Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT MS-DRG 862: POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC

Facility

$29,851.88

Service Code	MS-DRG 862
Min. Negotiated Rate	$20,946.13
Max. Negotiated Rate	$29,851.88
Rate for Payer: EPIC Health Plan Medicare	$20,946.13
Rate for Payer: Humana Medicare	$20,946.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,946.13
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,716.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,392.12
Rate for Payer: Molina Healthcare of CA Medicare	$26,392.12
Rate for Payer: Multiplan WC	$29,851.88

INPATIENT MS-DRG 863: POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC

Facility

$16,416.82

Service Code	MS-DRG 863
Min. Negotiated Rate	$11,526.78
Max. Negotiated Rate	$16,416.82
Rate for Payer: EPIC Health Plan Medicare	$11,526.78
Rate for Payer: Humana Medicare	$11,526.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,526.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,601.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,523.74
Rate for Payer: Molina Healthcare of CA Medicare	$14,523.74
Rate for Payer: Multiplan WC	$16,416.82

INPATIENT MS-DRG 864: FEVER AND INFLAMMATORY CONDITIONS

Facility

$13,843.07

Service Code	MS-DRG 864
Min. Negotiated Rate	$10,145.10
Max. Negotiated Rate	$13,843.07
Rate for Payer: EPIC Health Plan Medicare	$10,145.10
Rate for Payer: Humana Medicare	$10,145.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,145.10
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,971.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,782.83
Rate for Payer: Molina Healthcare of CA Medicare	$12,782.83
Rate for Payer: Multiplan WC	$13,843.07

INPATIENT MS-DRG 865: VIRAL ILLNESS WITH MCC

Facility

$27,300.98

Service Code	MS-DRG 865
Min. Negotiated Rate	$18,670.39
Max. Negotiated Rate	$27,300.98
Rate for Payer: EPIC Health Plan Medicare	$18,670.39
Rate for Payer: Humana Medicare	$18,670.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,670.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,031.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,524.69
Rate for Payer: Molina Healthcare of CA Medicare	$23,524.69
Rate for Payer: Multiplan WC	$27,300.98

INPATIENT MS-DRG 866: VIRAL ILLNESS WITHOUT MCC

Facility

$14,683.58

Service Code	MS-DRG 866
Min. Negotiated Rate	$10,538.09
Max. Negotiated Rate	$14,683.58
Rate for Payer: EPIC Health Plan Medicare	$10,538.09
Rate for Payer: Humana Medicare	$10,538.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,538.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,434.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,277.99
Rate for Payer: Molina Healthcare of CA Medicare	$13,277.99
Rate for Payer: Multiplan WC	$14,683.58

INPATIENT MS-DRG 867: OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC

Facility

$34,491.81

Service Code	MS-DRG 867
Min. Negotiated Rate	$23,764.62
Max. Negotiated Rate	$34,491.81
Rate for Payer: EPIC Health Plan Medicare	$23,764.62
Rate for Payer: Humana Medicare	$23,764.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,764.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,042.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,943.42
Rate for Payer: Molina Healthcare of CA Medicare	$29,943.42
Rate for Payer: Multiplan WC	$34,491.81

INPATIENT MS-DRG 868: OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC

Facility

$17,229.59

Service Code	MS-DRG 868
Min. Negotiated Rate	$12,427.60
Max. Negotiated Rate	$17,229.59
Rate for Payer: EPIC Health Plan Medicare	$12,427.60
Rate for Payer: Humana Medicare	$12,427.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,427.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,664.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,658.78
Rate for Payer: Molina Healthcare of CA Medicare	$15,658.78
Rate for Payer: Multiplan WC	$17,229.59

INPATIENT MS-DRG 869: OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC

Facility

$12,090.25

Service Code	MS-DRG 869
Min. Negotiated Rate	$7,981.98
Max. Negotiated Rate	$12,090.25
Rate for Payer: EPIC Health Plan Medicare	$7,981.98
Rate for Payer: Humana Medicare	$7,981.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,981.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,418.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,057.29
Rate for Payer: Molina Healthcare of CA Medicare	$10,057.29
Rate for Payer: Multiplan WC	$12,090.25

INPATIENT MS-DRG 870: SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS

Facility

$110,831.07

Service Code	MS-DRG 870
Min. Negotiated Rate	$78,632.28
Max. Negotiated Rate	$110,831.07
Rate for Payer: EPIC Health Plan Medicare	$78,632.28
Rate for Payer: Humana Medicare	$78,632.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$78,632.28
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$92,786.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$99,076.67
Rate for Payer: Molina Healthcare of CA Medicare	$99,076.67
Rate for Payer: Multiplan WC	$110,831.07

INPATIENT MS-DRG 871: SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC

Facility

$31,942.54

Service Code	MS-DRG 871
Min. Negotiated Rate	$22,529.36
Max. Negotiated Rate	$31,942.54
Rate for Payer: EPIC Health Plan Medicare	$22,529.36
Rate for Payer: Humana Medicare	$22,529.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,529.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,584.64
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,386.99
Rate for Payer: Molina Healthcare of CA Medicare	$28,386.99
Rate for Payer: Multiplan WC	$31,942.54

INPATIENT MS-DRG 872: SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC

Facility

$16,777.50

Service Code	MS-DRG 872
Min. Negotiated Rate	$11,801.53
Max. Negotiated Rate	$16,777.50
Rate for Payer: EPIC Health Plan Medicare	$11,801.53
Rate for Payer: Humana Medicare	$11,801.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,801.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,925.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,869.93
Rate for Payer: Molina Healthcare of CA Medicare	$14,869.93
Rate for Payer: Multiplan WC	$16,777.50

INPATIENT MS-DRG 876: O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS

Facility

$53,200.66

Service Code	MS-DRG 876
Min. Negotiated Rate	$42,222.75
Max. Negotiated Rate	$53,200.66
Rate for Payer: EPIC Health Plan Medicare	$42,222.75
Rate for Payer: Humana Medicare	$42,222.75
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$42,222.75
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$49,822.84
Rate for Payer: Molina Healthcare of CA Medi-Cal	$53,200.66
Rate for Payer: Molina Healthcare of CA Medicare	$53,200.66
Rate for Payer: Multiplan WC	$52,165.30

INPATIENT MS-DRG 880: ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION

Facility

$14,789.66

Service Code	MS-DRG 880
Min. Negotiated Rate	$10,953.62
Max. Negotiated Rate	$14,789.66
Rate for Payer: EPIC Health Plan Medicare	$10,953.62
Rate for Payer: Humana Medicare	$10,953.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,953.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,925.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,801.56
Rate for Payer: Molina Healthcare of CA Medicare	$13,801.56
Rate for Payer: Multiplan WC	$14,789.66

INPATIENT MS-DRG 881: DEPRESSIVE NEUROSES

Facility

$13,962.21

Service Code	MS-DRG 881
Min. Negotiated Rate	$10,411.98
Max. Negotiated Rate	$13,962.21
Rate for Payer: EPIC Health Plan Medicare	$10,411.98
Rate for Payer: Humana Medicare	$10,411.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,411.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,286.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,119.09
Rate for Payer: Molina Healthcare of CA Medicare	$13,119.09
Rate for Payer: Multiplan WC	$13,962.21

INPATIENT MS-DRG 882: NEUROSES EXCEPT DEPRESSIVE

Facility

$14,255.98

Service Code	MS-DRG 882
Min. Negotiated Rate	$10,781.31
Max. Negotiated Rate	$14,255.98
Rate for Payer: EPIC Health Plan Medicare	$10,781.31
Rate for Payer: Humana Medicare	$10,781.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,781.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,721.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,584.45
Rate for Payer: Molina Healthcare of CA Medicare	$13,584.45
Rate for Payer: Multiplan WC	$14,255.98

INPATIENT MS-DRG 883: DISORDERS OF PERSONALITY AND IMPULSE CONTROL

Facility

$26,866.01

Service Code	MS-DRG 883
Min. Negotiated Rate	$21,322.23
Max. Negotiated Rate	$26,866.01
Rate for Payer: EPIC Health Plan Medicare	$21,322.23
Rate for Payer: Humana Medicare	$21,322.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,322.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,160.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,866.01
Rate for Payer: Molina Healthcare of CA Medicare	$26,866.01
Rate for Payer: Multiplan WC	$26,349.50

INPATIENT MS-DRG 884: ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY

Facility

$25,623.23

Service Code	MS-DRG 884
Min. Negotiated Rate	$19,987.88
Max. Negotiated Rate	$25,623.23
Rate for Payer: EPIC Health Plan Medicare	$19,987.88
Rate for Payer: Humana Medicare	$19,987.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,987.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,585.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,184.73
Rate for Payer: Molina Healthcare of CA Medicare	$25,184.73
Rate for Payer: Multiplan WC	$25,623.23

INPATIENT MS-DRG 885: PSYCHOSES

Facility

$21,143.25

Service Code	MS-DRG 885
Min. Negotiated Rate	$15,590.66
Max. Negotiated Rate	$21,143.25
Rate for Payer: EPIC Health Plan Medicare	$15,590.66
Rate for Payer: Humana Medicare	$15,590.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,590.66
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,396.98
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,644.23
Rate for Payer: Molina Healthcare of CA Medicare	$19,644.23
Rate for Payer: Multiplan WC	$21,143.25

INPATIENT MS-DRG 886: BEHAVIORAL AND DEVELOPMENTAL DISORDERS

Facility

$24,117.75

Service Code	MS-DRG 886
Min. Negotiated Rate	$19,141.07
Max. Negotiated Rate	$24,117.75
Rate for Payer: EPIC Health Plan Medicare	$19,141.07
Rate for Payer: Humana Medicare	$19,141.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,141.07
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,586.46
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,117.75
Rate for Payer: Molina Healthcare of CA Medicare	$24,117.75
Rate for Payer: Multiplan WC	$22,277.52

INPATIENT MS-DRG 887: OTHER MENTAL DISORDER DIAGNOSES

Facility

$21,159.56

Service Code	MS-DRG 887
Min. Negotiated Rate	$14,793.42
Max. Negotiated Rate	$21,159.56
Rate for Payer: EPIC Health Plan Medicare	$14,793.42
Rate for Payer: Humana Medicare	$14,793.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,793.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,456.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,639.71
Rate for Payer: Molina Healthcare of CA Medicare	$18,639.71
Rate for Payer: Multiplan WC	$21,159.56

INPATIENT MS-DRG 894: ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA

Facility

$9,332.08

Service Code	MS-DRG 894
Min. Negotiated Rate	$6,673.51
Max. Negotiated Rate	$9,332.08
Rate for Payer: EPIC Health Plan Medicare	$6,673.51
Rate for Payer: Humana Medicare	$6,673.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$6,673.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$7,874.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,408.62
Rate for Payer: Molina Healthcare of CA Medicare	$8,408.62
Rate for Payer: Multiplan WC	$9,332.08

INPATIENT MS-DRG 895: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY

Facility

$25,438.81

Service Code	MS-DRG 895
Min. Negotiated Rate	$18,320.19
Max. Negotiated Rate	$25,438.81
Rate for Payer: EPIC Health Plan Medicare	$18,320.19
Rate for Payer: Humana Medicare	$18,320.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,320.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,617.82
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,083.44
Rate for Payer: Molina Healthcare of CA Medicare	$23,083.44
Rate for Payer: Multiplan WC	$25,438.81

INPATIENT MS-DRG 896: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC

Facility

$28,652.32

Service Code	MS-DRG 896
Min. Negotiated Rate	$20,226.59
Max. Negotiated Rate	$28,652.32
Rate for Payer: EPIC Health Plan Medicare	$20,226.59
Rate for Payer: Humana Medicare	$20,226.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,226.59
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,867.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,485.50
Rate for Payer: Molina Healthcare of CA Medicare	$25,485.50
Rate for Payer: Multiplan WC	$28,652.32

INPATIENT MS-DRG 897: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC

Facility

$13,893.67

Service Code	MS-DRG 897
Min. Negotiated Rate	$9,838.82
Max. Negotiated Rate	$13,893.67
Rate for Payer: EPIC Health Plan Medicare	$9,838.82
Rate for Payer: Humana Medicare	$9,838.82
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,838.82
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,609.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,396.91
Rate for Payer: Molina Healthcare of CA Medicare	$12,396.91
Rate for Payer: Multiplan WC	$13,893.67

INPATIENT MS-DRG 901: WOUND DEBRIDEMENTS FOR INJURIES WITH MCC

Facility

$71,787.47

Service Code	MS-DRG 901
Min. Negotiated Rate	$48,937.35
Max. Negotiated Rate	$71,787.47
Rate for Payer: EPIC Health Plan Medicare	$48,937.35
Rate for Payer: Humana Medicare	$48,937.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$48,937.35
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$57,746.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$61,661.06
Rate for Payer: Molina Healthcare of CA Medicare	$61,661.06
Rate for Payer: Multiplan WC	$71,787.47

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