Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT MS-DRG 142: MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC

Facility

$27,772.64

Service Code	MS-DRG 142
Min. Negotiated Rate	$17,601.78
Max. Negotiated Rate	$27,772.64
Rate for Payer: EPIC Health Plan Medicare	$17,601.78
Rate for Payer: Humana Medicare	$17,601.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,601.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,770.10
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,178.24
Rate for Payer: Molina Healthcare of CA Medicare	$22,178.24
Rate for Payer: Multiplan WC	$27,772.64

INPATIENT MS-DRG 143: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC

Facility

$51,778.51

Service Code	MS-DRG 143
Min. Negotiated Rate	$37,652.13
Max. Negotiated Rate	$51,778.51
Rate for Payer: EPIC Health Plan Medicare	$37,652.13
Rate for Payer: Humana Medicare	$37,652.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,652.13
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$44,429.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$47,441.68
Rate for Payer: Molina Healthcare of CA Medicare	$47,441.68
Rate for Payer: Multiplan WC	$51,778.51

INPATIENT MS-DRG 144: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC

Facility

$29,528.73

Service Code	MS-DRG 144
Min. Negotiated Rate	$19,690.59
Max. Negotiated Rate	$29,528.73
Rate for Payer: EPIC Health Plan Medicare	$19,690.59
Rate for Payer: Humana Medicare	$19,690.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,690.59
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,234.90
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,810.14
Rate for Payer: Molina Healthcare of CA Medicare	$24,810.14
Rate for Payer: Multiplan WC	$29,528.73

INPATIENT MS-DRG 145: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$19,711.94

Service Code	MS-DRG 145
Min. Negotiated Rate	$13,954.53
Max. Negotiated Rate	$19,711.94
Rate for Payer: EPIC Health Plan Medicare	$13,954.53
Rate for Payer: Humana Medicare	$13,954.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,954.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,466.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,582.71
Rate for Payer: Molina Healthcare of CA Medicare	$17,582.71
Rate for Payer: Multiplan WC	$19,711.94

INPATIENT MS-DRG 146: EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC

Facility

$32,872.81

Service Code	MS-DRG 146
Min. Negotiated Rate	$23,975.19
Max. Negotiated Rate	$32,872.81
Rate for Payer: EPIC Health Plan Medicare	$23,975.19
Rate for Payer: Humana Medicare	$23,975.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,975.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,290.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,208.74
Rate for Payer: Molina Healthcare of CA Medicare	$30,208.74
Rate for Payer: Multiplan WC	$32,872.81

INPATIENT MS-DRG 147: EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC

Facility

$19,765.79

Service Code	MS-DRG 147
Min. Negotiated Rate	$14,120.03
Max. Negotiated Rate	$19,765.79
Rate for Payer: EPIC Health Plan Medicare	$14,120.03
Rate for Payer: Humana Medicare	$14,120.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,120.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,661.64
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,791.24
Rate for Payer: Molina Healthcare of CA Medicare	$17,791.24
Rate for Payer: Multiplan WC	$19,765.79

INPATIENT MS-DRG 148: EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC

Facility

$13,343.66

Service Code	MS-DRG 148
Min. Negotiated Rate	$10,222.80
Max. Negotiated Rate	$13,343.66
Rate for Payer: EPIC Health Plan Medicare	$10,222.80
Rate for Payer: Humana Medicare	$10,222.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,222.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,062.90
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,880.73
Rate for Payer: Molina Healthcare of CA Medicare	$12,880.73
Rate for Payer: Multiplan WC	$13,343.66

INPATIENT MS-DRG 149: DYSEQUILIBRIUM

Facility

$12,322.00

Service Code	MS-DRG 149
Min. Negotiated Rate	$8,590.03
Max. Negotiated Rate	$12,322.00
Rate for Payer: EPIC Health Plan Medicare	$8,590.03
Rate for Payer: Humana Medicare	$8,590.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,590.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,136.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,823.44
Rate for Payer: Molina Healthcare of CA Medicare	$10,823.44
Rate for Payer: Multiplan WC	$12,322.00

INPATIENT MS-DRG 150: EPISTAXIS WITH MCC

Facility

$22,510.90

Service Code	MS-DRG 150
Min. Negotiated Rate	$15,006.24
Max. Negotiated Rate	$22,510.90
Rate for Payer: EPIC Health Plan Medicare	$15,006.24
Rate for Payer: Humana Medicare	$15,006.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,006.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,707.36
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,907.86
Rate for Payer: Molina Healthcare of CA Medicare	$18,907.86
Rate for Payer: Multiplan WC	$22,510.90

INPATIENT MS-DRG 151: EPISTAXIS WITHOUT MCC

Facility

$12,583.13

Service Code	MS-DRG 151
Min. Negotiated Rate	$8,882.83
Max. Negotiated Rate	$12,583.13
Rate for Payer: EPIC Health Plan Medicare	$8,882.83
Rate for Payer: Humana Medicare	$8,882.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,882.83
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,481.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,192.37
Rate for Payer: Molina Healthcare of CA Medicare	$11,192.37
Rate for Payer: Multiplan WC	$12,583.13

INPATIENT MS-DRG 152: OTITIS MEDIA AND URI WITH MCC

Facility

$19,547.10

Service Code	MS-DRG 152
Min. Negotiated Rate	$13,584.03
Max. Negotiated Rate	$19,547.10
Rate for Payer: EPIC Health Plan Medicare	$13,584.03
Rate for Payer: Humana Medicare	$13,584.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,584.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,029.16
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,115.88
Rate for Payer: Molina Healthcare of CA Medicare	$17,115.88
Rate for Payer: Multiplan WC	$19,547.10

INPATIENT MS-DRG 153: OTITIS MEDIA AND URI WITHOUT MCC

Facility

$11,269.32

Service Code	MS-DRG 153
Min. Negotiated Rate	$8,478.55
Max. Negotiated Rate	$11,269.32
Rate for Payer: EPIC Health Plan Medicare	$8,478.55
Rate for Payer: Humana Medicare	$8,478.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,478.55
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,004.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,682.97
Rate for Payer: Molina Healthcare of CA Medicare	$10,682.97
Rate for Payer: Multiplan WC	$11,269.32

INPATIENT MS-DRG 154: OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC

Facility

$24,528.13

Service Code	MS-DRG 154
Min. Negotiated Rate	$17,525.20
Max. Negotiated Rate	$24,528.13
Rate for Payer: EPIC Health Plan Medicare	$17,525.20
Rate for Payer: Humana Medicare	$17,525.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,525.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,679.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,081.75
Rate for Payer: Molina Healthcare of CA Medicare	$22,081.75
Rate for Payer: Multiplan WC	$24,528.13

INPATIENT MS-DRG 155: OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC

Facility

$15,003.46

Service Code	MS-DRG 155
Min. Negotiated Rate	$10,863.52
Max. Negotiated Rate	$15,003.46
Rate for Payer: EPIC Health Plan Medicare	$10,863.52
Rate for Payer: Humana Medicare	$10,863.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,863.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,818.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,688.04
Rate for Payer: Molina Healthcare of CA Medicare	$13,688.04
Rate for Payer: Multiplan WC	$15,003.46

INPATIENT MS-DRG 156: OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC

Facility

$11,125.70

Service Code	MS-DRG 156
Min. Negotiated Rate	$7,585.62
Max. Negotiated Rate	$11,125.70
Rate for Payer: EPIC Health Plan Medicare	$7,585.62
Rate for Payer: Humana Medicare	$7,585.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,585.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,951.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,557.88
Rate for Payer: Molina Healthcare of CA Medicare	$9,557.88
Rate for Payer: Multiplan WC	$11,125.70

INPATIENT MS-DRG 157: DENTAL AND ORAL DISEASES WITH MCC

Facility

$27,284.66

Service Code	MS-DRG 157
Min. Negotiated Rate	$19,425.98
Max. Negotiated Rate	$27,284.66
Rate for Payer: EPIC Health Plan Medicare	$19,425.98
Rate for Payer: Humana Medicare	$19,425.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,425.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,922.66
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,476.73
Rate for Payer: Molina Healthcare of CA Medicare	$24,476.73
Rate for Payer: Multiplan WC	$27,284.66

INPATIENT MS-DRG 158: DENTAL AND ORAL DISEASES WITH CC

Facility

$15,163.40

Service Code	MS-DRG 158
Min. Negotiated Rate	$10,772.33
Max. Negotiated Rate	$15,163.40
Rate for Payer: EPIC Health Plan Medicare	$10,772.33
Rate for Payer: Humana Medicare	$10,772.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,772.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,711.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,573.14
Rate for Payer: Molina Healthcare of CA Medicare	$13,573.14
Rate for Payer: Multiplan WC	$15,163.40

INPATIENT MS-DRG 159: DENTAL AND ORAL DISEASES WITHOUT CC/MCC

Facility

$12,238.76

Service Code	MS-DRG 159
Min. Negotiated Rate	$7,807.43
Max. Negotiated Rate	$12,238.76
Rate for Payer: EPIC Health Plan Medicare	$7,807.43
Rate for Payer: Humana Medicare	$7,807.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,807.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,212.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,837.36
Rate for Payer: Molina Healthcare of CA Medicare	$9,837.36
Rate for Payer: Multiplan WC	$12,238.76

INPATIENT MS-DRG 163: MAJOR CHEST PROCEDURES WITH MCC

Facility

$79,051.74

Service Code	MS-DRG 163
Min. Negotiated Rate	$53,281.63
Max. Negotiated Rate	$79,051.74
Rate for Payer: EPIC Health Plan Medicare	$53,281.63
Rate for Payer: Humana Medicare	$53,281.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$53,281.63
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$62,872.32
Rate for Payer: Molina Healthcare of CA Medi-Cal	$67,134.85
Rate for Payer: Molina Healthcare of CA Medicare	$67,134.85
Rate for Payer: Multiplan WC	$79,051.74

INPATIENT MS-DRG 164: MAJOR CHEST PROCEDURES WITH CC

Facility

$42,151.02

Service Code	MS-DRG 164
Min. Negotiated Rate	$28,923.04
Max. Negotiated Rate	$42,151.02
Rate for Payer: EPIC Health Plan Medicare	$28,923.04
Rate for Payer: Humana Medicare	$28,923.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,923.04
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,129.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$36,443.03
Rate for Payer: Molina Healthcare of CA Medicare	$36,443.03
Rate for Payer: Multiplan WC	$42,151.02

INPATIENT MS-DRG 165: MAJOR CHEST PROCEDURES WITHOUT CC/MCC

Facility

$31,448.02

Service Code	MS-DRG 165
Min. Negotiated Rate	$21,333.49
Max. Negotiated Rate	$31,448.02
Rate for Payer: EPIC Health Plan Medicare	$21,333.49
Rate for Payer: Humana Medicare	$21,333.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,333.49
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,173.52
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,880.20
Rate for Payer: Molina Healthcare of CA Medicare	$26,880.20
Rate for Payer: Multiplan WC	$31,448.02

INPATIENT MS-DRG 166: OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC

Facility

$59,827.79

Service Code	MS-DRG 166
Min. Negotiated Rate	$45,897.02
Max. Negotiated Rate	$59,827.79
Rate for Payer: EPIC Health Plan Medicare	$45,897.02
Rate for Payer: Humana Medicare	$45,897.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$45,897.02
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$54,158.48
Rate for Payer: Molina Healthcare of CA Medi-Cal	$57,830.25
Rate for Payer: Molina Healthcare of CA Medicare	$57,830.25
Rate for Payer: Multiplan WC	$59,827.79

INPATIENT MS-DRG 167: OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC

Facility

$31,026.96

Service Code	MS-DRG 167
Min. Negotiated Rate	$20,696.14
Max. Negotiated Rate	$31,026.96
Rate for Payer: EPIC Health Plan Medicare	$20,696.14
Rate for Payer: Humana Medicare	$20,696.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,696.14
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,421.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,077.14
Rate for Payer: Molina Healthcare of CA Medicare	$26,077.14
Rate for Payer: Multiplan WC	$31,026.96

INPATIENT MS-DRG 168: OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$23,135.98

Service Code	MS-DRG 168
Min. Negotiated Rate	$15,470.17
Max. Negotiated Rate	$23,135.98
Rate for Payer: EPIC Health Plan Medicare	$15,470.17
Rate for Payer: Humana Medicare	$15,470.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,470.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,254.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,492.41
Rate for Payer: Molina Healthcare of CA Medicare	$19,492.41
Rate for Payer: Multiplan WC	$23,135.98

INPATIENT MS-DRG 173: ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM

Facility

$43,886.15

Service Code	MS-DRG 173
Min. Negotiated Rate	$34,830.28
Max. Negotiated Rate	$43,886.15
Rate for Payer: EPIC Health Plan Medicare	$34,830.28
Rate for Payer: Humana Medicare	$34,830.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,830.28
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$41,099.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,886.15
Rate for Payer: Molina Healthcare of CA Medicare	$43,886.15

Know your out-of-pocket cost for care.

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