Loma Linda University Medical Center

All Charges

Charge

Type

Price

INPATIENT MS-DRG 884: ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY

Facility IP

$25,623.23

Service Code	MS-DRG 884
Min. Negotiated Rate	$19,987.88
Max. Negotiated Rate	$25,623.23
Rate for Payer: EPIC Health Plan Medicare	$19,987.88
Rate for Payer: Humana Medicare	$19,987.88
Rate for Payer: IEHP Medicare Advantage	$19,987.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,585.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,184.73
Rate for Payer: Molina Healthcare of CA Medicare	$25,184.73
Rate for Payer: Multiplan WC	$25,623.23

INPATIENT MS-DRG 885: PSYCHOSES

Facility IP

$21,143.25

Service Code	MS-DRG 885
Min. Negotiated Rate	$15,590.66
Max. Negotiated Rate	$21,143.25
Rate for Payer: EPIC Health Plan Medicare	$15,590.66
Rate for Payer: Humana Medicare	$15,590.66
Rate for Payer: IEHP Medicare Advantage	$15,590.66
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,396.98
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,644.23
Rate for Payer: Molina Healthcare of CA Medicare	$19,644.23
Rate for Payer: Multiplan WC	$21,143.25

INPATIENT MS-DRG 886: BEHAVIORAL AND DEVELOPMENTAL DISORDERS

Facility IP

$24,117.75

Service Code	MS-DRG 886
Min. Negotiated Rate	$19,141.07
Max. Negotiated Rate	$24,117.75
Rate for Payer: EPIC Health Plan Medicare	$19,141.07
Rate for Payer: Humana Medicare	$19,141.07
Rate for Payer: IEHP Medicare Advantage	$19,141.07
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,586.46
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,117.75
Rate for Payer: Molina Healthcare of CA Medicare	$24,117.75
Rate for Payer: Multiplan WC	$22,277.52

INPATIENT MS-DRG 887: OTHER MENTAL DISORDER DIAGNOSES

Facility IP

$21,159.56

Service Code	MS-DRG 887
Min. Negotiated Rate	$14,793.42
Max. Negotiated Rate	$21,159.56
Rate for Payer: EPIC Health Plan Medicare	$14,793.42
Rate for Payer: Humana Medicare	$14,793.42
Rate for Payer: IEHP Medicare Advantage	$14,793.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,456.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,639.71
Rate for Payer: Molina Healthcare of CA Medicare	$18,639.71
Rate for Payer: Multiplan WC	$21,159.56

INPATIENT MS-DRG 894: ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA

Facility IP

$9,332.08

Service Code	MS-DRG 894
Min. Negotiated Rate	$6,673.51
Max. Negotiated Rate	$9,332.08
Rate for Payer: EPIC Health Plan Medicare	$6,673.51
Rate for Payer: Humana Medicare	$6,673.51
Rate for Payer: IEHP Medicare Advantage	$6,673.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$7,874.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,408.62
Rate for Payer: Molina Healthcare of CA Medicare	$8,408.62
Rate for Payer: Multiplan WC	$9,332.08

INPATIENT MS-DRG 895: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY

Facility IP

$25,438.81

Service Code	MS-DRG 895
Min. Negotiated Rate	$18,320.19
Max. Negotiated Rate	$25,438.81
Rate for Payer: EPIC Health Plan Medicare	$18,320.19
Rate for Payer: Humana Medicare	$18,320.19
Rate for Payer: IEHP Medicare Advantage	$18,320.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,617.82
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,083.44
Rate for Payer: Molina Healthcare of CA Medicare	$23,083.44
Rate for Payer: Multiplan WC	$25,438.81

INPATIENT MS-DRG 896: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC

Facility IP

$28,652.32

Service Code	MS-DRG 896
Min. Negotiated Rate	$20,226.59
Max. Negotiated Rate	$28,652.32
Rate for Payer: EPIC Health Plan Medicare	$20,226.59
Rate for Payer: Humana Medicare	$20,226.59
Rate for Payer: IEHP Medicare Advantage	$20,226.59
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,867.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,485.50
Rate for Payer: Molina Healthcare of CA Medicare	$25,485.50
Rate for Payer: Multiplan WC	$28,652.32

INPATIENT MS-DRG 897: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC

Facility IP

$13,893.67

Service Code	MS-DRG 897
Min. Negotiated Rate	$9,838.82
Max. Negotiated Rate	$13,893.67
Rate for Payer: EPIC Health Plan Medicare	$9,838.82
Rate for Payer: Humana Medicare	$9,838.82
Rate for Payer: IEHP Medicare Advantage	$9,838.82
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,609.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,396.91
Rate for Payer: Molina Healthcare of CA Medicare	$12,396.91
Rate for Payer: Multiplan WC	$13,893.67

INPATIENT MS-DRG 901: WOUND DEBRIDEMENTS FOR INJURIES WITH MCC

Facility IP

$71,787.47

Service Code	MS-DRG 901
Min. Negotiated Rate	$48,937.35
Max. Negotiated Rate	$71,787.47
Rate for Payer: EPIC Health Plan Medicare	$48,937.35
Rate for Payer: Humana Medicare	$48,937.35
Rate for Payer: IEHP Medicare Advantage	$48,937.35
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$57,746.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$61,661.06
Rate for Payer: Molina Healthcare of CA Medicare	$61,661.06
Rate for Payer: Multiplan WC	$71,787.47

INPATIENT MS-DRG 902: WOUND DEBRIDEMENTS FOR INJURIES WITH CC

Facility IP

$32,344.02

Service Code	MS-DRG 902
Min. Negotiated Rate	$21,426.95
Max. Negotiated Rate	$32,344.02
Rate for Payer: EPIC Health Plan Medicare	$21,426.95
Rate for Payer: Humana Medicare	$21,426.95
Rate for Payer: IEHP Medicare Advantage	$21,426.95
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,283.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,997.96
Rate for Payer: Molina Healthcare of CA Medicare	$26,997.96
Rate for Payer: Multiplan WC	$32,344.02

INPATIENT MS-DRG 903: WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC

Facility IP

$19,839.24

Service Code	MS-DRG 903
Min. Negotiated Rate	$14,184.23
Max. Negotiated Rate	$19,839.24
Rate for Payer: EPIC Health Plan Medicare	$14,184.23
Rate for Payer: Humana Medicare	$14,184.23
Rate for Payer: IEHP Medicare Advantage	$14,184.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,737.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,872.13
Rate for Payer: Molina Healthcare of CA Medicare	$17,872.13
Rate for Payer: Multiplan WC	$19,839.24

INPATIENT MS-DRG 904: SKIN GRAFTS FOR INJURIES WITH CC/MCC

Facility IP

$57,968.88

Service Code	MS-DRG 904
Min. Negotiated Rate	$36,870.67
Max. Negotiated Rate	$57,968.88
Rate for Payer: EPIC Health Plan Medicare	$36,870.67
Rate for Payer: Humana Medicare	$36,870.67
Rate for Payer: IEHP Medicare Advantage	$36,870.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$43,507.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,457.04
Rate for Payer: Molina Healthcare of CA Medicare	$46,457.04
Rate for Payer: Multiplan WC	$57,968.88

INPATIENT MS-DRG 905: SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC

Facility IP

$25,458.39

Service Code	MS-DRG 905
Min. Negotiated Rate	$18,037.56
Max. Negotiated Rate	$25,458.39
Rate for Payer: EPIC Health Plan Medicare	$18,037.56
Rate for Payer: Humana Medicare	$18,037.56
Rate for Payer: IEHP Medicare Advantage	$18,037.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,284.32
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,727.33
Rate for Payer: Molina Healthcare of CA Medicare	$22,727.33
Rate for Payer: Multiplan WC	$25,458.39

INPATIENT MS-DRG 906: HAND PROCEDURES FOR INJURIES

Facility IP

$29,177.84

Service Code	MS-DRG 906
Min. Negotiated Rate	$21,392.05
Max. Negotiated Rate	$29,177.84
Rate for Payer: EPIC Health Plan Medicare	$21,392.05
Rate for Payer: Humana Medicare	$21,392.05
Rate for Payer: IEHP Medicare Advantage	$21,392.05
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,242.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,953.98
Rate for Payer: Molina Healthcare of CA Medicare	$26,953.98
Rate for Payer: Multiplan WC	$29,177.84

INPATIENT MS-DRG 907: OTHER O.R. PROCEDURES FOR INJURIES WITH MCC

Facility IP

$63,090.26

Service Code	MS-DRG 907
Min. Negotiated Rate	$42,087.62
Max. Negotiated Rate	$63,090.26
Rate for Payer: EPIC Health Plan Medicare	$42,087.62
Rate for Payer: Humana Medicare	$42,087.62
Rate for Payer: IEHP Medicare Advantage	$42,087.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$49,663.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$53,030.40
Rate for Payer: Molina Healthcare of CA Medicare	$53,030.40
Rate for Payer: Multiplan WC	$63,090.26

INPATIENT MS-DRG 908: OTHER O.R. PROCEDURES FOR INJURIES WITH CC

Facility IP

$33,563.17

Service Code	MS-DRG 908
Min. Negotiated Rate	$22,771.45
Max. Negotiated Rate	$33,563.17
Rate for Payer: EPIC Health Plan Medicare	$22,771.45
Rate for Payer: Humana Medicare	$22,771.45
Rate for Payer: IEHP Medicare Advantage	$22,771.45
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,870.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,692.03
Rate for Payer: Molina Healthcare of CA Medicare	$28,692.03
Rate for Payer: Multiplan WC	$33,563.17

INPATIENT MS-DRG 909: OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC

Facility IP

$22,272.63

Service Code	MS-DRG 909
Min. Negotiated Rate	$15,476.94
Max. Negotiated Rate	$22,272.63
Rate for Payer: EPIC Health Plan Medicare	$15,476.94
Rate for Payer: Humana Medicare	$15,476.94
Rate for Payer: IEHP Medicare Advantage	$15,476.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,262.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,500.94
Rate for Payer: Molina Healthcare of CA Medicare	$19,500.94
Rate for Payer: Multiplan WC	$22,272.63

INPATIENT MS-DRG 913: TRAUMATIC INJURY WITH MCC

Facility IP

$24,710.92

Service Code	MS-DRG 913
Min. Negotiated Rate	$17,033.14
Max. Negotiated Rate	$24,710.92
Rate for Payer: EPIC Health Plan Medicare	$17,033.14
Rate for Payer: Humana Medicare	$17,033.14
Rate for Payer: IEHP Medicare Advantage	$17,033.14
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,099.11
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,461.76
Rate for Payer: Molina Healthcare of CA Medicare	$21,461.76
Rate for Payer: Multiplan WC	$24,710.92

INPATIENT MS-DRG 914: TRAUMATIC INJURY WITHOUT MCC

Facility IP

$14,510.59

Service Code	MS-DRG 914
Min. Negotiated Rate	$10,425.50
Max. Negotiated Rate	$14,510.59
Rate for Payer: EPIC Health Plan Medicare	$10,425.50
Rate for Payer: Humana Medicare	$10,425.50
Rate for Payer: IEHP Medicare Advantage	$10,425.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,302.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,136.13
Rate for Payer: Molina Healthcare of CA Medicare	$13,136.13
Rate for Payer: Multiplan WC	$14,510.59

INPATIENT MS-DRG 915: ALLERGIC REACTIONS WITH MCC

Facility IP

$29,705.00

Service Code	MS-DRG 915
Min. Negotiated Rate	$20,180.41
Max. Negotiated Rate	$29,705.00
Rate for Payer: EPIC Health Plan Medicare	$20,180.41
Rate for Payer: Humana Medicare	$20,180.41
Rate for Payer: IEHP Medicare Advantage	$20,180.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,812.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,427.32
Rate for Payer: Molina Healthcare of CA Medicare	$25,427.32
Rate for Payer: Multiplan WC	$29,705.00

INPATIENT MS-DRG 916: ALLERGIC REACTIONS WITHOUT MCC

Facility IP

$10,840.09

Service Code	MS-DRG 916
Min. Negotiated Rate	$7,622.76
Max. Negotiated Rate	$10,840.09
Rate for Payer: EPIC Health Plan Medicare	$7,622.76
Rate for Payer: Humana Medicare	$7,622.76
Rate for Payer: IEHP Medicare Advantage	$7,622.76
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,994.86
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,604.68
Rate for Payer: Molina Healthcare of CA Medicare	$9,604.68
Rate for Payer: Multiplan WC	$10,840.09

INPATIENT MS-DRG 917: POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC

Facility IP

$24,848.01

Service Code	MS-DRG 917
Min. Negotiated Rate	$18,174.94
Max. Negotiated Rate	$24,848.01
Rate for Payer: EPIC Health Plan Medicare	$18,174.94
Rate for Payer: Humana Medicare	$18,174.94
Rate for Payer: IEHP Medicare Advantage	$18,174.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,446.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,900.42
Rate for Payer: Molina Healthcare of CA Medicare	$22,900.42
Rate for Payer: Multiplan WC	$24,848.01

INPATIENT MS-DRG 918: POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC

Facility IP

$13,345.30

Service Code	MS-DRG 918
Min. Negotiated Rate	$9,898.51
Max. Negotiated Rate	$13,345.30
Rate for Payer: EPIC Health Plan Medicare	$9,898.51
Rate for Payer: Humana Medicare	$9,898.51
Rate for Payer: IEHP Medicare Advantage	$9,898.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,680.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,472.12
Rate for Payer: Molina Healthcare of CA Medicare	$12,472.12
Rate for Payer: Multiplan WC	$13,345.30

INPATIENT MS-DRG 919: COMPLICATIONS OF TREATMENT WITH MCC

Facility IP

$29,272.50

Service Code	MS-DRG 919
Min. Negotiated Rate	$20,751.32
Max. Negotiated Rate	$29,272.50
Rate for Payer: EPIC Health Plan Medicare	$20,751.32
Rate for Payer: Humana Medicare	$20,751.32
Rate for Payer: IEHP Medicare Advantage	$20,751.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,486.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,146.66
Rate for Payer: Molina Healthcare of CA Medicare	$26,146.66
Rate for Payer: Multiplan WC	$29,272.50

INPATIENT MS-DRG 920: COMPLICATIONS OF TREATMENT WITH CC

Facility IP

$16,676.32

Service Code	MS-DRG 920
Min. Negotiated Rate	$11,845.43
Max. Negotiated Rate	$16,676.32
Rate for Payer: EPIC Health Plan Medicare	$11,845.43
Rate for Payer: Humana Medicare	$11,845.43
Rate for Payer: IEHP Medicare Advantage	$11,845.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,977.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,925.24
Rate for Payer: Molina Healthcare of CA Medicare	$14,925.24
Rate for Payer: Multiplan WC	$16,676.32

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