Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT MS-DRG 831: OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC

Facility

$19,499.77

Service Code	MS-DRG 831
Min. Negotiated Rate	$3,557.00
Max. Negotiated Rate	$19,499.77
Rate for Payer: EPIC Health Plan Medicare	$12,312.74
Rate for Payer: Humana Medicare	$12,312.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,312.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,529.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,514.05
Rate for Payer: Molina Healthcare of CA Medicare	$15,514.05
Rate for Payer: Multiplan WC	$19,499.77
Rate for Payer: United Healthcare All Other HMO/non HMO	$4,228.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$3,557.00

INPATIENT MS-DRG 832: OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC

Facility

$11,432.53

Service Code	MS-DRG 832
Min. Negotiated Rate	$3,557.00
Max. Negotiated Rate	$11,432.53
Rate for Payer: EPIC Health Plan Medicare	$8,511.21
Rate for Payer: Humana Medicare	$8,511.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,511.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,043.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,724.12
Rate for Payer: Molina Healthcare of CA Medicare	$10,724.12
Rate for Payer: Multiplan WC	$11,432.53
Rate for Payer: United Healthcare All Other HMO/non HMO	$4,228.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$3,557.00

INPATIENT MS-DRG 833: OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$8,225.54

Service Code	MS-DRG 833
Min. Negotiated Rate	$3,557.00
Max. Negotiated Rate	$8,225.54
Rate for Payer: EPIC Health Plan Medicare	$5,967.48
Rate for Payer: Humana Medicare	$5,967.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$5,967.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$7,041.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$7,519.02
Rate for Payer: Molina Healthcare of CA Medicare	$7,519.02
Rate for Payer: Multiplan WC	$8,225.54
Rate for Payer: United Healthcare All Other HMO/non HMO	$4,228.00
Rate for Payer: United Healthcare Navigate/Select/Select+	$3,557.00

INPATIENT MS-DRG 834: ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC

Facility

$90,252.52

Service Code	MS-DRG 834
Min. Negotiated Rate	$63,251.65
Max. Negotiated Rate	$90,252.52
Rate for Payer: EPIC Health Plan Medicare	$63,251.65
Rate for Payer: Humana Medicare	$63,251.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$63,251.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$74,636.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$79,697.08
Rate for Payer: Molina Healthcare of CA Medicare	$79,697.08
Rate for Payer: Multiplan WC	$90,252.52

INPATIENT MS-DRG 835: ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC

Facility

$34,225.77

Service Code	MS-DRG 835
Min. Negotiated Rate	$25,377.11
Max. Negotiated Rate	$34,225.77
Rate for Payer: EPIC Health Plan Medicare	$25,377.11
Rate for Payer: Humana Medicare	$25,377.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,377.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,944.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,975.16
Rate for Payer: Molina Healthcare of CA Medicare	$31,975.16
Rate for Payer: Multiplan WC	$34,225.77

INPATIENT MS-DRG 836: ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC

Facility

$25,603.65

Service Code	MS-DRG 836
Min. Negotiated Rate	$16,102.99
Max. Negotiated Rate	$25,603.65
Rate for Payer: EPIC Health Plan Medicare	$16,102.99
Rate for Payer: Humana Medicare	$16,102.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,102.99
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,001.53
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,289.77
Rate for Payer: Molina Healthcare of CA Medicare	$20,289.77
Rate for Payer: Multiplan WC	$25,603.65

INPATIENT MS-DRG 837: CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC

Facility

$87,840.35

Service Code	MS-DRG 837
Min. Negotiated Rate	$54,750.01
Max. Negotiated Rate	$87,840.35
Rate for Payer: EPIC Health Plan Medicare	$54,750.01
Rate for Payer: Humana Medicare	$54,750.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$54,750.01
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$64,605.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$68,985.01
Rate for Payer: Molina Healthcare of CA Medicare	$68,985.01
Rate for Payer: Multiplan WC	$87,840.35

INPATIENT MS-DRG 838: CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT

Facility

$36,298.48

Service Code	MS-DRG 838
Min. Negotiated Rate	$22,744.43
Max. Negotiated Rate	$36,298.48
Rate for Payer: EPIC Health Plan Medicare	$22,744.43
Rate for Payer: Humana Medicare	$22,744.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,744.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,838.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,657.98
Rate for Payer: Molina Healthcare of CA Medicare	$28,657.98
Rate for Payer: Multiplan WC	$36,298.48

INPATIENT MS-DRG 839: CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC

Facility

$22,435.83

Service Code	MS-DRG 839
Min. Negotiated Rate	$14,877.87
Max. Negotiated Rate	$22,435.83
Rate for Payer: EPIC Health Plan Medicare	$14,877.87
Rate for Payer: Humana Medicare	$14,877.87
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,877.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,555.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,746.12
Rate for Payer: Molina Healthcare of CA Medicare	$18,746.12
Rate for Payer: Multiplan WC	$22,435.83

INPATIENT MS-DRG 840: LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC

Facility

$50,707.89

Service Code	MS-DRG 840
Min. Negotiated Rate	$35,395.53
Max. Negotiated Rate	$50,707.89
Rate for Payer: EPIC Health Plan Medicare	$35,395.53
Rate for Payer: Humana Medicare	$35,395.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,395.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$41,766.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$44,598.37
Rate for Payer: Molina Healthcare of CA Medicare	$44,598.37
Rate for Payer: Multiplan WC	$50,707.89

INPATIENT MS-DRG 841: LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC

Facility

$26,027.98

Service Code	MS-DRG 841
Min. Negotiated Rate	$17,922.70
Max. Negotiated Rate	$26,027.98
Rate for Payer: EPIC Health Plan Medicare	$17,922.70
Rate for Payer: Humana Medicare	$17,922.70
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,922.70
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,148.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,582.60
Rate for Payer: Molina Healthcare of CA Medicare	$22,582.60
Rate for Payer: Multiplan WC	$26,027.98

INPATIENT MS-DRG 842: LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC

Facility

$18,012.97

Service Code	MS-DRG 842
Min. Negotiated Rate	$12,212.53
Max. Negotiated Rate	$18,012.97
Rate for Payer: EPIC Health Plan Medicare	$12,212.53
Rate for Payer: Humana Medicare	$12,212.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,212.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,410.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,387.79
Rate for Payer: Molina Healthcare of CA Medicare	$15,387.79
Rate for Payer: Multiplan WC	$18,012.97

INPATIENT MS-DRG 843: OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC

Facility

$31,619.39

Service Code	MS-DRG 843
Min. Negotiated Rate	$21,155.58
Max. Negotiated Rate	$31,619.39
Rate for Payer: EPIC Health Plan Medicare	$21,155.58
Rate for Payer: Humana Medicare	$21,155.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,155.58
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,963.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,656.03
Rate for Payer: Molina Healthcare of CA Medicare	$26,656.03
Rate for Payer: Multiplan WC	$31,619.39

INPATIENT MS-DRG 844: OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC

Facility

$18,615.20

Service Code	MS-DRG 844
Min. Negotiated Rate	$13,234.98
Max. Negotiated Rate	$18,615.20
Rate for Payer: EPIC Health Plan Medicare	$13,234.98
Rate for Payer: Humana Medicare	$13,234.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,234.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,617.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,676.07
Rate for Payer: Molina Healthcare of CA Medicare	$16,676.07
Rate for Payer: Multiplan WC	$18,615.20

INPATIENT MS-DRG 845: OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC

Facility

$13,799.01

Service Code	MS-DRG 845
Min. Negotiated Rate	$9,943.55
Max. Negotiated Rate	$13,799.01
Rate for Payer: EPIC Health Plan Medicare	$9,943.55
Rate for Payer: Humana Medicare	$9,943.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,943.55
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,733.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,528.87
Rate for Payer: Molina Healthcare of CA Medicare	$12,528.87
Rate for Payer: Multiplan WC	$13,799.01

INPATIENT MS-DRG 846: CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC

Facility

$39,316.15

Service Code	MS-DRG 846
Min. Negotiated Rate	$27,724.94
Max. Negotiated Rate	$39,316.15
Rate for Payer: EPIC Health Plan Medicare	$27,724.94
Rate for Payer: Humana Medicare	$27,724.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,724.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,715.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,933.42
Rate for Payer: Molina Healthcare of CA Medicare	$34,933.42
Rate for Payer: Multiplan WC	$39,316.15

INPATIENT MS-DRG 847: CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC

Facility

$19,880.04

Service Code	MS-DRG 847
Min. Negotiated Rate	$13,858.79
Max. Negotiated Rate	$19,880.04
Rate for Payer: EPIC Health Plan Medicare	$13,858.79
Rate for Payer: Humana Medicare	$13,858.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,858.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,353.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,462.08
Rate for Payer: Molina Healthcare of CA Medicare	$17,462.08
Rate for Payer: Multiplan WC	$19,880.04

INPATIENT MS-DRG 848: CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC

Facility

$15,163.40

Service Code	MS-DRG 848
Min. Negotiated Rate	$9,620.38
Max. Negotiated Rate	$15,163.40
Rate for Payer: EPIC Health Plan Medicare	$9,620.38
Rate for Payer: Humana Medicare	$9,620.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,620.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,352.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,121.68
Rate for Payer: Molina Healthcare of CA Medicare	$12,121.68
Rate for Payer: Multiplan WC	$15,163.40

INPATIENT MS-DRG 849: RADIOTHERAPY

Facility

$38,443.56

Service Code	MS-DRG 849
Min. Negotiated Rate	$30,510.76
Max. Negotiated Rate	$38,443.56
Rate for Payer: EPIC Health Plan Medicare	$30,510.76
Rate for Payer: Humana Medicare	$30,510.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,510.76
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,002.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,443.56
Rate for Payer: Molina Healthcare of CA Medicare	$38,443.56
Rate for Payer: Multiplan WC	$38,172.09

INPATIENT MS-DRG 853: INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC

Facility

$79,986.90

Service Code	MS-DRG 853
Min. Negotiated Rate	$56,498.74
Max. Negotiated Rate	$79,986.90
Rate for Payer: EPIC Health Plan Medicare	$56,498.74
Rate for Payer: Humana Medicare	$56,498.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$56,498.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$66,668.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$71,188.41
Rate for Payer: Molina Healthcare of CA Medicare	$71,188.41
Rate for Payer: Multiplan WC	$79,986.90

INPATIENT MS-DRG 854: INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC

Facility

$33,548.48

Service Code	MS-DRG 854
Min. Negotiated Rate	$23,155.43
Max. Negotiated Rate	$33,548.48
Rate for Payer: EPIC Health Plan Medicare	$23,155.43
Rate for Payer: Humana Medicare	$23,155.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,155.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,323.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,175.84
Rate for Payer: Molina Healthcare of CA Medicare	$29,175.84
Rate for Payer: Multiplan WC	$33,548.48

INPATIENT MS-DRG 855: INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$24,932.87

Service Code	MS-DRG 855
Min. Negotiated Rate	$19,367.41
Max. Negotiated Rate	$24,932.87
Rate for Payer: EPIC Health Plan Medicare	$19,367.41
Rate for Payer: Humana Medicare	$19,367.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,367.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,853.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,402.94
Rate for Payer: Molina Healthcare of CA Medicare	$24,402.94
Rate for Payer: Multiplan WC	$24,932.87

INPATIENT MS-DRG 856: POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC

Facility

$72,017.59

Service Code	MS-DRG 856
Min. Negotiated Rate	$50,070.16
Max. Negotiated Rate	$72,017.59
Rate for Payer: EPIC Health Plan Medicare	$50,070.16
Rate for Payer: Humana Medicare	$50,070.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$50,070.16
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$59,082.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$63,088.40
Rate for Payer: Molina Healthcare of CA Medicare	$63,088.40
Rate for Payer: Multiplan WC	$72,017.59

INPATIENT MS-DRG 857: POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC

Facility

$34,419.99

Service Code	MS-DRG 857
Min. Negotiated Rate	$24,253.33
Max. Negotiated Rate	$34,419.99
Rate for Payer: EPIC Health Plan Medicare	$24,253.33
Rate for Payer: Humana Medicare	$24,253.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,253.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,618.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,559.20
Rate for Payer: Molina Healthcare of CA Medicare	$30,559.20
Rate for Payer: Multiplan WC	$34,419.99

INPATIENT MS-DRG 858: POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$23,087.02

Service Code	MS-DRG 858
Min. Negotiated Rate	$14,656.04
Max. Negotiated Rate	$23,087.02
Rate for Payer: EPIC Health Plan Medicare	$14,656.04
Rate for Payer: Humana Medicare	$14,656.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,656.04
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,294.13
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,466.61
Rate for Payer: Molina Healthcare of CA Medicare	$18,466.61
Rate for Payer: Multiplan WC	$23,087.02

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