Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT MS-DRG 902: WOUND DEBRIDEMENTS FOR INJURIES WITH CC

Facility

$32,344.02

Service Code	MS-DRG 902
Min. Negotiated Rate	$21,426.95
Max. Negotiated Rate	$32,344.02
Rate for Payer: EPIC Health Plan Medicare	$21,426.95
Rate for Payer: Humana Medicare	$21,426.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,426.95
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,283.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,997.96
Rate for Payer: Molina Healthcare of CA Medicare	$26,997.96
Rate for Payer: Multiplan WC	$32,344.02

INPATIENT MS-DRG 903: WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC

Facility

$19,839.24

Service Code	MS-DRG 903
Min. Negotiated Rate	$14,184.23
Max. Negotiated Rate	$19,839.24
Rate for Payer: EPIC Health Plan Medicare	$14,184.23
Rate for Payer: Humana Medicare	$14,184.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,184.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,737.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,872.13
Rate for Payer: Molina Healthcare of CA Medicare	$17,872.13
Rate for Payer: Multiplan WC	$19,839.24

INPATIENT MS-DRG 904: SKIN GRAFTS FOR INJURIES WITH CC/MCC

Facility

$57,968.88

Service Code	MS-DRG 904
Min. Negotiated Rate	$36,870.67
Max. Negotiated Rate	$57,968.88
Rate for Payer: EPIC Health Plan Medicare	$36,870.67
Rate for Payer: Humana Medicare	$36,870.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,870.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$43,507.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,457.04
Rate for Payer: Molina Healthcare of CA Medicare	$46,457.04
Rate for Payer: Multiplan WC	$57,968.88

INPATIENT MS-DRG 905: SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC

Facility

$25,458.39

Service Code	MS-DRG 905
Min. Negotiated Rate	$18,037.56
Max. Negotiated Rate	$25,458.39
Rate for Payer: EPIC Health Plan Medicare	$18,037.56
Rate for Payer: Humana Medicare	$18,037.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,037.56
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,284.32
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,727.33
Rate for Payer: Molina Healthcare of CA Medicare	$22,727.33
Rate for Payer: Multiplan WC	$25,458.39

INPATIENT MS-DRG 906: HAND PROCEDURES FOR INJURIES

Facility

$29,177.84

Service Code	MS-DRG 906
Min. Negotiated Rate	$21,392.05
Max. Negotiated Rate	$29,177.84
Rate for Payer: EPIC Health Plan Medicare	$21,392.05
Rate for Payer: Humana Medicare	$21,392.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,392.05
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,242.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,953.98
Rate for Payer: Molina Healthcare of CA Medicare	$26,953.98
Rate for Payer: Multiplan WC	$29,177.84

INPATIENT MS-DRG 907: OTHER O.R. PROCEDURES FOR INJURIES WITH MCC

Facility

$63,090.26

Service Code	MS-DRG 907
Min. Negotiated Rate	$42,087.62
Max. Negotiated Rate	$63,090.26
Rate for Payer: EPIC Health Plan Medicare	$42,087.62
Rate for Payer: Humana Medicare	$42,087.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$42,087.62
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$49,663.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$53,030.40
Rate for Payer: Molina Healthcare of CA Medicare	$53,030.40
Rate for Payer: Multiplan WC	$63,090.26

INPATIENT MS-DRG 908: OTHER O.R. PROCEDURES FOR INJURIES WITH CC

Facility

$33,563.17

Service Code	MS-DRG 908
Min. Negotiated Rate	$22,771.45
Max. Negotiated Rate	$33,563.17
Rate for Payer: EPIC Health Plan Medicare	$22,771.45
Rate for Payer: Humana Medicare	$22,771.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,771.45
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,870.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,692.03
Rate for Payer: Molina Healthcare of CA Medicare	$28,692.03
Rate for Payer: Multiplan WC	$33,563.17

INPATIENT MS-DRG 909: OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC

Facility

$22,272.63

Service Code	MS-DRG 909
Min. Negotiated Rate	$15,476.94
Max. Negotiated Rate	$22,272.63
Rate for Payer: EPIC Health Plan Medicare	$15,476.94
Rate for Payer: Humana Medicare	$15,476.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,476.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,262.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,500.94
Rate for Payer: Molina Healthcare of CA Medicare	$19,500.94
Rate for Payer: Multiplan WC	$22,272.63

INPATIENT MS-DRG 913: TRAUMATIC INJURY WITH MCC

Facility

$24,710.92

Service Code	MS-DRG 913
Min. Negotiated Rate	$17,033.14
Max. Negotiated Rate	$24,710.92
Rate for Payer: EPIC Health Plan Medicare	$17,033.14
Rate for Payer: Humana Medicare	$17,033.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,033.14
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,099.11
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,461.76
Rate for Payer: Molina Healthcare of CA Medicare	$21,461.76
Rate for Payer: Multiplan WC	$24,710.92

INPATIENT MS-DRG 914: TRAUMATIC INJURY WITHOUT MCC

Facility

$14,510.59

Service Code	MS-DRG 914
Min. Negotiated Rate	$10,425.50
Max. Negotiated Rate	$14,510.59
Rate for Payer: EPIC Health Plan Medicare	$10,425.50
Rate for Payer: Humana Medicare	$10,425.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,425.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,302.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,136.13
Rate for Payer: Molina Healthcare of CA Medicare	$13,136.13
Rate for Payer: Multiplan WC	$14,510.59

INPATIENT MS-DRG 915: ALLERGIC REACTIONS WITH MCC

Facility

$29,705.00

Service Code	MS-DRG 915
Min. Negotiated Rate	$20,180.41
Max. Negotiated Rate	$29,705.00
Rate for Payer: EPIC Health Plan Medicare	$20,180.41
Rate for Payer: Humana Medicare	$20,180.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,180.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,812.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,427.32
Rate for Payer: Molina Healthcare of CA Medicare	$25,427.32
Rate for Payer: Multiplan WC	$29,705.00

INPATIENT MS-DRG 916: ALLERGIC REACTIONS WITHOUT MCC

Facility

$10,840.09

Service Code	MS-DRG 916
Min. Negotiated Rate	$7,622.76
Max. Negotiated Rate	$10,840.09
Rate for Payer: EPIC Health Plan Medicare	$7,622.76
Rate for Payer: Humana Medicare	$7,622.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,622.76
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,994.86
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,604.68
Rate for Payer: Molina Healthcare of CA Medicare	$9,604.68
Rate for Payer: Multiplan WC	$10,840.09

INPATIENT MS-DRG 917: POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC

Facility

$24,848.01

Service Code	MS-DRG 917
Min. Negotiated Rate	$18,174.94
Max. Negotiated Rate	$24,848.01
Rate for Payer: EPIC Health Plan Medicare	$18,174.94
Rate for Payer: Humana Medicare	$18,174.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,174.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,446.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,900.42
Rate for Payer: Molina Healthcare of CA Medicare	$22,900.42
Rate for Payer: Multiplan WC	$24,848.01

INPATIENT MS-DRG 918: POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC

Facility

$13,345.30

Service Code	MS-DRG 918
Min. Negotiated Rate	$9,898.51
Max. Negotiated Rate	$13,345.30
Rate for Payer: EPIC Health Plan Medicare	$9,898.51
Rate for Payer: Humana Medicare	$9,898.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,898.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,680.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,472.12
Rate for Payer: Molina Healthcare of CA Medicare	$12,472.12
Rate for Payer: Multiplan WC	$13,345.30

INPATIENT MS-DRG 919: COMPLICATIONS OF TREATMENT WITH MCC

Facility

$29,272.50

Service Code	MS-DRG 919
Min. Negotiated Rate	$20,751.32
Max. Negotiated Rate	$29,272.50
Rate for Payer: EPIC Health Plan Medicare	$20,751.32
Rate for Payer: Humana Medicare	$20,751.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$20,751.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,486.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,146.66
Rate for Payer: Molina Healthcare of CA Medicare	$26,146.66
Rate for Payer: Multiplan WC	$29,272.50

INPATIENT MS-DRG 920: COMPLICATIONS OF TREATMENT WITH CC

Facility

$16,676.32

Service Code	MS-DRG 920
Min. Negotiated Rate	$11,845.43
Max. Negotiated Rate	$16,676.32
Rate for Payer: EPIC Health Plan Medicare	$11,845.43
Rate for Payer: Humana Medicare	$11,845.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,845.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,977.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,925.24
Rate for Payer: Molina Healthcare of CA Medicare	$14,925.24
Rate for Payer: Multiplan WC	$16,676.32

INPATIENT MS-DRG 921: COMPLICATIONS OF TREATMENT WITHOUT CC/MCC

Facility

$11,879.72

Service Code	MS-DRG 921
Min. Negotiated Rate	$8,061.92
Max. Negotiated Rate	$11,879.72
Rate for Payer: EPIC Health Plan Medicare	$8,061.92
Rate for Payer: Humana Medicare	$8,061.92
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,061.92
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,513.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,158.02
Rate for Payer: Molina Healthcare of CA Medicare	$10,158.02
Rate for Payer: Multiplan WC	$11,879.72

INPATIENT MS-DRG 922: OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC

Facility

$25,391.48

Service Code	MS-DRG 922
Min. Negotiated Rate	$19,852.74
Max. Negotiated Rate	$25,391.48
Rate for Payer: EPIC Health Plan Medicare	$19,852.74
Rate for Payer: Humana Medicare	$19,852.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,852.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,426.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,014.45
Rate for Payer: Molina Healthcare of CA Medicare	$25,014.45
Rate for Payer: Multiplan WC	$25,391.48

INPATIENT MS-DRG 923: OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC

Facility

$15,393.53

Service Code	MS-DRG 923
Min. Negotiated Rate	$11,593.20
Max. Negotiated Rate	$15,393.53
Rate for Payer: EPIC Health Plan Medicare	$11,593.20
Rate for Payer: Humana Medicare	$11,593.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,593.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,679.98
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,607.43
Rate for Payer: Molina Healthcare of CA Medicare	$14,607.43
Rate for Payer: Multiplan WC	$15,393.53

INPATIENT MS-DRG 927: EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT

Facility

$374,239.18

Service Code	MS-DRG 927
Min. Negotiated Rate	$297,015.22
Max. Negotiated Rate	$374,239.18
Rate for Payer: EPIC Health Plan Medicare	$297,015.22
Rate for Payer: Humana Medicare	$297,015.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$297,015.22
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$350,477.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$374,239.18
Rate for Payer: Molina Healthcare of CA Medicare	$374,239.18
Rate for Payer: Multiplan WC	$309,799.53

INPATIENT MS-DRG 928: FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC

Facility

$101,045.28

Service Code	MS-DRG 928
Min. Negotiated Rate	$78,123.31
Max. Negotiated Rate	$101,045.28
Rate for Payer: EPIC Health Plan Medicare	$78,123.31
Rate for Payer: Humana Medicare	$78,123.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$78,123.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$92,185.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$98,435.37
Rate for Payer: Molina Healthcare of CA Medicare	$98,435.37
Rate for Payer: Multiplan WC	$101,045.28

INPATIENT MS-DRG 929: FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC

Facility

$47,962.77

Service Code	MS-DRG 929
Min. Negotiated Rate	$36,412.35
Max. Negotiated Rate	$47,962.77
Rate for Payer: EPIC Health Plan Medicare	$36,412.35
Rate for Payer: Humana Medicare	$36,412.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,412.35
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,966.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$45,879.56
Rate for Payer: Molina Healthcare of CA Medicare	$45,879.56
Rate for Payer: Multiplan WC	$47,962.77

INPATIENT MS-DRG 933: EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT

Facility

$49,500.16

Service Code	MS-DRG 933
Min. Negotiated Rate	$34,346.08
Max. Negotiated Rate	$49,500.16
Rate for Payer: EPIC Health Plan Medicare	$34,346.08
Rate for Payer: Humana Medicare	$34,346.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,346.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$40,528.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,276.06
Rate for Payer: Molina Healthcare of CA Medicare	$43,276.06
Rate for Payer: Multiplan WC	$49,500.16

INPATIENT MS-DRG 934: FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY

Facility

$30,617.31

Service Code	MS-DRG 934
Min. Negotiated Rate	$23,766.88
Max. Negotiated Rate	$30,617.31
Rate for Payer: EPIC Health Plan Medicare	$23,766.88
Rate for Payer: Humana Medicare	$23,766.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,766.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,044.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,946.27
Rate for Payer: Molina Healthcare of CA Medicare	$29,946.27
Rate for Payer: Multiplan WC	$30,617.31

INPATIENT MS-DRG 935: NON-EXTENSIVE BURNS

Facility

$33,034.38

Service Code	MS-DRG 935
Min. Negotiated Rate	$23,188.09
Max. Negotiated Rate	$33,034.38
Rate for Payer: EPIC Health Plan Medicare	$23,188.09
Rate for Payer: Humana Medicare	$23,188.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,188.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,361.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,216.99
Rate for Payer: Molina Healthcare of CA Medicare	$29,216.99
Rate for Payer: Multiplan WC	$33,034.38

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