Loma Linda University Medical Center

All Charges

Charge

Type

Price

INPATIENT MS-DRG 847: CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC

Facility IP

$19,880.04

Service Code	MS-DRG 847
Min. Negotiated Rate	$13,858.79
Max. Negotiated Rate	$19,880.04
Rate for Payer: EPIC Health Plan Medicare	$13,858.79
Rate for Payer: Humana Medicare	$13,858.79
Rate for Payer: IEHP Medicare Advantage	$13,858.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,353.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,462.08
Rate for Payer: Molina Healthcare of CA Medicare	$17,462.08
Rate for Payer: Multiplan WC	$19,880.04

INPATIENT MS-DRG 848: CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC

Facility IP

$15,163.40

Service Code	MS-DRG 848
Min. Negotiated Rate	$9,620.38
Max. Negotiated Rate	$15,163.40
Rate for Payer: EPIC Health Plan Medicare	$9,620.38
Rate for Payer: Humana Medicare	$9,620.38
Rate for Payer: IEHP Medicare Advantage	$9,620.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,352.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,121.68
Rate for Payer: Molina Healthcare of CA Medicare	$12,121.68
Rate for Payer: Multiplan WC	$15,163.40

INPATIENT MS-DRG 849: RADIOTHERAPY

Facility IP

$38,443.56

Service Code	MS-DRG 849
Min. Negotiated Rate	$30,510.76
Max. Negotiated Rate	$38,443.56
Rate for Payer: EPIC Health Plan Medicare	$30,510.76
Rate for Payer: Humana Medicare	$30,510.76
Rate for Payer: IEHP Medicare Advantage	$30,510.76
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,002.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,443.56
Rate for Payer: Molina Healthcare of CA Medicare	$38,443.56
Rate for Payer: Multiplan WC	$38,172.09

INPATIENT MS-DRG 853: INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC

Facility IP

$79,986.90

Service Code	MS-DRG 853
Min. Negotiated Rate	$56,498.74
Max. Negotiated Rate	$79,986.90
Rate for Payer: EPIC Health Plan Medicare	$56,498.74
Rate for Payer: Humana Medicare	$56,498.74
Rate for Payer: IEHP Medicare Advantage	$56,498.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$66,668.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$71,188.41
Rate for Payer: Molina Healthcare of CA Medicare	$71,188.41
Rate for Payer: Multiplan WC	$79,986.90

INPATIENT MS-DRG 854: INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC

Facility IP

$33,548.48

Service Code	MS-DRG 854
Min. Negotiated Rate	$23,155.43
Max. Negotiated Rate	$33,548.48
Rate for Payer: EPIC Health Plan Medicare	$23,155.43
Rate for Payer: Humana Medicare	$23,155.43
Rate for Payer: IEHP Medicare Advantage	$23,155.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,323.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,175.84
Rate for Payer: Molina Healthcare of CA Medicare	$29,175.84
Rate for Payer: Multiplan WC	$33,548.48

INPATIENT MS-DRG 855: INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility IP

$24,932.87

Service Code	MS-DRG 855
Min. Negotiated Rate	$19,367.41
Max. Negotiated Rate	$24,932.87
Rate for Payer: EPIC Health Plan Medicare	$19,367.41
Rate for Payer: Humana Medicare	$19,367.41
Rate for Payer: IEHP Medicare Advantage	$19,367.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,853.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,402.94
Rate for Payer: Molina Healthcare of CA Medicare	$24,402.94
Rate for Payer: Multiplan WC	$24,932.87

INPATIENT MS-DRG 856: POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC

Facility IP

$72,017.59

Service Code	MS-DRG 856
Min. Negotiated Rate	$50,070.16
Max. Negotiated Rate	$72,017.59
Rate for Payer: EPIC Health Plan Medicare	$50,070.16
Rate for Payer: Humana Medicare	$50,070.16
Rate for Payer: IEHP Medicare Advantage	$50,070.16
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$59,082.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$63,088.40
Rate for Payer: Molina Healthcare of CA Medicare	$63,088.40
Rate for Payer: Multiplan WC	$72,017.59

INPATIENT MS-DRG 857: POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC

Facility IP

$34,419.99

Service Code	MS-DRG 857
Min. Negotiated Rate	$24,253.33
Max. Negotiated Rate	$34,419.99
Rate for Payer: EPIC Health Plan Medicare	$24,253.33
Rate for Payer: Humana Medicare	$24,253.33
Rate for Payer: IEHP Medicare Advantage	$24,253.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,618.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,559.20
Rate for Payer: Molina Healthcare of CA Medicare	$30,559.20
Rate for Payer: Multiplan WC	$34,419.99

INPATIENT MS-DRG 858: POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility IP

$23,087.02

Service Code	MS-DRG 858
Min. Negotiated Rate	$14,656.04
Max. Negotiated Rate	$23,087.02
Rate for Payer: EPIC Health Plan Medicare	$14,656.04
Rate for Payer: Humana Medicare	$14,656.04
Rate for Payer: IEHP Medicare Advantage	$14,656.04
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,294.13
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,466.61
Rate for Payer: Molina Healthcare of CA Medicare	$18,466.61
Rate for Payer: Multiplan WC	$23,087.02

INPATIENT MS-DRG 862: POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC

Facility IP

$29,851.88

Service Code	MS-DRG 862
Min. Negotiated Rate	$20,946.13
Max. Negotiated Rate	$29,851.88
Rate for Payer: EPIC Health Plan Medicare	$20,946.13
Rate for Payer: Humana Medicare	$20,946.13
Rate for Payer: IEHP Medicare Advantage	$20,946.13
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,716.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,392.12
Rate for Payer: Molina Healthcare of CA Medicare	$26,392.12
Rate for Payer: Multiplan WC	$29,851.88

INPATIENT MS-DRG 863: POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC

Facility IP

$16,416.82

Service Code	MS-DRG 863
Min. Negotiated Rate	$11,526.78
Max. Negotiated Rate	$16,416.82
Rate for Payer: EPIC Health Plan Medicare	$11,526.78
Rate for Payer: Humana Medicare	$11,526.78
Rate for Payer: IEHP Medicare Advantage	$11,526.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,601.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,523.74
Rate for Payer: Molina Healthcare of CA Medicare	$14,523.74
Rate for Payer: Multiplan WC	$16,416.82

INPATIENT MS-DRG 864: FEVER AND INFLAMMATORY CONDITIONS

Facility IP

$13,843.07

Service Code	MS-DRG 864
Min. Negotiated Rate	$10,145.10
Max. Negotiated Rate	$13,843.07
Rate for Payer: EPIC Health Plan Medicare	$10,145.10
Rate for Payer: Humana Medicare	$10,145.10
Rate for Payer: IEHP Medicare Advantage	$10,145.10
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,971.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,782.83
Rate for Payer: Molina Healthcare of CA Medicare	$12,782.83
Rate for Payer: Multiplan WC	$13,843.07

INPATIENT MS-DRG 865: VIRAL ILLNESS WITH MCC

Facility IP

$27,300.98

Service Code	MS-DRG 865
Min. Negotiated Rate	$18,670.39
Max. Negotiated Rate	$27,300.98
Rate for Payer: EPIC Health Plan Medicare	$18,670.39
Rate for Payer: Humana Medicare	$18,670.39
Rate for Payer: IEHP Medicare Advantage	$18,670.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,031.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,524.69
Rate for Payer: Molina Healthcare of CA Medicare	$23,524.69
Rate for Payer: Multiplan WC	$27,300.98

INPATIENT MS-DRG 866: VIRAL ILLNESS WITHOUT MCC

Facility IP

$14,683.58

Service Code	MS-DRG 866
Min. Negotiated Rate	$10,538.09
Max. Negotiated Rate	$14,683.58
Rate for Payer: EPIC Health Plan Medicare	$10,538.09
Rate for Payer: Humana Medicare	$10,538.09
Rate for Payer: IEHP Medicare Advantage	$10,538.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,434.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,277.99
Rate for Payer: Molina Healthcare of CA Medicare	$13,277.99
Rate for Payer: Multiplan WC	$14,683.58

INPATIENT MS-DRG 867: OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC

Facility IP

$34,491.81

Service Code	MS-DRG 867
Min. Negotiated Rate	$23,764.62
Max. Negotiated Rate	$34,491.81
Rate for Payer: EPIC Health Plan Medicare	$23,764.62
Rate for Payer: Humana Medicare	$23,764.62
Rate for Payer: IEHP Medicare Advantage	$23,764.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,042.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,943.42
Rate for Payer: Molina Healthcare of CA Medicare	$29,943.42
Rate for Payer: Multiplan WC	$34,491.81

INPATIENT MS-DRG 868: OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC

Facility IP

$17,229.59

Service Code	MS-DRG 868
Min. Negotiated Rate	$12,427.60
Max. Negotiated Rate	$17,229.59
Rate for Payer: EPIC Health Plan Medicare	$12,427.60
Rate for Payer: Humana Medicare	$12,427.60
Rate for Payer: IEHP Medicare Advantage	$12,427.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,664.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,658.78
Rate for Payer: Molina Healthcare of CA Medicare	$15,658.78
Rate for Payer: Multiplan WC	$17,229.59

INPATIENT MS-DRG 869: OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC

Facility IP

$12,090.25

Service Code	MS-DRG 869
Min. Negotiated Rate	$7,981.98
Max. Negotiated Rate	$12,090.25
Rate for Payer: EPIC Health Plan Medicare	$7,981.98
Rate for Payer: Humana Medicare	$7,981.98
Rate for Payer: IEHP Medicare Advantage	$7,981.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,418.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,057.29
Rate for Payer: Molina Healthcare of CA Medicare	$10,057.29
Rate for Payer: Multiplan WC	$12,090.25

INPATIENT MS-DRG 870: SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS

Facility IP

$110,831.07

Service Code	MS-DRG 870
Min. Negotiated Rate	$78,632.28
Max. Negotiated Rate	$110,831.07
Rate for Payer: EPIC Health Plan Medicare	$78,632.28
Rate for Payer: Humana Medicare	$78,632.28
Rate for Payer: IEHP Medicare Advantage	$78,632.28
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$92,786.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$99,076.67
Rate for Payer: Molina Healthcare of CA Medicare	$99,076.67
Rate for Payer: Multiplan WC	$110,831.07

INPATIENT MS-DRG 871: SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC

Facility IP

$31,942.54

Service Code	MS-DRG 871
Min. Negotiated Rate	$22,529.36
Max. Negotiated Rate	$31,942.54
Rate for Payer: EPIC Health Plan Medicare	$22,529.36
Rate for Payer: Humana Medicare	$22,529.36
Rate for Payer: IEHP Medicare Advantage	$22,529.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,584.64
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,386.99
Rate for Payer: Molina Healthcare of CA Medicare	$28,386.99
Rate for Payer: Multiplan WC	$31,942.54

INPATIENT MS-DRG 872: SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC

Facility IP

$16,777.50

Service Code	MS-DRG 872
Min. Negotiated Rate	$11,801.53
Max. Negotiated Rate	$16,777.50
Rate for Payer: EPIC Health Plan Medicare	$11,801.53
Rate for Payer: Humana Medicare	$11,801.53
Rate for Payer: IEHP Medicare Advantage	$11,801.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,925.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,869.93
Rate for Payer: Molina Healthcare of CA Medicare	$14,869.93
Rate for Payer: Multiplan WC	$16,777.50

INPATIENT MS-DRG 876: O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS

Facility IP

$53,200.66

Service Code	MS-DRG 876
Min. Negotiated Rate	$42,222.75
Max. Negotiated Rate	$53,200.66
Rate for Payer: EPIC Health Plan Medicare	$42,222.75
Rate for Payer: Humana Medicare	$42,222.75
Rate for Payer: IEHP Medicare Advantage	$42,222.75
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$49,822.84
Rate for Payer: Molina Healthcare of CA Medi-Cal	$53,200.66
Rate for Payer: Molina Healthcare of CA Medicare	$53,200.66
Rate for Payer: Multiplan WC	$52,165.30

INPATIENT MS-DRG 880: ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION

Facility IP

$14,789.66

Service Code	MS-DRG 880
Min. Negotiated Rate	$10,953.62
Max. Negotiated Rate	$14,789.66
Rate for Payer: EPIC Health Plan Medicare	$10,953.62
Rate for Payer: Humana Medicare	$10,953.62
Rate for Payer: IEHP Medicare Advantage	$10,953.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,925.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,801.56
Rate for Payer: Molina Healthcare of CA Medicare	$13,801.56
Rate for Payer: Multiplan WC	$14,789.66

INPATIENT MS-DRG 881: DEPRESSIVE NEUROSES

Facility IP

$13,962.21

Service Code	MS-DRG 881
Min. Negotiated Rate	$10,411.98
Max. Negotiated Rate	$13,962.21
Rate for Payer: EPIC Health Plan Medicare	$10,411.98
Rate for Payer: Humana Medicare	$10,411.98
Rate for Payer: IEHP Medicare Advantage	$10,411.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,286.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,119.09
Rate for Payer: Molina Healthcare of CA Medicare	$13,119.09
Rate for Payer: Multiplan WC	$13,962.21

INPATIENT MS-DRG 882: NEUROSES EXCEPT DEPRESSIVE

Facility IP

$14,255.98

Service Code	MS-DRG 882
Min. Negotiated Rate	$10,781.31
Max. Negotiated Rate	$14,255.98
Rate for Payer: EPIC Health Plan Medicare	$10,781.31
Rate for Payer: Humana Medicare	$10,781.31
Rate for Payer: IEHP Medicare Advantage	$10,781.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,721.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,584.45
Rate for Payer: Molina Healthcare of CA Medicare	$13,584.45
Rate for Payer: Multiplan WC	$14,255.98

INPATIENT MS-DRG 883: DISORDERS OF PERSONALITY AND IMPULSE CONTROL

Facility IP

$26,866.01

Service Code	MS-DRG 883
Min. Negotiated Rate	$21,322.23
Max. Negotiated Rate	$26,866.01
Rate for Payer: EPIC Health Plan Medicare	$21,322.23
Rate for Payer: Humana Medicare	$21,322.23
Rate for Payer: IEHP Medicare Advantage	$21,322.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,160.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,866.01
Rate for Payer: Molina Healthcare of CA Medicare	$26,866.01
Rate for Payer: Multiplan WC	$26,349.50

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