Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT MS-DRG 175: PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE

Facility

$22,796.52

Service Code	MS-DRG 175
Min. Negotiated Rate	$16,002.79
Max. Negotiated Rate	$22,796.52
Rate for Payer: EPIC Health Plan Medicare	$16,002.79
Rate for Payer: Humana Medicare	$16,002.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,002.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,883.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,163.52
Rate for Payer: Molina Healthcare of CA Medicare	$20,163.52
Rate for Payer: Multiplan WC	$22,796.52

INPATIENT MS-DRG 176: PULMONARY EMBOLISM WITHOUT MCC

Facility

$13,343.66

Service Code	MS-DRG 176
Min. Negotiated Rate	$9,388.39
Max. Negotiated Rate	$13,343.66
Rate for Payer: EPIC Health Plan Medicare	$9,388.39
Rate for Payer: Humana Medicare	$9,388.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,388.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,078.30
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,829.37
Rate for Payer: Molina Healthcare of CA Medicare	$11,829.37
Rate for Payer: Multiplan WC	$13,343.66

INPATIENT MS-DRG 177: RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC

Facility

$29,048.91

Service Code	MS-DRG 177
Min. Negotiated Rate	$19,306.61
Max. Negotiated Rate	$29,048.91
Rate for Payer: EPIC Health Plan Medicare	$19,306.61
Rate for Payer: Humana Medicare	$19,306.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,306.61
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,781.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,326.33
Rate for Payer: Molina Healthcare of CA Medicare	$24,326.33
Rate for Payer: Multiplan WC	$29,048.91

INPATIENT MS-DRG 178: RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC

Facility

$17,740.41

Service Code	MS-DRG 178
Min. Negotiated Rate	$11,315.06
Max. Negotiated Rate	$17,740.41
Rate for Payer: EPIC Health Plan Medicare	$11,315.06
Rate for Payer: Humana Medicare	$11,315.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,315.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,351.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,256.98
Rate for Payer: Molina Healthcare of CA Medicare	$14,256.98
Rate for Payer: Multiplan WC	$17,740.41

INPATIENT MS-DRG 179: RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC

Facility

$12,818.15

Service Code	MS-DRG 179
Min. Negotiated Rate	$8,799.49
Max. Negotiated Rate	$12,818.15
Rate for Payer: EPIC Health Plan Medicare	$8,799.49
Rate for Payer: Humana Medicare	$8,799.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,799.49
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,383.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,087.36
Rate for Payer: Molina Healthcare of CA Medicare	$11,087.36
Rate for Payer: Multiplan WC	$12,818.15

INPATIENT MS-DRG 180: RESPIRATORY NEOPLASMS WITH MCC

Facility

$27,645.34

Service Code	MS-DRG 180
Min. Negotiated Rate	$19,777.29
Max. Negotiated Rate	$27,645.34
Rate for Payer: EPIC Health Plan Medicare	$19,777.29
Rate for Payer: Humana Medicare	$19,777.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,777.29
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,337.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,919.39
Rate for Payer: Molina Healthcare of CA Medicare	$24,919.39
Rate for Payer: Multiplan WC	$27,645.34

INPATIENT MS-DRG 181: RESPIRATORY NEOPLASMS WITH CC

Facility

$18,502.59

Service Code	MS-DRG 181
Min. Negotiated Rate	$12,603.27
Max. Negotiated Rate	$18,502.59
Rate for Payer: EPIC Health Plan Medicare	$12,603.27
Rate for Payer: Humana Medicare	$12,603.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,603.27
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,871.86
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,880.12
Rate for Payer: Molina Healthcare of CA Medicare	$15,880.12
Rate for Payer: Multiplan WC	$18,502.59

INPATIENT MS-DRG 182: RESPIRATORY NEOPLASMS WITHOUT CC/MCC

Facility

$14,484.47

Service Code	MS-DRG 182
Min. Negotiated Rate	$9,199.23
Max. Negotiated Rate	$14,484.47
Rate for Payer: EPIC Health Plan Medicare	$9,199.23
Rate for Payer: Humana Medicare	$9,199.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,199.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,855.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,591.03
Rate for Payer: Molina Healthcare of CA Medicare	$11,591.03
Rate for Payer: Multiplan WC	$14,484.47

INPATIENT MS-DRG 183: MAJOR CHEST TRAUMA WITH MCC

Facility

$24,516.70

Service Code	MS-DRG 183
Min. Negotiated Rate	$17,933.97
Max. Negotiated Rate	$24,516.70
Rate for Payer: EPIC Health Plan Medicare	$17,933.97
Rate for Payer: Humana Medicare	$17,933.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,933.97
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,162.08
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,596.80
Rate for Payer: Molina Healthcare of CA Medicare	$22,596.80
Rate for Payer: Multiplan WC	$24,516.70

INPATIENT MS-DRG 184: MAJOR CHEST TRAUMA WITH CC

Facility

$17,058.21

Service Code	MS-DRG 184
Min. Negotiated Rate	$12,049.25
Max. Negotiated Rate	$17,058.21
Rate for Payer: EPIC Health Plan Medicare	$12,049.25
Rate for Payer: Humana Medicare	$12,049.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,049.25
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,218.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,182.06
Rate for Payer: Molina Healthcare of CA Medicare	$15,182.06
Rate for Payer: Multiplan WC	$17,058.21

INPATIENT MS-DRG 185: MAJOR CHEST TRAUMA WITHOUT CC/MCC

Facility

$12,322.00

Service Code	MS-DRG 185
Min. Negotiated Rate	$8,713.90
Max. Negotiated Rate	$12,322.00
Rate for Payer: EPIC Health Plan Medicare	$8,713.90
Rate for Payer: Humana Medicare	$8,713.90
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,713.90
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,282.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,979.51
Rate for Payer: Molina Healthcare of CA Medicare	$10,979.51
Rate for Payer: Multiplan WC	$12,322.00

INPATIENT MS-DRG 186: PLEURAL EFFUSION WITH MCC

Facility

$24,918.19

Service Code	MS-DRG 186
Min. Negotiated Rate	$17,681.72
Max. Negotiated Rate	$24,918.19
Rate for Payer: EPIC Health Plan Medicare	$17,681.72
Rate for Payer: Humana Medicare	$17,681.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,681.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,864.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,278.97
Rate for Payer: Molina Healthcare of CA Medicare	$22,278.97
Rate for Payer: Multiplan WC	$24,918.19

INPATIENT MS-DRG 187: PLEURAL EFFUSION WITH CC

Facility

$17,069.64

Service Code	MS-DRG 187
Min. Negotiated Rate	$11,423.17
Max. Negotiated Rate	$17,069.64
Rate for Payer: EPIC Health Plan Medicare	$11,423.17
Rate for Payer: Humana Medicare	$11,423.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,423.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,479.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,393.19
Rate for Payer: Molina Healthcare of CA Medicare	$14,393.19
Rate for Payer: Multiplan WC	$17,069.64

INPATIENT MS-DRG 188: PLEURAL EFFUSION WITHOUT CC/MCC

Facility

$11,816.07

Service Code	MS-DRG 188
Min. Negotiated Rate	$8,610.30
Max. Negotiated Rate	$11,816.07
Rate for Payer: EPIC Health Plan Medicare	$8,610.30
Rate for Payer: Humana Medicare	$8,610.30
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,610.30
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,160.15
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,848.98
Rate for Payer: Molina Healthcare of CA Medicare	$10,848.98
Rate for Payer: Multiplan WC	$11,816.07

INPATIENT MS-DRG 189: PULMONARY EDEMA AND RESPIRATORY FAILURE

Facility

$19,698.88

Service Code	MS-DRG 189
Min. Negotiated Rate	$14,077.27
Max. Negotiated Rate	$19,698.88
Rate for Payer: EPIC Health Plan Medicare	$14,077.27
Rate for Payer: Humana Medicare	$14,077.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,077.27
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,611.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,737.36
Rate for Payer: Molina Healthcare of CA Medicare	$17,737.36
Rate for Payer: Multiplan WC	$19,698.88

INPATIENT MS-DRG 190: CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC

Facility

$17,715.93

Service Code	MS-DRG 190
Min. Negotiated Rate	$12,613.40
Max. Negotiated Rate	$17,715.93
Rate for Payer: EPIC Health Plan Medicare	$12,613.40
Rate for Payer: Humana Medicare	$12,613.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,613.40
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,883.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,892.88
Rate for Payer: Molina Healthcare of CA Medicare	$15,892.88
Rate for Payer: Multiplan WC	$17,715.93

INPATIENT MS-DRG 191: CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC

Facility

$14,104.20

Service Code	MS-DRG 191
Min. Negotiated Rate	$9,764.50
Max. Negotiated Rate	$14,104.20
Rate for Payer: EPIC Health Plan Medicare	$9,764.50
Rate for Payer: Humana Medicare	$9,764.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,764.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,522.11
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,303.27
Rate for Payer: Molina Healthcare of CA Medicare	$12,303.27
Rate for Payer: Multiplan WC	$14,104.20

INPATIENT MS-DRG 192: CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC

Facility

$10,642.61

Service Code	MS-DRG 192
Min. Negotiated Rate	$7,431.33
Max. Negotiated Rate	$10,642.61
Rate for Payer: EPIC Health Plan Medicare	$7,431.33
Rate for Payer: Humana Medicare	$7,431.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,431.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,768.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,363.48
Rate for Payer: Molina Healthcare of CA Medicare	$9,363.48
Rate for Payer: Multiplan WC	$10,642.61

INPATIENT MS-DRG 193: SIMPLE PNEUMONIA AND PLEURISY WITH MCC

Facility

$21,195.47

Service Code	MS-DRG 193
Min. Negotiated Rate	$15,142.48
Max. Negotiated Rate	$21,195.47
Rate for Payer: EPIC Health Plan Medicare	$15,142.48
Rate for Payer: Humana Medicare	$15,142.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,142.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,868.13
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,079.52
Rate for Payer: Molina Healthcare of CA Medicare	$19,079.52
Rate for Payer: Multiplan WC	$21,195.47

INPATIENT MS-DRG 194: SIMPLE PNEUMONIA AND PLEURISY WITH CC

Facility

$13,712.50

Service Code	MS-DRG 194
Min. Negotiated Rate	$9,462.73
Max. Negotiated Rate	$13,712.50
Rate for Payer: EPIC Health Plan Medicare	$9,462.73
Rate for Payer: Humana Medicare	$9,462.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,462.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,166.02
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,923.04
Rate for Payer: Molina Healthcare of CA Medicare	$11,923.04
Rate for Payer: Multiplan WC	$13,712.50

INPATIENT MS-DRG 195: SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC

Facility

$10,474.51

Service Code	MS-DRG 195
Min. Negotiated Rate	$7,248.91
Max. Negotiated Rate	$10,474.51
Rate for Payer: EPIC Health Plan Medicare	$7,248.91
Rate for Payer: Humana Medicare	$7,248.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,248.91
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,553.71
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,133.63
Rate for Payer: Molina Healthcare of CA Medicare	$9,133.63
Rate for Payer: Multiplan WC	$10,474.51

INPATIENT MS-DRG 196: INTERSTITIAL LUNG DISEASE WITH MCC

Facility

$28,360.18

Service Code	MS-DRG 196
Min. Negotiated Rate	$21,547.44
Max. Negotiated Rate	$28,360.18
Rate for Payer: EPIC Health Plan Medicare	$21,547.44
Rate for Payer: Humana Medicare	$21,547.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,547.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,425.98
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,149.77
Rate for Payer: Molina Healthcare of CA Medicare	$27,149.77
Rate for Payer: Multiplan WC	$28,360.18

INPATIENT MS-DRG 197: INTERSTITIAL LUNG DISEASE WITH CC

Facility

$16,052.87

Service Code	MS-DRG 197
Min. Negotiated Rate	$11,436.67
Max. Negotiated Rate	$16,052.87
Rate for Payer: EPIC Health Plan Medicare	$11,436.67
Rate for Payer: Humana Medicare	$11,436.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,436.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,495.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,410.20
Rate for Payer: Molina Healthcare of CA Medicare	$14,410.20
Rate for Payer: Multiplan WC	$16,052.87

INPATIENT MS-DRG 198: INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC

Facility

$11,602.26

Service Code	MS-DRG 198
Min. Negotiated Rate	$8,967.26
Max. Negotiated Rate	$11,602.26
Rate for Payer: EPIC Health Plan Medicare	$8,967.26
Rate for Payer: Humana Medicare	$8,967.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,967.26
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,581.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,298.75
Rate for Payer: Molina Healthcare of CA Medicare	$11,298.75
Rate for Payer: Multiplan WC	$11,602.26

INPATIENT MS-DRG 199: PNEUMOTHORAX WITH MCC

Facility

$28,701.28

Service Code	MS-DRG 199
Min. Negotiated Rate	$20,181.56
Max. Negotiated Rate	$28,701.28
Rate for Payer: EPIC Health Plan Medicare	$20,181.56
Rate for Payer: Humana Medicare	$20,181.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,181.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,814.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,428.77
Rate for Payer: Molina Healthcare of CA Medicare	$25,428.77
Rate for Payer: Multiplan WC	$28,701.28

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