Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT MS-DRG 566: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC

Facility

$12,121.26

Service Code	MS-DRG 566
Min. Negotiated Rate	$8,655.36
Max. Negotiated Rate	$12,121.26
Rate for Payer: EPIC Health Plan Medicare	$8,655.36
Rate for Payer: Humana Medicare	$8,655.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,655.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,213.32
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,905.75
Rate for Payer: Molina Healthcare of CA Medicare	$10,905.75
Rate for Payer: Multiplan WC	$12,121.26

INPATIENT MS-DRG 570: SKIN DEBRIDEMENT WITH MCC

Facility

$47,608.62

Service Code	MS-DRG 570
Min. Negotiated Rate	$33,109.67
Max. Negotiated Rate	$47,608.62
Rate for Payer: EPIC Health Plan Medicare	$33,109.67
Rate for Payer: Humana Medicare	$33,109.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,109.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,069.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$41,718.18
Rate for Payer: Molina Healthcare of CA Medicare	$41,718.18
Rate for Payer: Multiplan WC	$47,608.62

INPATIENT MS-DRG 571: SKIN DEBRIDEMENT WITH CC

Facility

$26,906.02

Service Code	MS-DRG 571
Min. Negotiated Rate	$19,255.95
Max. Negotiated Rate	$26,906.02
Rate for Payer: EPIC Health Plan Medicare	$19,255.95
Rate for Payer: Humana Medicare	$19,255.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,255.95
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,722.02
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,262.50
Rate for Payer: Molina Healthcare of CA Medicare	$24,262.50
Rate for Payer: Multiplan WC	$26,906.02

INPATIENT MS-DRG 572: SKIN DEBRIDEMENT WITHOUT CC/MCC

Facility

$19,643.38

Service Code	MS-DRG 572
Min. Negotiated Rate	$13,036.78
Max. Negotiated Rate	$19,643.38
Rate for Payer: EPIC Health Plan Medicare	$13,036.78
Rate for Payer: Humana Medicare	$13,036.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,036.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,383.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,426.34
Rate for Payer: Molina Healthcare of CA Medicare	$16,426.34
Rate for Payer: Multiplan WC	$19,643.38

INPATIENT MS-DRG 573: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility

$95,809.66

Service Code	MS-DRG 573
Min. Negotiated Rate	$70,222.98
Max. Negotiated Rate	$95,809.66
Rate for Payer: EPIC Health Plan Medicare	$70,222.98
Rate for Payer: Humana Medicare	$70,222.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$70,222.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$82,863.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$88,480.95
Rate for Payer: Molina Healthcare of CA Medicare	$88,480.95
Rate for Payer: Multiplan WC	$95,809.66

INPATIENT MS-DRG 574: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility

$58,828.98

Service Code	MS-DRG 574
Min. Negotiated Rate	$38,555.22
Max. Negotiated Rate	$58,828.98
Rate for Payer: EPIC Health Plan Medicare	$38,555.22
Rate for Payer: Humana Medicare	$38,555.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$38,555.22
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$45,495.16
Rate for Payer: Molina Healthcare of CA Medi-Cal	$48,579.58
Rate for Payer: Molina Healthcare of CA Medicare	$48,579.58
Rate for Payer: Multiplan WC	$58,828.98

INPATIENT MS-DRG 575: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility

$33,450.56

Service Code	MS-DRG 575
Min. Negotiated Rate	$23,243.27
Max. Negotiated Rate	$33,450.56
Rate for Payer: EPIC Health Plan Medicare	$23,243.27
Rate for Payer: Humana Medicare	$23,243.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,243.27
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,427.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,286.52
Rate for Payer: Molina Healthcare of CA Medicare	$29,286.52
Rate for Payer: Multiplan WC	$33,450.56

INPATIENT MS-DRG 576: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility

$92,194.67

Service Code	MS-DRG 576
Min. Negotiated Rate	$64,198.65
Max. Negotiated Rate	$92,194.67
Rate for Payer: EPIC Health Plan Medicare	$64,198.65
Rate for Payer: Humana Medicare	$64,198.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$64,198.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$75,754.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$80,890.30
Rate for Payer: Molina Healthcare of CA Medicare	$80,890.30
Rate for Payer: Multiplan WC	$92,194.67

INPATIENT MS-DRG 577: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility

$42,738.56

Service Code	MS-DRG 577
Min. Negotiated Rate	$30,034.45
Max. Negotiated Rate	$42,738.56
Rate for Payer: EPIC Health Plan Medicare	$30,034.45
Rate for Payer: Humana Medicare	$30,034.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,034.45
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,440.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,843.41
Rate for Payer: Molina Healthcare of CA Medicare	$37,843.41
Rate for Payer: Multiplan WC	$42,738.56

INPATIENT MS-DRG 578: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility

$27,948.90

Service Code	MS-DRG 578
Min. Negotiated Rate	$18,339.33
Max. Negotiated Rate	$27,948.90
Rate for Payer: EPIC Health Plan Medicare	$18,339.33
Rate for Payer: Humana Medicare	$18,339.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,339.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,640.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,107.56
Rate for Payer: Molina Healthcare of CA Medicare	$23,107.56
Rate for Payer: Multiplan WC	$27,948.90

INPATIENT MS-DRG 579: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC

Facility

$51,437.41

Service Code	MS-DRG 579
Min. Negotiated Rate	$37,839.05
Max. Negotiated Rate	$51,437.41
Rate for Payer: EPIC Health Plan Medicare	$37,839.05
Rate for Payer: Humana Medicare	$37,839.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,839.05
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$44,650.08
Rate for Payer: Molina Healthcare of CA Medi-Cal	$47,677.20
Rate for Payer: Molina Healthcare of CA Medicare	$47,677.20
Rate for Payer: Multiplan WC	$51,437.41

INPATIENT MS-DRG 580: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC

Facility

$28,335.70

Service Code	MS-DRG 580
Min. Negotiated Rate	$19,871.88
Max. Negotiated Rate	$28,335.70
Rate for Payer: EPIC Health Plan Medicare	$19,871.88
Rate for Payer: Humana Medicare	$19,871.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,871.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,448.82
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,038.57
Rate for Payer: Molina Healthcare of CA Medicare	$25,038.57
Rate for Payer: Multiplan WC	$28,335.70

INPATIENT MS-DRG 581: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC

Facility

$23,036.43

Service Code	MS-DRG 581
Min. Negotiated Rate	$15,368.83
Max. Negotiated Rate	$23,036.43
Rate for Payer: EPIC Health Plan Medicare	$15,368.83
Rate for Payer: Humana Medicare	$15,368.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,368.83
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,135.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,364.73
Rate for Payer: Molina Healthcare of CA Medicare	$19,364.73
Rate for Payer: Multiplan WC	$23,036.43

INPATIENT MS-DRG 582: MASTECTOMY FOR MALIGNANCY WITH CC/MCC

Facility

$31,576.96

Service Code	MS-DRG 582
Min. Negotiated Rate	$19,812.20
Max. Negotiated Rate	$31,576.96
Rate for Payer: EPIC Health Plan Medicare	$19,812.20
Rate for Payer: Humana Medicare	$19,812.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,812.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,378.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,963.37
Rate for Payer: Molina Healthcare of CA Medicare	$24,963.37
Rate for Payer: Multiplan WC	$31,576.96

INPATIENT MS-DRG 583: MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC

Facility

$24,657.05

Service Code	MS-DRG 583
Min. Negotiated Rate	$17,341.67
Max. Negotiated Rate	$24,657.05
Rate for Payer: EPIC Health Plan Medicare	$17,341.67
Rate for Payer: Humana Medicare	$17,341.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,341.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,463.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,850.50
Rate for Payer: Molina Healthcare of CA Medicare	$21,850.50
Rate for Payer: Multiplan WC	$24,657.05

INPATIENT MS-DRG 584: BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC

Facility

$34,857.38

Service Code	MS-DRG 584
Min. Negotiated Rate	$22,259.11
Max. Negotiated Rate	$34,857.38
Rate for Payer: EPIC Health Plan Medicare	$22,259.11
Rate for Payer: Humana Medicare	$22,259.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,259.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,265.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,046.48
Rate for Payer: Molina Healthcare of CA Medicare	$28,046.48
Rate for Payer: Multiplan WC	$34,857.38

INPATIENT MS-DRG 585: BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC

Facility

$30,047.72

Service Code	MS-DRG 585
Min. Negotiated Rate	$19,166.98
Max. Negotiated Rate	$30,047.72
Rate for Payer: EPIC Health Plan Medicare	$19,166.98
Rate for Payer: Humana Medicare	$19,166.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,166.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,617.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,150.39
Rate for Payer: Molina Healthcare of CA Medicare	$24,150.39
Rate for Payer: Multiplan WC	$30,047.72

INPATIENT MS-DRG 592: SKIN ULCERS WITH MCC

Facility

$29,912.22

Service Code	MS-DRG 592
Min. Negotiated Rate	$23,739.86
Max. Negotiated Rate	$29,912.22
Rate for Payer: EPIC Health Plan Medicare	$23,739.86
Rate for Payer: Humana Medicare	$23,739.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,739.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,013.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,912.22
Rate for Payer: Molina Healthcare of CA Medicare	$29,912.22
Rate for Payer: Multiplan WC	$29,115.82

INPATIENT MS-DRG 593: SKIN ULCERS WITH CC

Facility

$18,799.61

Service Code	MS-DRG 593
Min. Negotiated Rate	$13,828.39
Max. Negotiated Rate	$18,799.61
Rate for Payer: EPIC Health Plan Medicare	$13,828.39
Rate for Payer: Humana Medicare	$13,828.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,828.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,317.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,423.77
Rate for Payer: Molina Healthcare of CA Medicare	$17,423.77
Rate for Payer: Multiplan WC	$18,799.61

INPATIENT MS-DRG 594: SKIN ULCERS WITHOUT CC/MCC

Facility

$12,630.46

Service Code	MS-DRG 594
Min. Negotiated Rate	$9,070.86
Max. Negotiated Rate	$12,630.46
Rate for Payer: EPIC Health Plan Medicare	$9,070.86
Rate for Payer: Humana Medicare	$9,070.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,070.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,703.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,429.28
Rate for Payer: Molina Healthcare of CA Medicare	$11,429.28
Rate for Payer: Multiplan WC	$12,630.46

INPATIENT MS-DRG 595: MAJOR SKIN DISORDERS WITH MCC

Facility

$34,948.78

Service Code	MS-DRG 595
Min. Negotiated Rate	$24,695.86
Max. Negotiated Rate	$34,948.78
Rate for Payer: EPIC Health Plan Medicare	$24,695.86
Rate for Payer: Humana Medicare	$24,695.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,695.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,141.11
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,116.78
Rate for Payer: Molina Healthcare of CA Medicare	$31,116.78
Rate for Payer: Multiplan WC	$34,948.78

INPATIENT MS-DRG 596: MAJOR SKIN DISORDERS WITHOUT MCC

Facility

$17,818.75

Service Code	MS-DRG 596
Min. Negotiated Rate	$11,566.19
Max. Negotiated Rate	$17,818.75
Rate for Payer: EPIC Health Plan Medicare	$11,566.19
Rate for Payer: Humana Medicare	$11,566.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,566.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,648.10
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,573.40
Rate for Payer: Molina Healthcare of CA Medicare	$14,573.40
Rate for Payer: Multiplan WC	$17,818.75

INPATIENT MS-DRG 597: MALIGNANT BREAST DISORDERS WITH MCC

Facility

$27,483.77

Service Code	MS-DRG 597
Min. Negotiated Rate	$18,226.73
Max. Negotiated Rate	$27,483.77
Rate for Payer: EPIC Health Plan Medicare	$18,226.73
Rate for Payer: Humana Medicare	$18,226.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,226.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,507.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,965.68
Rate for Payer: Molina Healthcare of CA Medicare	$22,965.68
Rate for Payer: Multiplan WC	$27,483.77

INPATIENT MS-DRG 598: MALIGNANT BREAST DISORDERS WITH CC

Facility

$17,431.96

Service Code	MS-DRG 598
Min. Negotiated Rate	$13,703.42
Max. Negotiated Rate	$17,431.96
Rate for Payer: EPIC Health Plan Medicare	$13,703.42
Rate for Payer: Humana Medicare	$13,703.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,703.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,170.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,266.31
Rate for Payer: Molina Healthcare of CA Medicare	$17,266.31
Rate for Payer: Multiplan WC	$17,431.96

INPATIENT MS-DRG 599: MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility

$12,201.23

Service Code	MS-DRG 599
Min. Negotiated Rate	$7,780.40
Max. Negotiated Rate	$12,201.23
Rate for Payer: EPIC Health Plan Medicare	$7,780.40
Rate for Payer: Humana Medicare	$7,780.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,780.40
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,180.87
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,803.30
Rate for Payer: Molina Healthcare of CA Medicare	$9,803.30
Rate for Payer: Multiplan WC	$12,201.23

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