Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT MS-DRG 776: POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES

Facility

$11,377.04

Service Code	MS-DRG 776
Min. Negotiated Rate	$8,274.75
Max. Negotiated Rate	$11,377.04
Rate for Payer: EPIC Health Plan Medicare	$8,274.75
Rate for Payer: Humana Medicare	$8,274.75
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,274.75
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,764.20
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,426.18
Rate for Payer: Molina Healthcare of CA Medicare	$10,426.18
Rate for Payer: Multiplan WC	$11,377.04

INPATIENT MS-DRG 779: ABORTION WITHOUT D&C

Facility

$16,624.09

Service Code	MS-DRG 779
Min. Negotiated Rate	$11,343.22
Max. Negotiated Rate	$16,624.09
Rate for Payer: EPIC Health Plan Medicare	$11,343.22
Rate for Payer: Humana Medicare	$11,343.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,343.22
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,385.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,292.46
Rate for Payer: Molina Healthcare of CA Medicare	$14,292.46
Rate for Payer: Multiplan WC	$16,624.09

INPATIENT MS-DRG 783: CESAREAN SECTION WITH STERILIZATION WITH MCC

Facility

$31,493.72

Service Code	MS-DRG 783
Min. Negotiated Rate	$7,879.00
Max. Negotiated Rate	$31,493.72
Rate for Payer: EPIC Health Plan Medicare	$20,155.65
Rate for Payer: Heritage Provider Network Senior	$7,879.00
Rate for Payer: Humana Medicare	$20,155.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,155.65
Rate for Payer: Kaiser Permanente of CA Commercial	$12,936.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,783.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,396.12
Rate for Payer: Molina Healthcare of CA Medicare	$25,396.12
Rate for Payer: Multiplan WC	$31,493.72
Rate for Payer: United Healthcare All Other HMO/non HMO	$11,507.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$9,678.00

INPATIENT MS-DRG 784: CESAREAN SECTION WITH STERILIZATION WITH CC

Facility

$17,038.63

Service Code	MS-DRG 784
Min. Negotiated Rate	$7,879.00
Max. Negotiated Rate	$17,038.63
Rate for Payer: EPIC Health Plan Medicare	$11,736.22
Rate for Payer: Heritage Provider Network Senior	$7,879.00
Rate for Payer: Humana Medicare	$11,736.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,736.22
Rate for Payer: Kaiser Permanente of CA Commercial	$12,936.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,848.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,787.64
Rate for Payer: Molina Healthcare of CA Medicare	$14,787.64
Rate for Payer: Multiplan WC	$17,038.63
Rate for Payer: United Healthcare All Other HMO/non HMO	$11,507.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$9,678.00

INPATIENT MS-DRG 785: CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC

Facility

$14,885.96

Service Code	MS-DRG 785
Min. Negotiated Rate	$7,879.00
Max. Negotiated Rate	$14,885.96
Rate for Payer: EPIC Health Plan Medicare	$9,959.29
Rate for Payer: Heritage Provider Network Senior	$7,879.00
Rate for Payer: Humana Medicare	$9,959.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,959.29
Rate for Payer: Kaiser Permanente of CA Commercial	$12,936.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,751.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,548.71
Rate for Payer: Molina Healthcare of CA Medicare	$12,548.71
Rate for Payer: Multiplan WC	$14,885.96
Rate for Payer: United Healthcare All Other HMO/non HMO	$11,507.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$9,678.00

INPATIENT MS-DRG 786: CESAREAN SECTION WITHOUT STERILIZATION WITH MCC

Facility

$26,357.65

Service Code	MS-DRG 786
Min. Negotiated Rate	$7,879.00
Max. Negotiated Rate	$26,357.65
Rate for Payer: EPIC Health Plan Medicare	$19,904.54
Rate for Payer: Heritage Provider Network Senior	$7,879.00
Rate for Payer: Humana Medicare	$19,904.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,904.54
Rate for Payer: Kaiser Permanente of CA Commercial	$12,936.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,487.36
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,079.72
Rate for Payer: Molina Healthcare of CA Medicare	$25,079.72
Rate for Payer: Multiplan WC	$26,357.65
Rate for Payer: United Healthcare All Other HMO/non HMO	$11,507.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$9,678.00

INPATIENT MS-DRG 787: CESAREAN SECTION WITHOUT STERILIZATION WITH CC

Facility

$17,386.26

Service Code	MS-DRG 787
Min. Negotiated Rate	$7,879.00
Max. Negotiated Rate	$17,386.26
Rate for Payer: EPIC Health Plan Medicare	$12,040.25
Rate for Payer: Heritage Provider Network Senior	$7,879.00
Rate for Payer: Humana Medicare	$12,040.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,040.25
Rate for Payer: Kaiser Permanente of CA Commercial	$12,936.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,207.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,170.72
Rate for Payer: Molina Healthcare of CA Medicare	$15,170.72
Rate for Payer: Multiplan WC	$17,386.26
Rate for Payer: United Healthcare All Other HMO/non HMO	$11,507.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$9,678.00

INPATIENT MS-DRG 788: CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC

Facility

$14,238.03

Service Code	MS-DRG 788
Min. Negotiated Rate	$7,879.00
Max. Negotiated Rate	$14,238.03
Rate for Payer: EPIC Health Plan Medicare	$9,832.05
Rate for Payer: Heritage Provider Network Senior	$7,879.00
Rate for Payer: Humana Medicare	$9,832.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,832.05
Rate for Payer: Kaiser Permanente of CA Commercial	$12,936.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,601.82
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,388.38
Rate for Payer: Molina Healthcare of CA Medicare	$12,388.38
Rate for Payer: Multiplan WC	$14,238.03
Rate for Payer: United Healthcare All Other HMO/non HMO	$11,507.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$9,678.00

INPATIENT MS-DRG 789: NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY

Facility

$29,798.02

Service Code	MS-DRG 789
Min. Negotiated Rate	$2,679.00
Max. Negotiated Rate	$29,798.02
Rate for Payer: EPIC Health Plan Medicare	$20,691.63
Rate for Payer: Humana Medicare	$20,691.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,691.63
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,416.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,071.45
Rate for Payer: Molina Healthcare of CA Medicare	$26,071.45
Rate for Payer: Multiplan WC	$29,798.02
Rate for Payer: United Healthcare All Other HMO/non HMO	$3,174.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$2,679.00

INPATIENT MS-DRG 790: EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE

Facility

$98,267.53

Service Code	MS-DRG 790
Min. Negotiated Rate	$4,956.00
Max. Negotiated Rate	$98,267.53
Rate for Payer: EPIC Health Plan Medicare	$67,768.21
Rate for Payer: Humana Medicare	$67,768.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$67,768.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$79,966.49
Rate for Payer: Molina Healthcare of CA Medi-Cal	$85,387.94
Rate for Payer: Molina Healthcare of CA Medicare	$85,387.94
Rate for Payer: Multiplan WC	$98,267.53
Rate for Payer: United Healthcare All Other HMO/non HMO	$5,885.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$4,956.00

INPATIENT MS-DRG 791: PREMATURITY WITH MAJOR PROBLEMS

Facility

$67,111.64

Service Code	MS-DRG 791
Min. Negotiated Rate	$4,550.00
Max. Negotiated Rate	$67,111.64
Rate for Payer: EPIC Health Plan Medicare	$46,346.33
Rate for Payer: Humana Medicare	$46,346.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$46,346.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$54,688.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$58,396.38
Rate for Payer: Molina Healthcare of CA Medicare	$58,396.38
Rate for Payer: Multiplan WC	$67,111.64
Rate for Payer: United Healthcare All Other HMO/non HMO	$5,408.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$4,550.00

INPATIENT MS-DRG 792: PREMATURITY WITHOUT MAJOR PROBLEMS

Facility

$40,494.49

Service Code	MS-DRG 792
Min. Negotiated Rate	$2,679.00
Max. Negotiated Rate	$40,494.49
Rate for Payer: EPIC Health Plan Medicare	$28,045.84
Rate for Payer: Humana Medicare	$28,045.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,045.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,094.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,337.76
Rate for Payer: Molina Healthcare of CA Medicare	$35,337.76
Rate for Payer: Multiplan WC	$40,494.49
Rate for Payer: United Healthcare All Other HMO/non HMO	$3,174.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$2,679.00

INPATIENT MS-DRG 793: FULL TERM NEONATE WITH MAJOR PROBLEMS

Facility

$68,937.91

Service Code	MS-DRG 793
Min. Negotiated Rate	$4,550.00
Max. Negotiated Rate	$68,937.91
Rate for Payer: EPIC Health Plan Medicare	$47,603.00
Rate for Payer: Humana Medicare	$47,603.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$47,603.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$56,171.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$59,979.78
Rate for Payer: Molina Healthcare of CA Medicare	$59,979.78
Rate for Payer: Multiplan WC	$68,937.91
Rate for Payer: United Healthcare All Other HMO/non HMO	$5,408.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$4,550.00

INPATIENT MS-DRG 794: NEONATE WITH OTHER SIGNIFICANT PROBLEMS

Facility

$24,400.82

Service Code	MS-DRG 794
Min. Negotiated Rate	$2,679.00
Max. Negotiated Rate	$24,400.82
Rate for Payer: EPIC Health Plan Medicare	$16,981.32
Rate for Payer: Humana Medicare	$16,981.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,981.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,037.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,396.46
Rate for Payer: Molina Healthcare of CA Medicare	$21,396.46
Rate for Payer: Multiplan WC	$24,400.82
Rate for Payer: United Healthcare All Other HMO/non HMO	$3,174.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$2,679.00

INPATIENT MS-DRG 795: NORMAL NEWBORN

Facility

$3,303.28

Service Code	MS-DRG 795
Min. Negotiated Rate	$876.00
Max. Negotiated Rate	$3,303.28
Rate for Payer: EPIC Health Plan Medicare	$2,475.62
Rate for Payer: Humana Medicare	$2,475.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$2,475.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$2,921.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$3,119.28
Rate for Payer: Molina Healthcare of CA Medicare	$3,119.28
Rate for Payer: Multiplan WC	$3,303.28
Rate for Payer: United Healthcare All Other HMO/non HMO	$1,044.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$876.00

INPATIENT MS-DRG 796: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC

Facility

$21,428.86

Service Code	MS-DRG 796
Min. Negotiated Rate	$5,677.00
Max. Negotiated Rate	$21,428.86
Rate for Payer: EPIC Health Plan Medicare	$16,176.18
Rate for Payer: Heritage Provider Network Senior	$5,677.00
Rate for Payer: Humana Medicare	$16,176.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,176.18
Rate for Payer: Kaiser Permanente of CA Commercial	$9,224.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,087.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,381.99
Rate for Payer: Molina Healthcare of CA Medicare	$20,381.99
Rate for Payer: Multiplan WC	$21,428.86
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 797: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC

Facility

$15,143.82

Service Code	MS-DRG 797
Min. Negotiated Rate	$5,677.00
Max. Negotiated Rate	$15,143.82
Rate for Payer: EPIC Health Plan Medicare	$11,418.67
Rate for Payer: Heritage Provider Network Senior	$5,677.00
Rate for Payer: Humana Medicare	$11,418.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,418.67
Rate for Payer: Kaiser Permanente of CA Commercial	$9,224.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,474.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,387.52
Rate for Payer: Molina Healthcare of CA Medicare	$14,387.52
Rate for Payer: Multiplan WC	$15,143.82
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 798: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC

Facility

$15,143.82

Service Code	MS-DRG 798
Min. Negotiated Rate	$5,677.00
Max. Negotiated Rate	$15,143.82
Rate for Payer: EPIC Health Plan Medicare	$9,607.99
Rate for Payer: Heritage Provider Network Senior	$5,677.00
Rate for Payer: Humana Medicare	$9,607.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,607.99
Rate for Payer: Kaiser Permanente of CA Commercial	$9,224.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,337.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,106.07
Rate for Payer: Molina Healthcare of CA Medicare	$12,106.07
Rate for Payer: Multiplan WC	$15,143.82
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 799: SPLENIC PROCEDURES WITH MCC

Facility

$84,992.41

Service Code	MS-DRG 799
Min. Negotiated Rate	$55,995.42
Max. Negotiated Rate	$84,992.41
Rate for Payer: EPIC Health Plan Medicare	$55,995.42
Rate for Payer: Humana Medicare	$55,995.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$55,995.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$66,074.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$70,554.23
Rate for Payer: Molina Healthcare of CA Medicare	$70,554.23
Rate for Payer: Multiplan WC	$84,992.41

INPATIENT MS-DRG 800: SPLENIC PROCEDURES WITH CC

Facility

$43,388.13

Service Code	MS-DRG 800
Min. Negotiated Rate	$31,932.96
Max. Negotiated Rate	$43,388.13
Rate for Payer: EPIC Health Plan Medicare	$31,932.96
Rate for Payer: Humana Medicare	$31,932.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,932.96
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,680.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$40,235.53
Rate for Payer: Molina Healthcare of CA Medicare	$40,235.53
Rate for Payer: Multiplan WC	$43,388.13

INPATIENT MS-DRG 801: SPLENIC PROCEDURES WITHOUT CC/MCC

Facility

$29,311.67

Service Code	MS-DRG 801
Min. Negotiated Rate	$20,357.21
Max. Negotiated Rate	$29,311.67
Rate for Payer: EPIC Health Plan Medicare	$20,357.21
Rate for Payer: Humana Medicare	$20,357.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,357.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,021.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,650.08
Rate for Payer: Molina Healthcare of CA Medicare	$25,650.08
Rate for Payer: Multiplan WC	$29,311.67

INPATIENT MS-DRG 802: OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC

Facility

$62,213.85

Service Code	MS-DRG 802
Min. Negotiated Rate	$38,836.75
Max. Negotiated Rate	$62,213.85
Rate for Payer: EPIC Health Plan Medicare	$38,836.75
Rate for Payer: Humana Medicare	$38,836.75
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$38,836.75
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$45,827.36
Rate for Payer: Molina Healthcare of CA Medi-Cal	$48,934.30
Rate for Payer: Molina Healthcare of CA Medicare	$48,934.30
Rate for Payer: Multiplan WC	$62,213.85

INPATIENT MS-DRG 803: OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC

Facility

$33,510.94

Service Code	MS-DRG 803
Min. Negotiated Rate	$21,128.55
Max. Negotiated Rate	$33,510.94
Rate for Payer: EPIC Health Plan Medicare	$21,128.55
Rate for Payer: Humana Medicare	$21,128.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,128.55
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,931.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,621.97
Rate for Payer: Molina Healthcare of CA Medicare	$26,621.97
Rate for Payer: Multiplan WC	$33,510.94

INPATIENT MS-DRG 804: OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC

Facility

$20,593.24

Service Code	MS-DRG 804
Min. Negotiated Rate	$13,834.03
Max. Negotiated Rate	$20,593.24
Rate for Payer: EPIC Health Plan Medicare	$13,834.03
Rate for Payer: Humana Medicare	$13,834.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,834.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,324.16
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,430.88
Rate for Payer: Molina Healthcare of CA Medicare	$17,430.88
Rate for Payer: Multiplan WC	$20,593.24

INPATIENT MS-DRG 805: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC

Facility

$16,411.92

Service Code	MS-DRG 805
Min. Negotiated Rate	$5,677.00
Max. Negotiated Rate	$16,411.92
Rate for Payer: EPIC Health Plan Medicare	$11,557.16
Rate for Payer: Heritage Provider Network Senior	$5,677.00
Rate for Payer: Humana Medicare	$11,557.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,557.16
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,637.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,562.02
Rate for Payer: Molina Healthcare of CA Medicare	$14,562.02
Rate for Payer: Multiplan WC	$16,411.92
Rate for Payer: United Healthcare All Other HMO/non HMO	$8,090.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$6,819.00

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