Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT MS-DRG 737: UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC

Facility

$33,024.59

Service Code	MS-DRG 737
Min. Negotiated Rate	$22,430.26
Max. Negotiated Rate	$33,024.59
Rate for Payer: EPIC Health Plan Medicare	$22,430.26
Rate for Payer: Humana Medicare	$22,430.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,430.26
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,467.71
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,262.13
Rate for Payer: Molina Healthcare of CA Medicare	$28,262.13
Rate for Payer: Multiplan WC	$33,024.59

INPATIENT MS-DRG 738: UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$22,910.75

Service Code	MS-DRG 738
Min. Negotiated Rate	$15,570.39
Max. Negotiated Rate	$22,910.75
Rate for Payer: EPIC Health Plan Medicare	$15,570.39
Rate for Payer: Humana Medicare	$15,570.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,570.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,373.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,618.69
Rate for Payer: Molina Healthcare of CA Medicare	$19,618.69
Rate for Payer: Multiplan WC	$22,910.75

INPATIENT MS-DRG 739: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC

Facility

$63,687.59

Service Code	MS-DRG 739
Min. Negotiated Rate	$40,925.54
Max. Negotiated Rate	$63,687.59
Rate for Payer: EPIC Health Plan Medicare	$40,925.54
Rate for Payer: Humana Medicare	$40,925.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$40,925.54
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$48,292.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$51,566.18
Rate for Payer: Molina Healthcare of CA Medicare	$51,566.18
Rate for Payer: Multiplan WC	$63,687.59

INPATIENT MS-DRG 740: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC

Facility

$29,416.12

Service Code	MS-DRG 740
Min. Negotiated Rate	$20,326.81
Max. Negotiated Rate	$29,416.12
Rate for Payer: EPIC Health Plan Medicare	$20,326.81
Rate for Payer: Humana Medicare	$20,326.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,326.81
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,985.64
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,611.78
Rate for Payer: Molina Healthcare of CA Medicare	$25,611.78
Rate for Payer: Multiplan WC	$29,416.12

INPATIENT MS-DRG 741: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$21,427.22

Service Code	MS-DRG 741
Min. Negotiated Rate	$14,835.08
Max. Negotiated Rate	$21,427.22
Rate for Payer: EPIC Health Plan Medicare	$14,835.08
Rate for Payer: Humana Medicare	$14,835.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,835.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,505.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,692.20
Rate for Payer: Molina Healthcare of CA Medicare	$18,692.20
Rate for Payer: Multiplan WC	$21,427.22

INPATIENT MS-DRG 742: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC

Facility

$29,411.22

Service Code	MS-DRG 742
Min. Negotiated Rate	$20,269.38
Max. Negotiated Rate	$29,411.22
Rate for Payer: EPIC Health Plan Medicare	$20,269.38
Rate for Payer: Humana Medicare	$20,269.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,269.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,917.87
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,539.42
Rate for Payer: Molina Healthcare of CA Medicare	$25,539.42
Rate for Payer: Multiplan WC	$29,411.22

INPATIENT MS-DRG 743: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC

Facility

$19,104.81

Service Code	MS-DRG 743
Min. Negotiated Rate	$13,289.03
Max. Negotiated Rate	$19,104.81
Rate for Payer: EPIC Health Plan Medicare	$13,289.03
Rate for Payer: Humana Medicare	$13,289.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,289.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,681.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,744.18
Rate for Payer: Molina Healthcare of CA Medicare	$16,744.18
Rate for Payer: Multiplan WC	$19,104.81

INPATIENT MS-DRG 744: D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC

Facility

$30,981.26

Service Code	MS-DRG 744
Min. Negotiated Rate	$21,401.06
Max. Negotiated Rate	$30,981.26
Rate for Payer: EPIC Health Plan Medicare	$21,401.06
Rate for Payer: Humana Medicare	$21,401.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,401.06
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,253.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,965.34
Rate for Payer: Molina Healthcare of CA Medicare	$26,965.34
Rate for Payer: Multiplan WC	$30,981.26

INPATIENT MS-DRG 745: D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC

Facility

$18,781.66

Service Code	MS-DRG 745
Min. Negotiated Rate	$11,869.08
Max. Negotiated Rate	$18,781.66
Rate for Payer: EPIC Health Plan Medicare	$11,869.08
Rate for Payer: Humana Medicare	$11,869.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,869.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,005.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,955.04
Rate for Payer: Molina Healthcare of CA Medicare	$14,955.04
Rate for Payer: Multiplan WC	$18,781.66

INPATIENT MS-DRG 746: VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC

Facility

$25,515.52

Service Code	MS-DRG 746
Min. Negotiated Rate	$19,078.03
Max. Negotiated Rate	$25,515.52
Rate for Payer: EPIC Health Plan Medicare	$19,078.03
Rate for Payer: Humana Medicare	$19,078.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,078.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,512.08
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,038.32
Rate for Payer: Molina Healthcare of CA Medicare	$24,038.32
Rate for Payer: Multiplan WC	$25,515.52

INPATIENT MS-DRG 747: VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC

Facility

$15,971.27

Service Code	MS-DRG 747
Min. Negotiated Rate	$10,194.65
Max. Negotiated Rate	$15,971.27
Rate for Payer: EPIC Health Plan Medicare	$10,194.65
Rate for Payer: Humana Medicare	$10,194.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,194.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,029.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,845.26
Rate for Payer: Molina Healthcare of CA Medicare	$12,845.26
Rate for Payer: Multiplan WC	$15,971.27

INPATIENT MS-DRG 748: FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

Facility

$23,129.45

Service Code	MS-DRG 748
Min. Negotiated Rate	$16,024.19
Max. Negotiated Rate	$23,129.45
Rate for Payer: EPIC Health Plan Medicare	$16,024.19
Rate for Payer: Humana Medicare	$16,024.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,024.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,908.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,190.48
Rate for Payer: Molina Healthcare of CA Medicare	$20,190.48
Rate for Payer: Multiplan WC	$23,129.45

INPATIENT MS-DRG 749: OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC

Facility

$41,228.91

Service Code	MS-DRG 749
Min. Negotiated Rate	$28,549.19
Max. Negotiated Rate	$41,228.91
Rate for Payer: EPIC Health Plan Medicare	$28,549.19
Rate for Payer: Humana Medicare	$28,549.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,549.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,688.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,971.98
Rate for Payer: Molina Healthcare of CA Medicare	$35,971.98
Rate for Payer: Multiplan WC	$41,228.91

INPATIENT MS-DRG 750: OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$23,289.40

Service Code	MS-DRG 750
Min. Negotiated Rate	$15,518.60
Max. Negotiated Rate	$23,289.40
Rate for Payer: EPIC Health Plan Medicare	$15,518.60
Rate for Payer: Humana Medicare	$15,518.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,518.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,311.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,553.44
Rate for Payer: Molina Healthcare of CA Medicare	$19,553.44
Rate for Payer: Multiplan WC	$23,289.40

INPATIENT MS-DRG 754: MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$28,347.13

Service Code	MS-DRG 754
Min. Negotiated Rate	$21,064.36
Max. Negotiated Rate	$28,347.13
Rate for Payer: EPIC Health Plan Medicare	$21,064.36
Rate for Payer: Humana Medicare	$21,064.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,064.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,855.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,541.09
Rate for Payer: Molina Healthcare of CA Medicare	$26,541.09
Rate for Payer: Multiplan WC	$28,347.13

INPATIENT MS-DRG 755: MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC

Facility

$17,644.13

Service Code	MS-DRG 755
Min. Negotiated Rate	$12,418.59
Max. Negotiated Rate	$17,644.13
Rate for Payer: EPIC Health Plan Medicare	$12,418.59
Rate for Payer: Humana Medicare	$12,418.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,418.59
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,653.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,647.42
Rate for Payer: Molina Healthcare of CA Medicare	$15,647.42
Rate for Payer: Multiplan WC	$17,644.13

INPATIENT MS-DRG 756: MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility

$16,268.30

Service Code	MS-DRG 756
Min. Negotiated Rate	$11,348.85
Max. Negotiated Rate	$16,268.30
Rate for Payer: EPIC Health Plan Medicare	$11,348.85
Rate for Payer: Humana Medicare	$11,348.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,348.85
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,391.64
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,299.55
Rate for Payer: Molina Healthcare of CA Medicare	$14,299.55
Rate for Payer: Multiplan WC	$16,268.30

INPATIENT MS-DRG 757: INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$22,395.03

Service Code	MS-DRG 757
Min. Negotiated Rate	$17,000.47
Max. Negotiated Rate	$22,395.03
Rate for Payer: EPIC Health Plan Medicare	$17,000.47
Rate for Payer: Humana Medicare	$17,000.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,000.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,060.55
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,420.59
Rate for Payer: Molina Healthcare of CA Medicare	$21,420.59
Rate for Payer: Multiplan WC	$22,395.03

INPATIENT MS-DRG 758: INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC

Facility

$15,594.26

Service Code	MS-DRG 758
Min. Negotiated Rate	$11,381.50
Max. Negotiated Rate	$15,594.26
Rate for Payer: EPIC Health Plan Medicare	$11,381.50
Rate for Payer: Humana Medicare	$11,381.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,381.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,430.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,340.69
Rate for Payer: Molina Healthcare of CA Medicare	$14,340.69
Rate for Payer: Multiplan WC	$15,594.26

INPATIENT MS-DRG 759: INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility

$10,125.25

Service Code	MS-DRG 759
Min. Negotiated Rate	$7,480.89
Max. Negotiated Rate	$10,125.25
Rate for Payer: EPIC Health Plan Medicare	$7,480.89
Rate for Payer: Humana Medicare	$7,480.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,480.89
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,827.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,425.92
Rate for Payer: Molina Healthcare of CA Medicare	$9,425.92
Rate for Payer: Multiplan WC	$10,125.25

INPATIENT MS-DRG 760: MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC

Facility

$15,775.42

Service Code	MS-DRG 760
Min. Negotiated Rate	$11,413.03
Max. Negotiated Rate	$15,775.42
Rate for Payer: EPIC Health Plan Medicare	$11,413.03
Rate for Payer: Humana Medicare	$11,413.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,413.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,467.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,380.42
Rate for Payer: Molina Healthcare of CA Medicare	$14,380.42
Rate for Payer: Multiplan WC	$15,775.42

INPATIENT MS-DRG 761: MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC

Facility

$9,232.52

Service Code	MS-DRG 761
Min. Negotiated Rate	$7,023.71
Max. Negotiated Rate	$9,232.52
Rate for Payer: EPIC Health Plan Medicare	$7,023.71
Rate for Payer: Humana Medicare	$7,023.71
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,023.71
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,287.98
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,849.87
Rate for Payer: Molina Healthcare of CA Medicare	$8,849.87
Rate for Payer: Multiplan WC	$9,232.52

INPATIENT MS-DRG 768: VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C

Facility

$18,716.38

Service Code	MS-DRG 768
Min. Negotiated Rate	$6,819.00
Max. Negotiated Rate	$18,716.38
Rate for Payer: EPIC Health Plan Medicare	$13,920.73
Rate for Payer: Humana Medicare	$13,920.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,920.73
Rate for Payer: Kaiser Permanente of CA Commercial	$9,224.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,426.46
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,540.12
Rate for Payer: Molina Healthcare of CA Medicare	$17,540.12
Rate for Payer: Multiplan WC	$18,716.38
Rate for Payer: United Healthcare All Other HMO/non HMO	$8,090.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$6,819.00

INPATIENT MS-DRG 769: POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES

Facility

$27,113.30

Service Code	MS-DRG 769
Min. Negotiated Rate	$17,589.39
Max. Negotiated Rate	$27,113.30
Rate for Payer: EPIC Health Plan Medicare	$17,589.39
Rate for Payer: Humana Medicare	$17,589.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,589.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,755.48
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,162.63
Rate for Payer: Molina Healthcare of CA Medicare	$22,162.63
Rate for Payer: Multiplan WC	$27,113.30

INPATIENT MS-DRG 770: ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$14,130.32

Service Code	MS-DRG 770
Min. Negotiated Rate	$9,198.10
Max. Negotiated Rate	$14,130.32
Rate for Payer: EPIC Health Plan Medicare	$9,198.10
Rate for Payer: Humana Medicare	$9,198.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,198.10
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,853.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,589.61
Rate for Payer: Molina Healthcare of CA Medicare	$11,589.61
Rate for Payer: Multiplan WC	$14,130.32

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