Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT MS-DRG 939: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC

Facility

$50,546.30

Service Code	MS-DRG 939
Min. Negotiated Rate	$36,410.11
Max. Negotiated Rate	$50,546.30
Rate for Payer: EPIC Health Plan Medicare	$36,410.11
Rate for Payer: Humana Medicare	$36,410.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,410.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,963.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$45,876.74
Rate for Payer: Molina Healthcare of CA Medicare	$45,876.74
Rate for Payer: Multiplan WC	$50,546.30

INPATIENT MS-DRG 940: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC

Facility

$35,959.02

Service Code	MS-DRG 940
Min. Negotiated Rate	$24,601.28
Max. Negotiated Rate	$35,959.02
Rate for Payer: EPIC Health Plan Medicare	$24,601.28
Rate for Payer: Humana Medicare	$24,601.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,601.28
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,029.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,997.61
Rate for Payer: Molina Healthcare of CA Medicare	$30,997.61
Rate for Payer: Multiplan WC	$35,959.02

INPATIENT MS-DRG 941: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC

Facility

$30,803.36

Service Code	MS-DRG 941
Min. Negotiated Rate	$21,103.77
Max. Negotiated Rate	$30,803.36
Rate for Payer: EPIC Health Plan Medicare	$21,103.77
Rate for Payer: Humana Medicare	$21,103.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,103.77
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,902.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,590.75
Rate for Payer: Molina Healthcare of CA Medicare	$26,590.75
Rate for Payer: Multiplan WC	$30,803.36

INPATIENT MS-DRG 945: REHABILITATION WITH CC/MCC

Facility

$24,565.66

Service Code	MS-DRG 945
Min. Negotiated Rate	$17,202.02
Max. Negotiated Rate	$24,565.66
Rate for Payer: EPIC Health Plan Medicare	$17,202.02
Rate for Payer: Humana Medicare	$17,202.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,202.02
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,298.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,674.55
Rate for Payer: Molina Healthcare of CA Medicare	$21,674.55
Rate for Payer: Multiplan WC	$24,565.66

INPATIENT MS-DRG 946: REHABILITATION WITHOUT CC/MCC

Facility

$18,321.42

Service Code	MS-DRG 946
Min. Negotiated Rate	$11,607.84
Max. Negotiated Rate	$18,321.42
Rate for Payer: EPIC Health Plan Medicare	$11,607.84
Rate for Payer: Humana Medicare	$11,607.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,607.84
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,697.25
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,625.88
Rate for Payer: Molina Healthcare of CA Medicare	$14,625.88
Rate for Payer: Multiplan WC	$18,321.42

INPATIENT MS-DRG 947: SIGNS AND SYMPTOMS WITH MCC

Facility

$19,839.24

Service Code	MS-DRG 947
Min. Negotiated Rate	$14,297.96
Max. Negotiated Rate	$19,839.24
Rate for Payer: EPIC Health Plan Medicare	$14,297.96
Rate for Payer: Humana Medicare	$14,297.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,297.96
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,871.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,015.43
Rate for Payer: Molina Healthcare of CA Medicare	$18,015.43
Rate for Payer: Multiplan WC	$19,839.24

INPATIENT MS-DRG 948: SIGNS AND SYMPTOMS WITHOUT MCC

Facility

$12,690.84

Service Code	MS-DRG 948
Min. Negotiated Rate	$9,223.99
Max. Negotiated Rate	$12,690.84
Rate for Payer: EPIC Health Plan Medicare	$9,223.99
Rate for Payer: Humana Medicare	$9,223.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,223.99
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,884.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,622.23
Rate for Payer: Molina Healthcare of CA Medicare	$11,622.23
Rate for Payer: Multiplan WC	$12,690.84

INPATIENT MS-DRG 949: AFTERCARE WITH CC/MCC

Facility

$19,454.07

Service Code	MS-DRG 949
Min. Negotiated Rate	$12,284.58
Max. Negotiated Rate	$19,454.07
Rate for Payer: EPIC Health Plan Medicare	$12,284.58
Rate for Payer: Humana Medicare	$12,284.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,284.58
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,495.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,478.57
Rate for Payer: Molina Healthcare of CA Medicare	$15,478.57
Rate for Payer: Multiplan WC	$19,454.07

INPATIENT MS-DRG 950: AFTERCARE WITHOUT CC/MCC

Facility

$11,579.42

Service Code	MS-DRG 950
Min. Negotiated Rate	$7,395.31
Max. Negotiated Rate	$11,579.42
Rate for Payer: EPIC Health Plan Medicare	$7,395.31
Rate for Payer: Humana Medicare	$7,395.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,395.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,726.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,318.09
Rate for Payer: Molina Healthcare of CA Medicare	$9,318.09
Rate for Payer: Multiplan WC	$11,579.42

INPATIENT MS-DRG 951: OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$9,289.65

Service Code	MS-DRG 951
Min. Negotiated Rate	$6,848.04
Max. Negotiated Rate	$9,289.65
Rate for Payer: EPIC Health Plan Medicare	$6,848.04
Rate for Payer: Humana Medicare	$6,848.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$6,848.04
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,080.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,628.53
Rate for Payer: Molina Healthcare of CA Medicare	$8,628.53
Rate for Payer: Multiplan WC	$9,289.65

INPATIENT MS-DRG 955: CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$109,935.08

Service Code	MS-DRG 955
Min. Negotiated Rate	$68,782.79
Max. Negotiated Rate	$109,935.08
Rate for Payer: EPIC Health Plan Medicare	$68,782.79
Rate for Payer: Humana Medicare	$68,782.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$68,782.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$81,163.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$86,666.32
Rate for Payer: Molina Healthcare of CA Medicare	$86,666.32
Rate for Payer: Multiplan WC	$109,935.08

INPATIENT MS-DRG 956: LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$62,086.56

Service Code	MS-DRG 956
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$62,086.56
Rate for Payer: EPIC Health Plan Medicare	$43,874.67
Rate for Payer: Heritage Provider Network Commercial	$4,319.00
Rate for Payer: Heritage Provider Network Senior	$3,928.00
Rate for Payer: Humana Medicare	$43,874.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$43,874.67
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$51,772.11
Rate for Payer: Molina Healthcare of CA Medi-Cal	$55,282.08
Rate for Payer: Molina Healthcare of CA Medicare	$55,282.08
Rate for Payer: Multiplan WC	$62,086.56

INPATIENT MS-DRG 957: OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$120,943.27

Service Code	MS-DRG 957
Min. Negotiated Rate	$81,645.58
Max. Negotiated Rate	$120,943.27
Rate for Payer: EPIC Health Plan Medicare	$81,645.58
Rate for Payer: Humana Medicare	$81,645.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$81,645.58
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$96,341.78
Rate for Payer: Molina Healthcare of CA Medi-Cal	$102,873.43
Rate for Payer: Molina Healthcare of CA Medicare	$102,873.43
Rate for Payer: Multiplan WC	$120,943.27

INPATIENT MS-DRG 958: OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$68,064.76

Service Code	MS-DRG 958
Min. Negotiated Rate	$45,750.64
Max. Negotiated Rate	$68,064.76
Rate for Payer: EPIC Health Plan Medicare	$45,750.64
Rate for Payer: Humana Medicare	$45,750.64
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$45,750.64
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$53,985.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$57,645.81
Rate for Payer: Molina Healthcare of CA Medicare	$57,645.81
Rate for Payer: Multiplan WC	$68,064.76

INPATIENT MS-DRG 959: OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$41,922.54

Service Code	MS-DRG 959
Min. Negotiated Rate	$28,720.33
Max. Negotiated Rate	$41,922.54
Rate for Payer: EPIC Health Plan Medicare	$28,720.33
Rate for Payer: Humana Medicare	$28,720.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,720.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,889.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$36,187.62
Rate for Payer: Molina Healthcare of CA Medicare	$36,187.62
Rate for Payer: Multiplan WC	$41,922.54

INPATIENT MS-DRG 963: OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$45,260.08

Service Code	MS-DRG 963
Min. Negotiated Rate	$30,993.83
Max. Negotiated Rate	$45,260.08
Rate for Payer: EPIC Health Plan Medicare	$30,993.83
Rate for Payer: Humana Medicare	$30,993.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,993.83
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,572.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$39,052.23
Rate for Payer: Molina Healthcare of CA Medicare	$39,052.23
Rate for Payer: Multiplan WC	$45,260.08

INPATIENT MS-DRG 964: OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$23,901.42

Service Code	MS-DRG 964
Min. Negotiated Rate	$17,106.31
Max. Negotiated Rate	$23,901.42
Rate for Payer: EPIC Health Plan Medicare	$17,106.31
Rate for Payer: Humana Medicare	$17,106.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,106.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,185.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,553.95
Rate for Payer: Molina Healthcare of CA Medicare	$21,553.95
Rate for Payer: Multiplan WC	$23,901.42

INPATIENT MS-DRG 965: OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$14,850.05

Service Code	MS-DRG 965
Min. Negotiated Rate	$10,968.26
Max. Negotiated Rate	$14,850.05
Rate for Payer: EPIC Health Plan Medicare	$10,968.26
Rate for Payer: Humana Medicare	$10,968.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,968.26
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,942.55
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,820.01
Rate for Payer: Molina Healthcare of CA Medicare	$13,820.01
Rate for Payer: Multiplan WC	$14,850.05

INPATIENT MS-DRG 969: HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC

Facility

$118,284.66

Service Code	MS-DRG 969
Min. Negotiated Rate	$77,592.95
Max. Negotiated Rate	$118,284.66
Rate for Payer: EPIC Health Plan Medicare	$77,592.95
Rate for Payer: Humana Medicare	$77,592.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$77,592.95
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$91,559.68
Rate for Payer: Molina Healthcare of CA Medi-Cal	$97,767.12
Rate for Payer: Molina Healthcare of CA Medicare	$97,767.12
Rate for Payer: Multiplan WC	$118,284.66

INPATIENT MS-DRG 970: HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC

Facility

$50,404.32

Service Code	MS-DRG 970
Min. Negotiated Rate	$31,503.93
Max. Negotiated Rate	$50,404.32
Rate for Payer: EPIC Health Plan Medicare	$31,503.93
Rate for Payer: Humana Medicare	$31,503.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,503.93
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,174.64
Rate for Payer: Molina Healthcare of CA Medi-Cal	$39,694.95
Rate for Payer: Molina Healthcare of CA Medicare	$39,694.95
Rate for Payer: Multiplan WC	$50,404.32

INPATIENT MS-DRG 974: HIV WITH MAJOR RELATED CONDITION WITH MCC

Facility

$46,888.87

Service Code	MS-DRG 974
Min. Negotiated Rate	$33,045.48
Max. Negotiated Rate	$46,888.87
Rate for Payer: EPIC Health Plan Medicare	$33,045.48
Rate for Payer: Humana Medicare	$33,045.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,045.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$38,993.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$41,637.30
Rate for Payer: Molina Healthcare of CA Medicare	$41,637.30
Rate for Payer: Multiplan WC	$46,888.87

INPATIENT MS-DRG 975: HIV WITH MAJOR RELATED CONDITION WITH CC

Facility

$22,452.15

Service Code	MS-DRG 975
Min. Negotiated Rate	$15,555.76
Max. Negotiated Rate	$22,452.15
Rate for Payer: EPIC Health Plan Medicare	$15,555.76
Rate for Payer: Humana Medicare	$15,555.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,555.76
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,355.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,600.26
Rate for Payer: Molina Healthcare of CA Medicare	$19,600.26
Rate for Payer: Multiplan WC	$22,452.15

INPATIENT MS-DRG 976: HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC

Facility

$15,060.58

Service Code	MS-DRG 976
Min. Negotiated Rate	$9,722.85
Max. Negotiated Rate	$15,060.58
Rate for Payer: EPIC Health Plan Medicare	$9,722.85
Rate for Payer: Humana Medicare	$9,722.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,722.85
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,472.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,250.79
Rate for Payer: Molina Healthcare of CA Medicare	$12,250.79
Rate for Payer: Multiplan WC	$15,060.58

INPATIENT MS-DRG 977: HIV WITH OR WITHOUT OTHER RELATED CONDITION

Facility

$21,215.05

Service Code	MS-DRG 977
Min. Negotiated Rate	$16,150.31
Max. Negotiated Rate	$21,215.05
Rate for Payer: EPIC Health Plan Medicare	$16,150.31
Rate for Payer: Humana Medicare	$16,150.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$16,150.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,057.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,349.39
Rate for Payer: Molina Healthcare of CA Medicare	$20,349.39
Rate for Payer: Multiplan WC	$21,215.05

INPATIENT MS-DRG 981: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC

Facility

$74,754.55

Service Code	MS-DRG 981
Min. Negotiated Rate	$53,583.41
Max. Negotiated Rate	$74,754.55
Rate for Payer: EPIC Health Plan Medicare	$53,583.41
Rate for Payer: Humana Medicare	$53,583.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$53,583.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$63,228.42
Rate for Payer: Molina Healthcare of CA Medi-Cal	$67,515.10
Rate for Payer: Molina Healthcare of CA Medicare	$67,515.10
Rate for Payer: Multiplan WC	$74,754.55

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