Loma Linda University Medical Center

All Charges

Charge

Type

Price

INPATIENT MS-DRG 921: COMPLICATIONS OF TREATMENT WITHOUT CC/MCC

Facility IP

$11,879.72

Service Code	MS-DRG 921
Min. Negotiated Rate	$8,061.92
Max. Negotiated Rate	$11,879.72
Rate for Payer: EPIC Health Plan Medicare	$8,061.92
Rate for Payer: Humana Medicare	$8,061.92
Rate for Payer: IEHP Medicare Advantage	$8,061.92
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,513.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,158.02
Rate for Payer: Molina Healthcare of CA Medicare	$10,158.02
Rate for Payer: Multiplan WC	$11,879.72

INPATIENT MS-DRG 922: OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC

Facility IP

$25,391.48

Service Code	MS-DRG 922
Min. Negotiated Rate	$19,852.74
Max. Negotiated Rate	$25,391.48
Rate for Payer: EPIC Health Plan Medicare	$19,852.74
Rate for Payer: Humana Medicare	$19,852.74
Rate for Payer: IEHP Medicare Advantage	$19,852.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,426.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,014.45
Rate for Payer: Molina Healthcare of CA Medicare	$25,014.45
Rate for Payer: Multiplan WC	$25,391.48

INPATIENT MS-DRG 923: OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC

Facility IP

$15,393.53

Service Code	MS-DRG 923
Min. Negotiated Rate	$11,593.20
Max. Negotiated Rate	$15,393.53
Rate for Payer: EPIC Health Plan Medicare	$11,593.20
Rate for Payer: Humana Medicare	$11,593.20
Rate for Payer: IEHP Medicare Advantage	$11,593.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,679.98
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,607.43
Rate for Payer: Molina Healthcare of CA Medicare	$14,607.43
Rate for Payer: Multiplan WC	$15,393.53

INPATIENT MS-DRG 927: EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT

Facility IP

$374,239.18

Service Code	MS-DRG 927
Min. Negotiated Rate	$297,015.22
Max. Negotiated Rate	$374,239.18
Rate for Payer: EPIC Health Plan Medicare	$297,015.22
Rate for Payer: Humana Medicare	$297,015.22
Rate for Payer: IEHP Medicare Advantage	$297,015.22
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$350,477.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$374,239.18
Rate for Payer: Molina Healthcare of CA Medicare	$374,239.18
Rate for Payer: Multiplan WC	$309,799.53

INPATIENT MS-DRG 928: FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC

Facility IP

$101,045.28

Service Code	MS-DRG 928
Min. Negotiated Rate	$78,123.31
Max. Negotiated Rate	$101,045.28
Rate for Payer: EPIC Health Plan Medicare	$78,123.31
Rate for Payer: Humana Medicare	$78,123.31
Rate for Payer: IEHP Medicare Advantage	$78,123.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$92,185.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$98,435.37
Rate for Payer: Molina Healthcare of CA Medicare	$98,435.37
Rate for Payer: Multiplan WC	$101,045.28

INPATIENT MS-DRG 929: FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC

Facility IP

$47,962.77

Service Code	MS-DRG 929
Min. Negotiated Rate	$36,412.35
Max. Negotiated Rate	$47,962.77
Rate for Payer: EPIC Health Plan Medicare	$36,412.35
Rate for Payer: Humana Medicare	$36,412.35
Rate for Payer: IEHP Medicare Advantage	$36,412.35
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,966.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$45,879.56
Rate for Payer: Molina Healthcare of CA Medicare	$45,879.56
Rate for Payer: Multiplan WC	$47,962.77

INPATIENT MS-DRG 933: EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT

Facility IP

$49,500.16

Service Code	MS-DRG 933
Min. Negotiated Rate	$34,346.08
Max. Negotiated Rate	$49,500.16
Rate for Payer: EPIC Health Plan Medicare	$34,346.08
Rate for Payer: Humana Medicare	$34,346.08
Rate for Payer: IEHP Medicare Advantage	$34,346.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,528.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,276.06
Rate for Payer: Molina Healthcare of CA Medicare	$43,276.06
Rate for Payer: Multiplan WC	$49,500.16

INPATIENT MS-DRG 934: FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY

Facility IP

$30,617.31

Service Code	MS-DRG 934
Min. Negotiated Rate	$23,766.88
Max. Negotiated Rate	$30,617.31
Rate for Payer: EPIC Health Plan Medicare	$23,766.88
Rate for Payer: Humana Medicare	$23,766.88
Rate for Payer: IEHP Medicare Advantage	$23,766.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,044.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,946.27
Rate for Payer: Molina Healthcare of CA Medicare	$29,946.27
Rate for Payer: Multiplan WC	$30,617.31

INPATIENT MS-DRG 935: NON-EXTENSIVE BURNS

Facility IP

$33,034.38

Service Code	MS-DRG 935
Min. Negotiated Rate	$23,188.09
Max. Negotiated Rate	$33,034.38
Rate for Payer: EPIC Health Plan Medicare	$23,188.09
Rate for Payer: Humana Medicare	$23,188.09
Rate for Payer: IEHP Medicare Advantage	$23,188.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,361.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,216.99
Rate for Payer: Molina Healthcare of CA Medicare	$29,216.99
Rate for Payer: Multiplan WC	$33,034.38

INPATIENT MS-DRG 939: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC

Facility IP

$50,546.30

Service Code	MS-DRG 939
Min. Negotiated Rate	$36,410.11
Max. Negotiated Rate	$50,546.30
Rate for Payer: EPIC Health Plan Medicare	$36,410.11
Rate for Payer: Humana Medicare	$36,410.11
Rate for Payer: IEHP Medicare Advantage	$36,410.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,963.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$45,876.74
Rate for Payer: Molina Healthcare of CA Medicare	$45,876.74
Rate for Payer: Multiplan WC	$50,546.30

INPATIENT MS-DRG 940: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC

Facility IP

$35,959.02

Service Code	MS-DRG 940
Min. Negotiated Rate	$24,601.28
Max. Negotiated Rate	$35,959.02
Rate for Payer: EPIC Health Plan Medicare	$24,601.28
Rate for Payer: Humana Medicare	$24,601.28
Rate for Payer: IEHP Medicare Advantage	$24,601.28
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,029.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,997.61
Rate for Payer: Molina Healthcare of CA Medicare	$30,997.61
Rate for Payer: Multiplan WC	$35,959.02

INPATIENT MS-DRG 941: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC

Facility IP

$30,803.36

Service Code	MS-DRG 941
Min. Negotiated Rate	$21,103.77
Max. Negotiated Rate	$30,803.36
Rate for Payer: EPIC Health Plan Medicare	$21,103.77
Rate for Payer: Humana Medicare	$21,103.77
Rate for Payer: IEHP Medicare Advantage	$21,103.77
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,902.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,590.75
Rate for Payer: Molina Healthcare of CA Medicare	$26,590.75
Rate for Payer: Multiplan WC	$30,803.36

INPATIENT MS-DRG 945: REHABILITATION WITH CC/MCC

Facility IP

$24,565.66

Service Code	MS-DRG 945
Min. Negotiated Rate	$17,202.02
Max. Negotiated Rate	$24,565.66
Rate for Payer: EPIC Health Plan Medicare	$17,202.02
Rate for Payer: Humana Medicare	$17,202.02
Rate for Payer: IEHP Medicare Advantage	$17,202.02
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,298.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,674.55
Rate for Payer: Molina Healthcare of CA Medicare	$21,674.55
Rate for Payer: Multiplan WC	$24,565.66

INPATIENT MS-DRG 946: REHABILITATION WITHOUT CC/MCC

Facility IP

$18,321.42

Service Code	MS-DRG 946
Min. Negotiated Rate	$11,607.84
Max. Negotiated Rate	$18,321.42
Rate for Payer: EPIC Health Plan Medicare	$11,607.84
Rate for Payer: Humana Medicare	$11,607.84
Rate for Payer: IEHP Medicare Advantage	$11,607.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,697.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,625.88
Rate for Payer: Molina Healthcare of CA Medicare	$14,625.88
Rate for Payer: Multiplan WC	$18,321.42

INPATIENT MS-DRG 947: SIGNS AND SYMPTOMS WITH MCC

Facility IP

$19,839.24

Service Code	MS-DRG 947
Min. Negotiated Rate	$14,297.96
Max. Negotiated Rate	$19,839.24
Rate for Payer: EPIC Health Plan Medicare	$14,297.96
Rate for Payer: Humana Medicare	$14,297.96
Rate for Payer: IEHP Medicare Advantage	$14,297.96
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,871.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,015.43
Rate for Payer: Molina Healthcare of CA Medicare	$18,015.43
Rate for Payer: Multiplan WC	$19,839.24

INPATIENT MS-DRG 948: SIGNS AND SYMPTOMS WITHOUT MCC

Facility IP

$12,690.84

Service Code	MS-DRG 948
Min. Negotiated Rate	$9,223.99
Max. Negotiated Rate	$12,690.84
Rate for Payer: EPIC Health Plan Medicare	$9,223.99
Rate for Payer: Humana Medicare	$9,223.99
Rate for Payer: IEHP Medicare Advantage	$9,223.99
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,884.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,622.23
Rate for Payer: Molina Healthcare of CA Medicare	$11,622.23
Rate for Payer: Multiplan WC	$12,690.84

INPATIENT MS-DRG 949: AFTERCARE WITH CC/MCC

Facility IP

$19,454.07

Service Code	MS-DRG 949
Min. Negotiated Rate	$12,284.58
Max. Negotiated Rate	$19,454.07
Rate for Payer: EPIC Health Plan Medicare	$12,284.58
Rate for Payer: Humana Medicare	$12,284.58
Rate for Payer: IEHP Medicare Advantage	$12,284.58
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,495.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,478.57
Rate for Payer: Molina Healthcare of CA Medicare	$15,478.57
Rate for Payer: Multiplan WC	$19,454.07

INPATIENT MS-DRG 950: AFTERCARE WITHOUT CC/MCC

Facility IP

$11,579.42

Service Code	MS-DRG 950
Min. Negotiated Rate	$7,395.31
Max. Negotiated Rate	$11,579.42
Rate for Payer: EPIC Health Plan Medicare	$7,395.31
Rate for Payer: Humana Medicare	$7,395.31
Rate for Payer: IEHP Medicare Advantage	$7,395.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,726.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,318.09
Rate for Payer: Molina Healthcare of CA Medicare	$9,318.09
Rate for Payer: Multiplan WC	$11,579.42

INPATIENT MS-DRG 951: OTHER FACTORS INFLUENCING HEALTH STATUS

Facility IP

$9,289.65

Service Code	MS-DRG 951
Min. Negotiated Rate	$6,848.04
Max. Negotiated Rate	$9,289.65
Rate for Payer: EPIC Health Plan Medicare	$6,848.04
Rate for Payer: Humana Medicare	$6,848.04
Rate for Payer: IEHP Medicare Advantage	$6,848.04
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,080.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,628.53
Rate for Payer: Molina Healthcare of CA Medicare	$8,628.53
Rate for Payer: Multiplan WC	$9,289.65

INPATIENT MS-DRG 955: CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA

Facility IP

$109,935.08

Service Code	MS-DRG 955
Min. Negotiated Rate	$68,782.79
Max. Negotiated Rate	$109,935.08
Rate for Payer: EPIC Health Plan Medicare	$68,782.79
Rate for Payer: Humana Medicare	$68,782.79
Rate for Payer: IEHP Medicare Advantage	$68,782.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$81,163.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$86,666.32
Rate for Payer: Molina Healthcare of CA Medicare	$86,666.32
Rate for Payer: Multiplan WC	$109,935.08

INPATIENT MS-DRG 956: LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility IP

$62,086.56

Service Code	MS-DRG 956
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$62,086.56
Rate for Payer: EPIC Health Plan Medicare	$43,874.67
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$43,874.67
Rate for Payer: IEHP Medicare Advantage	$43,874.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$51,772.11
Rate for Payer: Molina Healthcare of CA Medi-Cal	$55,282.08
Rate for Payer: Molina Healthcare of CA Medicare	$55,282.08
Rate for Payer: Multiplan WC	$62,086.56

INPATIENT MS-DRG 957: OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility IP

$120,943.27

Service Code	MS-DRG 957
Min. Negotiated Rate	$81,645.58
Max. Negotiated Rate	$120,943.27
Rate for Payer: EPIC Health Plan Medicare	$81,645.58
Rate for Payer: Humana Medicare	$81,645.58
Rate for Payer: IEHP Medicare Advantage	$81,645.58
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$96,341.78
Rate for Payer: Molina Healthcare of CA Medi-Cal	$102,873.43
Rate for Payer: Molina Healthcare of CA Medicare	$102,873.43
Rate for Payer: Multiplan WC	$120,943.27

INPATIENT MS-DRG 958: OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility IP

$68,064.76

Service Code	MS-DRG 958
Min. Negotiated Rate	$45,750.64
Max. Negotiated Rate	$68,064.76
Rate for Payer: EPIC Health Plan Medicare	$45,750.64
Rate for Payer: Humana Medicare	$45,750.64
Rate for Payer: IEHP Medicare Advantage	$45,750.64
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$53,985.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$57,645.81
Rate for Payer: Molina Healthcare of CA Medicare	$57,645.81
Rate for Payer: Multiplan WC	$68,064.76

INPATIENT MS-DRG 959: OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility IP

$41,922.54

Service Code	MS-DRG 959
Min. Negotiated Rate	$28,720.33
Max. Negotiated Rate	$41,922.54
Rate for Payer: EPIC Health Plan Medicare	$28,720.33
Rate for Payer: Humana Medicare	$28,720.33
Rate for Payer: IEHP Medicare Advantage	$28,720.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,889.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$36,187.62
Rate for Payer: Molina Healthcare of CA Medicare	$36,187.62
Rate for Payer: Multiplan WC	$41,922.54

INPATIENT MS-DRG 963: OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility IP

$45,260.08

Service Code	MS-DRG 963
Min. Negotiated Rate	$30,993.83
Max. Negotiated Rate	$45,260.08
Rate for Payer: EPIC Health Plan Medicare	$30,993.83
Rate for Payer: Humana Medicare	$30,993.83
Rate for Payer: IEHP Medicare Advantage	$30,993.83
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,572.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$39,052.23
Rate for Payer: Molina Healthcare of CA Medicare	$39,052.23
Rate for Payer: Multiplan WC	$45,260.08

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