Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT MS-DRG 096: BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility

$37,280.98

Service Code	MS-DRG 096
Min. Negotiated Rate	$24,748.78
Max. Negotiated Rate	$37,280.98
Rate for Payer: EPIC Health Plan Medicare	$24,748.78
Rate for Payer: Humana Medicare	$24,748.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,748.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,203.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,183.46
Rate for Payer: Molina Healthcare of CA Medicare	$31,183.46
Rate for Payer: Multiplan WC	$37,280.98

INPATIENT MS-DRG 097: NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC

Facility

$63,457.48

Service Code	MS-DRG 097
Min. Negotiated Rate	$41,157.50
Max. Negotiated Rate	$63,457.48
Rate for Payer: EPIC Health Plan Medicare	$41,157.50
Rate for Payer: Humana Medicare	$41,157.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$41,157.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$48,565.85
Rate for Payer: Molina Healthcare of CA Medi-Cal	$51,858.45
Rate for Payer: Molina Healthcare of CA Medicare	$51,858.45
Rate for Payer: Multiplan WC	$63,457.48

INPATIENT MS-DRG 098: NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC

Facility

$34,015.24

Service Code	MS-DRG 098
Min. Negotiated Rate	$24,465.02
Max. Negotiated Rate	$34,015.24
Rate for Payer: EPIC Health Plan Medicare	$24,465.02
Rate for Payer: Humana Medicare	$24,465.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,465.02
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,868.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,825.93
Rate for Payer: Molina Healthcare of CA Medicare	$30,825.93
Rate for Payer: Multiplan WC	$34,015.24

INPATIENT MS-DRG 099: NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$22,824.26

Service Code	MS-DRG 099
Min. Negotiated Rate	$15,070.44
Max. Negotiated Rate	$22,824.26
Rate for Payer: EPIC Health Plan Medicare	$15,070.44
Rate for Payer: Humana Medicare	$15,070.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,070.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,783.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,988.75
Rate for Payer: Molina Healthcare of CA Medicare	$18,988.75
Rate for Payer: Multiplan WC	$22,824.26

INPATIENT MS-DRG 100: SEIZURES WITH MCC

Facility

$31,351.74

Service Code	MS-DRG 100
Min. Negotiated Rate	$22,528.23
Max. Negotiated Rate	$31,351.74
Rate for Payer: EPIC Health Plan Medicare	$22,528.23
Rate for Payer: Humana Medicare	$22,528.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,528.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,583.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,385.57
Rate for Payer: Molina Healthcare of CA Medicare	$28,385.57
Rate for Payer: Multiplan WC	$31,351.74

INPATIENT MS-DRG 101: SEIZURES WITHOUT MCC

Facility

$14,712.96

Service Code	MS-DRG 101
Min. Negotiated Rate	$10,446.89
Max. Negotiated Rate	$14,712.96
Rate for Payer: EPIC Health Plan Medicare	$10,446.89
Rate for Payer: Humana Medicare	$10,446.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,446.89
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,327.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,163.08
Rate for Payer: Molina Healthcare of CA Medicare	$13,163.08
Rate for Payer: Multiplan WC	$14,712.96

INPATIENT MS-DRG 102: HEADACHES WITH MCC

Facility

$18,766.97

Service Code	MS-DRG 102
Min. Negotiated Rate	$13,791.24
Max. Negotiated Rate	$18,766.97
Rate for Payer: EPIC Health Plan Medicare	$13,791.24
Rate for Payer: Humana Medicare	$13,791.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,791.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,273.66
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,376.96
Rate for Payer: Molina Healthcare of CA Medicare	$17,376.96
Rate for Payer: Multiplan WC	$18,766.97

INPATIENT MS-DRG 103: HEADACHES WITHOUT MCC

Facility

$13,586.84

Service Code	MS-DRG 103
Min. Negotiated Rate	$9,690.17
Max. Negotiated Rate	$13,586.84
Rate for Payer: EPIC Health Plan Medicare	$9,690.17
Rate for Payer: Humana Medicare	$9,690.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,690.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,434.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,209.61
Rate for Payer: Molina Healthcare of CA Medicare	$12,209.61
Rate for Payer: Multiplan WC	$13,586.84

INPATIENT MS-DRG 113: ORBITAL PROCEDURES WITH CC/MCC

Facility

$36,644.48

Service Code	MS-DRG 113
Min. Negotiated Rate	$28,437.70
Max. Negotiated Rate	$36,644.48
Rate for Payer: EPIC Health Plan Medicare	$28,437.70
Rate for Payer: Humana Medicare	$28,437.70
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,437.70
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,556.49
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,831.50
Rate for Payer: Molina Healthcare of CA Medicare	$35,831.50
Rate for Payer: Multiplan WC	$36,644.48

INPATIENT MS-DRG 114: ORBITAL PROCEDURES WITHOUT CC/MCC

Facility

$21,262.38

Service Code	MS-DRG 114
Min. Negotiated Rate	$14,075.01
Max. Negotiated Rate	$21,262.38
Rate for Payer: EPIC Health Plan Medicare	$14,075.01
Rate for Payer: Humana Medicare	$14,075.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,075.01
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,608.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,734.51
Rate for Payer: Molina Healthcare of CA Medicare	$17,734.51
Rate for Payer: Multiplan WC	$21,262.38

INPATIENT MS-DRG 115: EXTRAOCULAR PROCEDURES EXCEPT ORBIT

Facility

$24,792.51

Service Code	MS-DRG 115
Min. Negotiated Rate	$17,820.22
Max. Negotiated Rate	$24,792.51
Rate for Payer: EPIC Health Plan Medicare	$17,820.22
Rate for Payer: Humana Medicare	$17,820.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,820.22
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,027.86
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,453.48
Rate for Payer: Molina Healthcare of CA Medicare	$22,453.48
Rate for Payer: Multiplan WC	$24,792.51

INPATIENT MS-DRG 116: INTRAOCULAR PROCEDURES WITH CC/MCC

Facility

$30,788.68

Service Code	MS-DRG 116
Min. Negotiated Rate	$20,820.01
Max. Negotiated Rate	$30,788.68
Rate for Payer: EPIC Health Plan Medicare	$20,820.01
Rate for Payer: Humana Medicare	$20,820.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,820.01
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,567.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,233.21
Rate for Payer: Molina Healthcare of CA Medicare	$26,233.21
Rate for Payer: Multiplan WC	$30,788.68

INPATIENT MS-DRG 117: INTRAOCULAR PROCEDURES WITHOUT CC/MCC

Facility

$17,260.61

Service Code	MS-DRG 117
Min. Negotiated Rate	$13,698.90
Max. Negotiated Rate	$17,260.61
Rate for Payer: EPIC Health Plan Medicare	$13,698.90
Rate for Payer: Humana Medicare	$13,698.90
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,698.90
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,164.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,260.61
Rate for Payer: Molina Healthcare of CA Medicare	$17,260.61
Rate for Payer: Multiplan WC	$16,203.02

INPATIENT MS-DRG 121: ACUTE MAJOR EYE INFECTIONS WITH CC/MCC

Facility

$19,997.55

Service Code	MS-DRG 121
Min. Negotiated Rate	$14,631.26
Max. Negotiated Rate	$19,997.55
Rate for Payer: EPIC Health Plan Medicare	$14,631.26
Rate for Payer: Humana Medicare	$14,631.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,631.26
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,264.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,435.39
Rate for Payer: Molina Healthcare of CA Medicare	$18,435.39
Rate for Payer: Multiplan WC	$19,997.55

INPATIENT MS-DRG 122: ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC

Facility

$11,274.22

Service Code	MS-DRG 122
Min. Negotiated Rate	$8,587.78
Max. Negotiated Rate	$11,274.22
Rate for Payer: EPIC Health Plan Medicare	$8,587.78
Rate for Payer: Humana Medicare	$8,587.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,587.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,133.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,820.60
Rate for Payer: Molina Healthcare of CA Medicare	$10,820.60
Rate for Payer: Multiplan WC	$11,274.22

INPATIENT MS-DRG 123: NEUROLOGICAL EYE DISORDERS

Facility

$12,955.24

Service Code	MS-DRG 123
Min. Negotiated Rate	$9,257.78
Max. Negotiated Rate	$12,955.24
Rate for Payer: EPIC Health Plan Medicare	$9,257.78
Rate for Payer: Humana Medicare	$9,257.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,257.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,924.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,664.80
Rate for Payer: Molina Healthcare of CA Medicare	$11,664.80
Rate for Payer: Multiplan WC	$12,955.24

INPATIENT MS-DRG 124: OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT

Facility

$22,860.17

Service Code	MS-DRG 124
Min. Negotiated Rate	$15,089.57
Max. Negotiated Rate	$22,860.17
Rate for Payer: EPIC Health Plan Medicare	$15,089.57
Rate for Payer: Humana Medicare	$15,089.57
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,089.57
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,805.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,012.86
Rate for Payer: Molina Healthcare of CA Medicare	$19,012.86
Rate for Payer: Multiplan WC	$22,860.17

INPATIENT MS-DRG 125: OTHER DISORDERS OF THE EYE WITHOUT MCC

Facility

$14,069.93

Service Code	MS-DRG 125
Min. Negotiated Rate	$9,184.58
Max. Negotiated Rate	$14,069.93
Rate for Payer: EPIC Health Plan Medicare	$9,184.58
Rate for Payer: Humana Medicare	$9,184.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,184.58
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,837.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,572.57
Rate for Payer: Molina Healthcare of CA Medicare	$11,572.57
Rate for Payer: Multiplan WC	$14,069.93

INPATIENT MS-DRG 135: SINUS AND MASTOID PROCEDURES WITH CC/MCC

Facility

$39,996.72

Service Code	MS-DRG 135
Min. Negotiated Rate	$30,068.22
Max. Negotiated Rate	$39,996.72
Rate for Payer: EPIC Health Plan Medicare	$30,068.22
Rate for Payer: Humana Medicare	$30,068.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,068.22
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,480.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,885.96
Rate for Payer: Molina Healthcare of CA Medicare	$37,885.96
Rate for Payer: Multiplan WC	$39,996.72

INPATIENT MS-DRG 136: SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC

Facility

$18,936.71

Service Code	MS-DRG 136
Min. Negotiated Rate	$11,963.68
Max. Negotiated Rate	$18,936.71
Rate for Payer: EPIC Health Plan Medicare	$11,963.68
Rate for Payer: Humana Medicare	$11,963.68
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,963.68
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,117.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,074.24
Rate for Payer: Molina Healthcare of CA Medicare	$15,074.24
Rate for Payer: Multiplan WC	$18,936.71

INPATIENT MS-DRG 137: MOUTH PROCEDURES WITH CC/MCC

Facility

$24,474.27

Service Code	MS-DRG 137
Min. Negotiated Rate	$17,147.98
Max. Negotiated Rate	$24,474.27
Rate for Payer: EPIC Health Plan Medicare	$17,147.98
Rate for Payer: Humana Medicare	$17,147.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,147.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,234.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,606.45
Rate for Payer: Molina Healthcare of CA Medicare	$21,606.45
Rate for Payer: Multiplan WC	$24,474.27

INPATIENT MS-DRG 138: MOUTH PROCEDURES WITHOUT CC/MCC

Facility

$14,432.24

Service Code	MS-DRG 138
Min. Negotiated Rate	$9,952.56
Max. Negotiated Rate	$14,432.24
Rate for Payer: EPIC Health Plan Medicare	$9,952.56
Rate for Payer: Humana Medicare	$9,952.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,952.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,744.02
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,540.23
Rate for Payer: Molina Healthcare of CA Medicare	$12,540.23
Rate for Payer: Multiplan WC	$14,432.24

INPATIENT MS-DRG 139: SALIVARY GLAND PROCEDURES

Facility

$20,523.06

Service Code	MS-DRG 139
Min. Negotiated Rate	$13,578.41
Max. Negotiated Rate	$20,523.06
Rate for Payer: EPIC Health Plan Medicare	$13,578.41
Rate for Payer: Humana Medicare	$13,578.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,578.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,022.52
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,108.80
Rate for Payer: Molina Healthcare of CA Medicare	$17,108.80
Rate for Payer: Multiplan WC	$20,523.06

INPATIENT MS-DRG 140: MAJOR HEAD AND NECK PROCEDURES WITH MCC

Facility

$67,833.01

Service Code	MS-DRG 140
Min. Negotiated Rate	$42,747.48
Max. Negotiated Rate	$67,833.01
Rate for Payer: EPIC Health Plan Medicare	$42,747.48
Rate for Payer: Humana Medicare	$42,747.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$42,747.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$50,442.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$53,861.82
Rate for Payer: Molina Healthcare of CA Medicare	$53,861.82
Rate for Payer: Multiplan WC	$67,833.01

INPATIENT MS-DRG 141: MAJOR HEAD AND NECK PROCEDURES WITH CC

Facility

$36,437.21

Service Code	MS-DRG 141
Min. Negotiated Rate	$23,532.66
Max. Negotiated Rate	$36,437.21
Rate for Payer: EPIC Health Plan Medicare	$23,532.66
Rate for Payer: Humana Medicare	$23,532.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,532.66
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,768.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,651.15
Rate for Payer: Molina Healthcare of CA Medicare	$29,651.15
Rate for Payer: Multiplan WC	$36,437.21

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