
Min. Negotiated Rate	$11,343.22
Max. Negotiated Rate	$16,624.09
Rate for Payer: EPIC Health Plan Medicare	$11,343.22
Rate for Payer: Humana Medicare	$11,343.22
Rate for Payer: IEHP Medicare Advantage	$11,343.22
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,385.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,292.46
Rate for Payer: Molina Healthcare of CA Medicare	$14,292.46
Rate for Payer: Multiplan WC	$16,624.09

INPATIENT MS-DRG 783: CESAREAN SECTION WITH STERILIZATION WITH MCC

Facility IP

$31,493.72

Service Code	MS-DRG 783
Min. Negotiated Rate	$7,879.00
Max. Negotiated Rate	$31,493.72
Rate for Payer: EPIC Health Plan Medicare	$20,155.65
Rate for Payer: Heritage Provider Network Senior	$7,879.00
Rate for Payer: Humana Medicare	$20,155.65
Rate for Payer: IEHP Medicare Advantage	$20,155.65
Rate for Payer: Kaiser Permanente of CA Commercial	$12,936.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,783.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,396.12
Rate for Payer: Molina Healthcare of CA Medicare	$25,396.12
Rate for Payer: Multiplan WC	$31,493.72
Rate for Payer: United Healthcare All Other HMO/non HMO	$11,507.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$9,678.00

INPATIENT MS-DRG 784: CESAREAN SECTION WITH STERILIZATION WITH CC

Facility IP

$17,038.63

Service Code	MS-DRG 784
Min. Negotiated Rate	$7,879.00
Max. Negotiated Rate	$17,038.63
Rate for Payer: EPIC Health Plan Medicare	$11,736.22
Rate for Payer: Heritage Provider Network Senior	$7,879.00
Rate for Payer: Humana Medicare	$11,736.22
Rate for Payer: IEHP Medicare Advantage	$11,736.22
Rate for Payer: Kaiser Permanente of CA Commercial	$12,936.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,848.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,787.64
Rate for Payer: Molina Healthcare of CA Medicare	$14,787.64
Rate for Payer: Multiplan WC	$17,038.63
Rate for Payer: United Healthcare All Other HMO/non HMO	$11,507.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$9,678.00

INPATIENT MS-DRG 785: CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC

Facility IP

$14,885.96

Service Code	MS-DRG 785
Min. Negotiated Rate	$7,879.00
Max. Negotiated Rate	$14,885.96
Rate for Payer: EPIC Health Plan Medicare	$9,959.29
Rate for Payer: Heritage Provider Network Senior	$7,879.00
Rate for Payer: Humana Medicare	$9,959.29
Rate for Payer: IEHP Medicare Advantage	$9,959.29
Rate for Payer: Kaiser Permanente of CA Commercial	$12,936.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,751.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,548.71
Rate for Payer: Molina Healthcare of CA Medicare	$12,548.71
Rate for Payer: Multiplan WC	$14,885.96
Rate for Payer: United Healthcare All Other HMO/non HMO	$11,507.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$9,678.00

INPATIENT MS-DRG 786: CESAREAN SECTION WITHOUT STERILIZATION WITH MCC

Facility IP

$26,357.65

Service Code	MS-DRG 786
Min. Negotiated Rate	$7,879.00
Max. Negotiated Rate	$26,357.65
Rate for Payer: EPIC Health Plan Medicare	$19,904.54
Rate for Payer: Heritage Provider Network Senior	$7,879.00
Rate for Payer: Humana Medicare	$19,904.54
Rate for Payer: IEHP Medicare Advantage	$19,904.54
Rate for Payer: Kaiser Permanente of CA Commercial	$12,936.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,487.36
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,079.72
Rate for Payer: Molina Healthcare of CA Medicare	$25,079.72
Rate for Payer: Multiplan WC	$26,357.65
Rate for Payer: United Healthcare All Other HMO/non HMO	$11,507.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$9,678.00

INPATIENT MS-DRG 787: CESAREAN SECTION WITHOUT STERILIZATION WITH CC

Facility IP

$17,386.26

Service Code	MS-DRG 787
Min. Negotiated Rate	$7,879.00
Max. Negotiated Rate	$17,386.26
Rate for Payer: EPIC Health Plan Medicare	$12,040.25
Rate for Payer: Heritage Provider Network Senior	$7,879.00
Rate for Payer: Humana Medicare	$12,040.25
Rate for Payer: IEHP Medicare Advantage	$12,040.25
Rate for Payer: Kaiser Permanente of CA Commercial	$12,936.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,207.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,170.72
Rate for Payer: Molina Healthcare of CA Medicare	$15,170.72
Rate for Payer: Multiplan WC	$17,386.26
Rate for Payer: United Healthcare All Other HMO/non HMO	$11,507.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$9,678.00

INPATIENT MS-DRG 788: CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC

Facility IP

$14,238.03

Service Code	MS-DRG 788
Min. Negotiated Rate	$7,879.00
Max. Negotiated Rate	$14,238.03
Rate for Payer: EPIC Health Plan Medicare	$9,832.05
Rate for Payer: Heritage Provider Network Senior	$7,879.00
Rate for Payer: Humana Medicare	$9,832.05
Rate for Payer: IEHP Medicare Advantage	$9,832.05
Rate for Payer: Kaiser Permanente of CA Commercial	$12,936.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,601.82
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,388.38
Rate for Payer: Molina Healthcare of CA Medicare	$12,388.38
Rate for Payer: Multiplan WC	$14,238.03
Rate for Payer: United Healthcare All Other HMO/non HMO	$11,507.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$9,678.00

INPATIENT MS-DRG 789: NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY

Facility IP

$29,798.02

Service Code	MS-DRG 789
Min. Negotiated Rate	$2,679.00
Max. Negotiated Rate	$29,798.02
Rate for Payer: EPIC Health Plan Medicare	$20,691.63
Rate for Payer: Humana Medicare	$20,691.63
Rate for Payer: IEHP Medicare Advantage	$20,691.63
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,416.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,071.45
Rate for Payer: Molina Healthcare of CA Medicare	$26,071.45
Rate for Payer: Multiplan WC	$29,798.02
Rate for Payer: United Healthcare All Other HMO/non HMO	$3,174.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$2,679.00

INPATIENT MS-DRG 790: EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE

Facility IP

$98,267.53

Service Code	MS-DRG 790
Min. Negotiated Rate	$4,956.00
Max. Negotiated Rate	$98,267.53
Rate for Payer: EPIC Health Plan Medicare	$67,768.21
Rate for Payer: Humana Medicare	$67,768.21
Rate for Payer: IEHP Medicare Advantage	$67,768.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$79,966.49
Rate for Payer: Molina Healthcare of CA Medi-Cal	$85,387.94
Rate for Payer: Molina Healthcare of CA Medicare	$85,387.94
Rate for Payer: Multiplan WC	$98,267.53
Rate for Payer: United Healthcare All Other HMO/non HMO	$5,885.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$4,956.00

INPATIENT MS-DRG 791: PREMATURITY WITH MAJOR PROBLEMS

Facility IP

$67,111.64

Service Code	MS-DRG 791
Min. Negotiated Rate	$4,550.00
Max. Negotiated Rate	$67,111.64
Rate for Payer: EPIC Health Plan Medicare	$46,346.33
Rate for Payer: Humana Medicare	$46,346.33
Rate for Payer: IEHP Medicare Advantage	$46,346.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$54,688.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$58,396.38
Rate for Payer: Molina Healthcare of CA Medicare	$58,396.38
Rate for Payer: Multiplan WC	$67,111.64
Rate for Payer: United Healthcare All Other HMO/non HMO	$5,408.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$4,550.00

INPATIENT MS-DRG 792: PREMATURITY WITHOUT MAJOR PROBLEMS

Facility IP

$40,494.49

Service Code	MS-DRG 792
Min. Negotiated Rate	$2,679.00
Max. Negotiated Rate	$40,494.49
Rate for Payer: EPIC Health Plan Medicare	$28,045.84
Rate for Payer: Humana Medicare	$28,045.84
Rate for Payer: IEHP Medicare Advantage	$28,045.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,094.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,337.76
Rate for Payer: Molina Healthcare of CA Medicare	$35,337.76
Rate for Payer: Multiplan WC	$40,494.49
Rate for Payer: United Healthcare All Other HMO/non HMO	$3,174.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$2,679.00

INPATIENT MS-DRG 793: FULL TERM NEONATE WITH MAJOR PROBLEMS

Facility IP

$68,937.91

Service Code	MS-DRG 793
Min. Negotiated Rate	$4,550.00
Max. Negotiated Rate	$68,937.91
Rate for Payer: EPIC Health Plan Medicare	$47,603.00
Rate for Payer: Humana Medicare	$47,603.00
Rate for Payer: IEHP Medicare Advantage	$47,603.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$56,171.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$59,979.78
Rate for Payer: Molina Healthcare of CA Medicare	$59,979.78
Rate for Payer: Multiplan WC	$68,937.91
Rate for Payer: United Healthcare All Other HMO/non HMO	$5,408.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$4,550.00

INPATIENT MS-DRG 794: NEONATE WITH OTHER SIGNIFICANT PROBLEMS

Facility IP

$24,400.82

Service Code	MS-DRG 794
Min. Negotiated Rate	$2,679.00
Max. Negotiated Rate	$24,400.82
Rate for Payer: EPIC Health Plan Medicare	$16,981.32
Rate for Payer: Humana Medicare	$16,981.32
Rate for Payer: IEHP Medicare Advantage	$16,981.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,037.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,396.46
Rate for Payer: Molina Healthcare of CA Medicare	$21,396.46
Rate for Payer: Multiplan WC	$24,400.82
Rate for Payer: United Healthcare All Other HMO/non HMO	$3,174.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$2,679.00

INPATIENT MS-DRG 795: NORMAL NEWBORN

Facility IP

$3,303.28

Service Code	MS-DRG 795
Min. Negotiated Rate	$876.00
Max. Negotiated Rate	$3,303.28
Rate for Payer: EPIC Health Plan Medicare	$2,475.62
Rate for Payer: Humana Medicare	$2,475.62
Rate for Payer: IEHP Medicare Advantage	$2,475.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$2,921.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$3,119.28
Rate for Payer: Molina Healthcare of CA Medicare	$3,119.28
Rate for Payer: Multiplan WC	$3,303.28
Rate for Payer: United Healthcare All Other HMO/non HMO	$1,044.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$876.00

INPATIENT MS-DRG 796: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC

Facility IP

$21,428.86

Service Code	MS-DRG 796
Min. Negotiated Rate	$5,677.00
Max. Negotiated Rate	$21,428.86
Rate for Payer: EPIC Health Plan Medicare	$16,176.18
Rate for Payer: Heritage Provider Network Senior	$5,677.00
Rate for Payer: Humana Medicare	$16,176.18
Rate for Payer: IEHP Medicare Advantage	$16,176.18
Rate for Payer: Kaiser Permanente of CA Commercial	$9,224.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,087.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,381.99
Rate for Payer: Molina Healthcare of CA Medicare	$20,381.99
Rate for Payer: Multiplan WC	$21,428.86
Rate for Payer: United Healthcare All Other HMO/non HMO	$8,090.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$6,819.00

Price Transparency.

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