Loma Linda University Medical Center

All Charges

Charge

Type

Price

INPATIENT MS-DRG 797: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC

Facility IP

$15,143.82

Service Code	MS-DRG 797
Min. Negotiated Rate	$5,677.00
Max. Negotiated Rate	$15,143.82
Rate for Payer: EPIC Health Plan Medicare	$11,418.67
Rate for Payer: Heritage Provider Network Senior	$5,677.00
Rate for Payer: Humana Medicare	$11,418.67
Rate for Payer: IEHP Medicare Advantage	$11,418.67
Rate for Payer: Kaiser Permanente of CA Commercial	$9,224.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,474.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,387.52
Rate for Payer: Molina Healthcare of CA Medicare	$14,387.52
Rate for Payer: Multiplan WC	$15,143.82
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 798: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC

Facility IP

$15,143.82

Service Code	MS-DRG 798
Min. Negotiated Rate	$5,677.00
Max. Negotiated Rate	$15,143.82
Rate for Payer: EPIC Health Plan Medicare	$9,607.99
Rate for Payer: Heritage Provider Network Senior	$5,677.00
Rate for Payer: Humana Medicare	$9,607.99
Rate for Payer: IEHP Medicare Advantage	$9,607.99
Rate for Payer: Kaiser Permanente of CA Commercial	$9,224.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,337.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,106.07
Rate for Payer: Molina Healthcare of CA Medicare	$12,106.07
Rate for Payer: Multiplan WC	$15,143.82
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 799: SPLENIC PROCEDURES WITH MCC

Facility IP

$84,992.41

Service Code	MS-DRG 799
Min. Negotiated Rate	$55,995.42
Max. Negotiated Rate	$84,992.41
Rate for Payer: EPIC Health Plan Medicare	$55,995.42
Rate for Payer: Humana Medicare	$55,995.42
Rate for Payer: IEHP Medicare Advantage	$55,995.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$66,074.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$70,554.23
Rate for Payer: Molina Healthcare of CA Medicare	$70,554.23
Rate for Payer: Multiplan WC	$84,992.41

INPATIENT MS-DRG 800: SPLENIC PROCEDURES WITH CC

Facility IP

$43,388.13

Service Code	MS-DRG 800
Min. Negotiated Rate	$31,932.96
Max. Negotiated Rate	$43,388.13
Rate for Payer: EPIC Health Plan Medicare	$31,932.96
Rate for Payer: Humana Medicare	$31,932.96
Rate for Payer: IEHP Medicare Advantage	$31,932.96
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,680.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$40,235.53
Rate for Payer: Molina Healthcare of CA Medicare	$40,235.53
Rate for Payer: Multiplan WC	$43,388.13

INPATIENT MS-DRG 801: SPLENIC PROCEDURES WITHOUT CC/MCC

Facility IP

$29,311.67

Service Code	MS-DRG 801
Min. Negotiated Rate	$20,357.21
Max. Negotiated Rate	$29,311.67
Rate for Payer: EPIC Health Plan Medicare	$20,357.21
Rate for Payer: Humana Medicare	$20,357.21
Rate for Payer: IEHP Medicare Advantage	$20,357.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,021.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,650.08
Rate for Payer: Molina Healthcare of CA Medicare	$25,650.08
Rate for Payer: Multiplan WC	$29,311.67

INPATIENT MS-DRG 802: OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC

Facility IP

$62,213.85

Service Code	MS-DRG 802
Min. Negotiated Rate	$38,836.75
Max. Negotiated Rate	$62,213.85
Rate for Payer: EPIC Health Plan Medicare	$38,836.75
Rate for Payer: Humana Medicare	$38,836.75
Rate for Payer: IEHP Medicare Advantage	$38,836.75
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$45,827.36
Rate for Payer: Molina Healthcare of CA Medi-Cal	$48,934.30
Rate for Payer: Molina Healthcare of CA Medicare	$48,934.30
Rate for Payer: Multiplan WC	$62,213.85

INPATIENT MS-DRG 803: OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC

Facility IP

$33,510.94

Service Code	MS-DRG 803
Min. Negotiated Rate	$21,128.55
Max. Negotiated Rate	$33,510.94
Rate for Payer: EPIC Health Plan Medicare	$21,128.55
Rate for Payer: Humana Medicare	$21,128.55
Rate for Payer: IEHP Medicare Advantage	$21,128.55
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,931.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,621.97
Rate for Payer: Molina Healthcare of CA Medicare	$26,621.97
Rate for Payer: Multiplan WC	$33,510.94

INPATIENT MS-DRG 804: OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC

Facility IP

$20,593.24

Service Code	MS-DRG 804
Min. Negotiated Rate	$13,834.03
Max. Negotiated Rate	$20,593.24
Rate for Payer: EPIC Health Plan Medicare	$13,834.03
Rate for Payer: Humana Medicare	$13,834.03
Rate for Payer: IEHP Medicare Advantage	$13,834.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,324.16
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,430.88
Rate for Payer: Molina Healthcare of CA Medicare	$17,430.88
Rate for Payer: Multiplan WC	$20,593.24

INPATIENT MS-DRG 805: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC

Facility IP

$16,411.92

Service Code	MS-DRG 805
Min. Negotiated Rate	$5,677.00
Max. Negotiated Rate	$16,411.92
Rate for Payer: EPIC Health Plan Medicare	$11,557.16
Rate for Payer: Heritage Provider Network Senior	$5,677.00
Rate for Payer: Humana Medicare	$11,557.16
Rate for Payer: IEHP Medicare Advantage	$11,557.16
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,637.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,562.02
Rate for Payer: Molina Healthcare of CA Medicare	$14,562.02
Rate for Payer: Multiplan WC	$16,411.92
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 806: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC

Facility IP

$11,388.46

Service Code	MS-DRG 806
Min. Negotiated Rate	$5,677.00
Max. Negotiated Rate	$11,388.46
Rate for Payer: EPIC Health Plan Medicare	$8,612.56
Rate for Payer: Heritage Provider Network Senior	$5,677.00
Rate for Payer: Humana Medicare	$8,612.56
Rate for Payer: IEHP Medicare Advantage	$8,612.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,162.82
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,851.83
Rate for Payer: Molina Healthcare of CA Medicare	$10,851.83
Rate for Payer: Multiplan WC	$11,388.46
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 807: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC

Facility IP

$10,304.78

Service Code	MS-DRG 807
Min. Negotiated Rate	$5,677.00
Max. Negotiated Rate	$10,304.78
Rate for Payer: EPIC Health Plan Medicare	$7,572.09
Rate for Payer: Heritage Provider Network Senior	$5,677.00
Rate for Payer: Humana Medicare	$7,572.09
Rate for Payer: IEHP Medicare Advantage	$7,572.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,935.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,540.83
Rate for Payer: Molina Healthcare of CA Medicare	$9,540.83
Rate for Payer: Multiplan WC	$10,304.78
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 808: MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC

Facility IP

$34,942.25

Service Code	MS-DRG 808
Min. Negotiated Rate	$24,865.89
Max. Negotiated Rate	$34,942.25
Rate for Payer: EPIC Health Plan Medicare	$24,865.89
Rate for Payer: Humana Medicare	$24,865.89
Rate for Payer: IEHP Medicare Advantage	$24,865.89
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,341.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,331.02
Rate for Payer: Molina Healthcare of CA Medicare	$31,331.02
Rate for Payer: Multiplan WC	$34,942.25

INPATIENT MS-DRG 809: MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC

Facility IP

$19,840.86

Service Code	MS-DRG 809
Min. Negotiated Rate	$13,766.47
Max. Negotiated Rate	$19,840.86
Rate for Payer: EPIC Health Plan Medicare	$13,766.47
Rate for Payer: Humana Medicare	$13,766.47
Rate for Payer: IEHP Medicare Advantage	$13,766.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,244.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,345.75
Rate for Payer: Molina Healthcare of CA Medicare	$17,345.75
Rate for Payer: Multiplan WC	$19,840.86

INPATIENT MS-DRG 810: MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC

Facility IP

$15,321.71

Service Code	MS-DRG 810
Min. Negotiated Rate	$11,515.51
Max. Negotiated Rate	$15,321.71
Rate for Payer: EPIC Health Plan Medicare	$11,515.51
Rate for Payer: Humana Medicare	$11,515.51
Rate for Payer: IEHP Medicare Advantage	$11,515.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,588.30
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,509.54
Rate for Payer: Molina Healthcare of CA Medicare	$14,509.54
Rate for Payer: Multiplan WC	$15,321.71

INPATIENT MS-DRG 811: RED BLOOD CELL DISORDERS WITH MCC

Facility IP

$22,690.43

Service Code	MS-DRG 811
Min. Negotiated Rate	$16,009.54
Max. Negotiated Rate	$22,690.43
Rate for Payer: EPIC Health Plan Medicare	$16,009.54
Rate for Payer: Humana Medicare	$16,009.54
Rate for Payer: IEHP Medicare Advantage	$16,009.54
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,891.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,172.02
Rate for Payer: Molina Healthcare of CA Medicare	$20,172.02
Rate for Payer: Multiplan WC	$22,690.43

INPATIENT MS-DRG 812: RED BLOOD CELL DISORDERS WITHOUT MCC

Facility IP

$14,655.83

Service Code	MS-DRG 812
Min. Negotiated Rate	$10,346.66
Max. Negotiated Rate	$14,655.83
Rate for Payer: EPIC Health Plan Medicare	$10,346.66
Rate for Payer: Humana Medicare	$10,346.66
Rate for Payer: IEHP Medicare Advantage	$10,346.66
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,209.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,036.79
Rate for Payer: Molina Healthcare of CA Medicare	$13,036.79
Rate for Payer: Multiplan WC	$14,655.83

INPATIENT MS-DRG 813: COAGULATION DISORDERS

Facility IP

$25,543.26

Service Code	MS-DRG 813
Min. Negotiated Rate	$17,770.68
Max. Negotiated Rate	$25,543.26
Rate for Payer: EPIC Health Plan Medicare	$17,770.68
Rate for Payer: Humana Medicare	$17,770.68
Rate for Payer: IEHP Medicare Advantage	$17,770.68
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,969.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,391.06
Rate for Payer: Molina Healthcare of CA Medicare	$22,391.06
Rate for Payer: Multiplan WC	$25,543.26

INPATIENT MS-DRG 814: RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC

Facility IP

$30,667.90

Service Code	MS-DRG 814
Min. Negotiated Rate	$24,167.74
Max. Negotiated Rate	$30,667.90
Rate for Payer: EPIC Health Plan Medicare	$24,167.74
Rate for Payer: Humana Medicare	$24,167.74
Rate for Payer: IEHP Medicare Advantage	$24,167.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,517.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,451.35
Rate for Payer: Molina Healthcare of CA Medicare	$30,451.35
Rate for Payer: Multiplan WC	$30,667.90

INPATIENT MS-DRG 815: RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC

Facility IP

$16,828.10

Service Code	MS-DRG 815
Min. Negotiated Rate	$11,399.53
Max. Negotiated Rate	$16,828.10
Rate for Payer: EPIC Health Plan Medicare	$11,399.53
Rate for Payer: Humana Medicare	$11,399.53
Rate for Payer: IEHP Medicare Advantage	$11,399.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,451.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,363.41
Rate for Payer: Molina Healthcare of CA Medicare	$14,363.41
Rate for Payer: Multiplan WC	$16,828.10

INPATIENT MS-DRG 816: RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC

Facility IP

$11,897.66

Service Code	MS-DRG 816
Min. Negotiated Rate	$8,201.54
Max. Negotiated Rate	$11,897.66
Rate for Payer: EPIC Health Plan Medicare	$8,201.54
Rate for Payer: Humana Medicare	$8,201.54
Rate for Payer: IEHP Medicare Advantage	$8,201.54
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,677.82
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,333.94
Rate for Payer: Molina Healthcare of CA Medicare	$10,333.94
Rate for Payer: Multiplan WC	$11,897.66

INPATIENT MS-DRG 817: OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC

Facility IP

$51,079.99

Service Code	MS-DRG 817
Min. Negotiated Rate	$3,557.00
Max. Negotiated Rate	$51,079.99
Rate for Payer: EPIC Health Plan Medicare	$31,922.82
Rate for Payer: Humana Medicare	$31,922.82
Rate for Payer: IEHP Medicare Advantage	$31,922.82
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,668.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$40,222.75
Rate for Payer: Molina Healthcare of CA Medicare	$40,222.75
Rate for Payer: Multiplan WC	$51,079.99
Rate for Payer: United Healthcare All Other HMO/non HMO	$4,228.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$3,557.00

INPATIENT MS-DRG 818: OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC

Facility IP

$25,951.27

Service Code	MS-DRG 818
Min. Negotiated Rate	$3,557.00
Max. Negotiated Rate	$25,951.27
Rate for Payer: EPIC Health Plan Medicare	$16,319.22
Rate for Payer: Humana Medicare	$16,319.22
Rate for Payer: IEHP Medicare Advantage	$16,319.22
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,256.68
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,562.22
Rate for Payer: Molina Healthcare of CA Medicare	$20,562.22
Rate for Payer: Multiplan WC	$25,951.27
Rate for Payer: United Healthcare All Other HMO/non HMO	$4,228.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$3,557.00

INPATIENT MS-DRG 819: OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility IP

$14,500.79

Service Code	MS-DRG 819
Min. Negotiated Rate	$3,557.00
Max. Negotiated Rate	$14,500.79
Rate for Payer: EPIC Health Plan Medicare	$10,419.87
Rate for Payer: Humana Medicare	$10,419.87
Rate for Payer: IEHP Medicare Advantage	$10,419.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,295.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,129.04
Rate for Payer: Molina Healthcare of CA Medicare	$13,129.04
Rate for Payer: Multiplan WC	$14,500.79
Rate for Payer: United Healthcare All Other HMO/non HMO	$4,228.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$3,557.00

INPATIENT MS-DRG 820: LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC

Facility IP

$86,786.04

Service Code	MS-DRG 820
Min. Negotiated Rate	$68,292.96
Max. Negotiated Rate	$86,786.04
Rate for Payer: EPIC Health Plan Medicare	$68,292.96
Rate for Payer: Humana Medicare	$68,292.96
Rate for Payer: IEHP Medicare Advantage	$68,292.96
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$80,585.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$86,049.13
Rate for Payer: Molina Healthcare of CA Medicare	$86,049.13
Rate for Payer: Multiplan WC	$86,786.04

INPATIENT MS-DRG 821: LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC

Facility IP

$35,291.51

Service Code	MS-DRG 821
Min. Negotiated Rate	$25,338.84
Max. Negotiated Rate	$35,291.51
Rate for Payer: EPIC Health Plan Medicare	$25,338.84
Rate for Payer: Humana Medicare	$25,338.84
Rate for Payer: IEHP Medicare Advantage	$25,338.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,899.83
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,926.94
Rate for Payer: Molina Healthcare of CA Medicare	$31,926.94
Rate for Payer: Multiplan WC	$35,291.51

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