Loma Linda University Medical Center

All Charges

Charge

Type

Price

INPATIENT MS-DRG 028: SPINAL PROCEDURES WITH MCC

Facility IP

$95,923.90

Service Code	MS-DRG 028
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$95,923.90
Rate for Payer: EPIC Health Plan Medicare	$68,060.98
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	$68,060.98
Rate for Payer: IEHP Medicare Advantage	$68,060.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$80,311.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$85,756.83
Rate for Payer: Molina Healthcare of CA Medicare	$85,756.83
Rate for Payer: Multiplan WC	$95,923.90

INPATIENT MS-DRG 029: SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS

Facility IP

$55,777.03

Service Code	MS-DRG 029
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$55,777.03
Rate for Payer: EPIC Health Plan Medicare	$38,807.44
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	$38,807.44
Rate for Payer: IEHP Medicare Advantage	$38,807.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$45,792.78
Rate for Payer: Molina Healthcare of CA Medi-Cal	$48,897.37
Rate for Payer: Molina Healthcare of CA Medicare	$48,897.37
Rate for Payer: Multiplan WC	$55,777.03

INPATIENT MS-DRG 030: SPINAL PROCEDURES WITHOUT CC/MCC

Facility IP

$38,209.62

Service Code	MS-DRG 030
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$38,209.62
Rate for Payer: EPIC Health Plan Medicare	$26,317.38
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	$26,317.38
Rate for Payer: IEHP Medicare Advantage	$26,317.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,054.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$33,159.90
Rate for Payer: Molina Healthcare of CA Medicare	$33,159.90
Rate for Payer: Multiplan WC	$38,209.62

INPATIENT MS-DRG 031: VENTRICULAR SHUNT PROCEDURES WITH MCC

Facility IP

$67,256.90

Service Code	MS-DRG 031
Min. Negotiated Rate	$46,559.15
Max. Negotiated Rate	$67,256.90
Rate for Payer: EPIC Health Plan Medicare	$46,559.15
Rate for Payer: Humana Medicare	$46,559.15
Rate for Payer: IEHP Medicare Advantage	$46,559.15
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$54,939.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$58,664.53
Rate for Payer: Molina Healthcare of CA Medicare	$58,664.53
Rate for Payer: Multiplan WC	$67,256.90

INPATIENT MS-DRG 032: VENTRICULAR SHUNT PROCEDURES WITH CC

Facility IP

$33,530.52

Service Code	MS-DRG 032
Min. Negotiated Rate	$24,457.13
Max. Negotiated Rate	$33,530.52
Rate for Payer: EPIC Health Plan Medicare	$24,457.13
Rate for Payer: Humana Medicare	$24,457.13
Rate for Payer: IEHP Medicare Advantage	$24,457.13
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,859.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,815.98
Rate for Payer: Molina Healthcare of CA Medicare	$30,815.98
Rate for Payer: Multiplan WC	$33,530.52

INPATIENT MS-DRG 033: VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC

Facility IP

$27,720.42

Service Code	MS-DRG 033
Min. Negotiated Rate	$18,478.96
Max. Negotiated Rate	$27,720.42
Rate for Payer: EPIC Health Plan Medicare	$18,478.96
Rate for Payer: Humana Medicare	$18,478.96
Rate for Payer: IEHP Medicare Advantage	$18,478.96
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,805.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,283.49
Rate for Payer: Molina Healthcare of CA Medicare	$23,283.49
Rate for Payer: Multiplan WC	$27,720.42

INPATIENT MS-DRG 034: CAROTID ARTERY STENT PROCEDURES WITH MCC

Facility IP

$65,272.32

Service Code	MS-DRG 034
Min. Negotiated Rate	$14,752.00
Max. Negotiated Rate	$65,272.32
Rate for Payer: Cigna of CA HMO/PPO	$24,300.00
Rate for Payer: EPIC Health Plan Commercial	$14,752.00
Rate for Payer: EPIC Health Plan Medicare	$44,135.92
Rate for Payer: Humana Medicare	$44,135.92
Rate for Payer: IEHP Medicare Advantage	$44,135.92
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$52,080.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$55,611.26
Rate for Payer: Molina Healthcare of CA Medicare	$55,611.26
Rate for Payer: Multiplan WC	$65,272.32

INPATIENT MS-DRG 035: CAROTID ARTERY STENT PROCEDURES WITH CC

Facility IP

$37,272.82

Service Code	MS-DRG 035
Min. Negotiated Rate	$14,752.00
Max. Negotiated Rate	$37,272.82
Rate for Payer: Cigna of CA HMO/PPO	$24,300.00
Rate for Payer: EPIC Health Plan Commercial	$14,752.00
Rate for Payer: EPIC Health Plan Medicare	$26,097.79
Rate for Payer: Humana Medicare	$26,097.79
Rate for Payer: IEHP Medicare Advantage	$26,097.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,795.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,883.22
Rate for Payer: Molina Healthcare of CA Medicare	$32,883.22
Rate for Payer: Multiplan WC	$37,272.82

INPATIENT MS-DRG 036: CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC

Facility IP

$30,694.02

Service Code	MS-DRG 036
Min. Negotiated Rate	$14,752.00
Max. Negotiated Rate	$30,694.02
Rate for Payer: Cigna of CA HMO/PPO	$24,300.00
Rate for Payer: EPIC Health Plan Commercial	$14,752.00
Rate for Payer: EPIC Health Plan Medicare	$20,565.53
Rate for Payer: Humana Medicare	$20,565.53
Rate for Payer: IEHP Medicare Advantage	$20,565.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,267.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,912.57
Rate for Payer: Molina Healthcare of CA Medicare	$25,912.57
Rate for Payer: Multiplan WC	$30,694.02

INPATIENT MS-DRG 037: EXTRACRANIAL PROCEDURES WITH MCC

Facility IP

$55,049.14

Service Code	MS-DRG 037
Min. Negotiated Rate	$38,215.15
Max. Negotiated Rate	$55,049.14
Rate for Payer: EPIC Health Plan Medicare	$38,215.15
Rate for Payer: Humana Medicare	$38,215.15
Rate for Payer: IEHP Medicare Advantage	$38,215.15
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$45,093.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$48,151.09
Rate for Payer: Molina Healthcare of CA Medicare	$48,151.09
Rate for Payer: Multiplan WC	$55,049.14

INPATIENT MS-DRG 038: EXTRACRANIAL PROCEDURES WITH CC

Facility IP

$26,692.22

Service Code	MS-DRG 038
Min. Negotiated Rate	$18,219.98
Max. Negotiated Rate	$26,692.22
Rate for Payer: EPIC Health Plan Medicare	$18,219.98
Rate for Payer: Humana Medicare	$18,219.98
Rate for Payer: IEHP Medicare Advantage	$18,219.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,499.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,957.17
Rate for Payer: Molina Healthcare of CA Medicare	$22,957.17
Rate for Payer: Multiplan WC	$26,692.22

INPATIENT MS-DRG 039: EXTRACRANIAL PROCEDURES WITHOUT CC/MCC

Facility IP

$18,812.67

Service Code	MS-DRG 039
Min. Negotiated Rate	$13,052.55
Max. Negotiated Rate	$18,812.67
Rate for Payer: EPIC Health Plan Medicare	$13,052.55
Rate for Payer: Humana Medicare	$13,052.55
Rate for Payer: IEHP Medicare Advantage	$13,052.55
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,402.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,446.21
Rate for Payer: Molina Healthcare of CA Medicare	$16,446.21
Rate for Payer: Multiplan WC	$18,812.67

INPATIENT MS-DRG 040: PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC

Facility IP

$61,828.69

Service Code	MS-DRG 040
Min. Negotiated Rate	$43,562.75
Max. Negotiated Rate	$61,828.69
Rate for Payer: EPIC Health Plan Medicare	$43,562.75
Rate for Payer: Humana Medicare	$43,562.75
Rate for Payer: IEHP Medicare Advantage	$43,562.75
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$51,404.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$54,889.06
Rate for Payer: Molina Healthcare of CA Medicare	$54,889.06
Rate for Payer: Multiplan WC	$61,828.69

INPATIENT MS-DRG 041: PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR

Facility IP

$38,159.02

Service Code	MS-DRG 041
Min. Negotiated Rate	$25,323.07
Max. Negotiated Rate	$38,159.02
Rate for Payer: EPIC Health Plan Medicare	$25,323.07
Rate for Payer: Humana Medicare	$25,323.07
Rate for Payer: IEHP Medicare Advantage	$25,323.07
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,881.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,907.07
Rate for Payer: Molina Healthcare of CA Medicare	$31,907.07
Rate for Payer: Multiplan WC	$38,159.02

INPATIENT MS-DRG 042: PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC

Facility IP

$30,188.08

Service Code	MS-DRG 042
Min. Negotiated Rate	$19,795.32
Max. Negotiated Rate	$30,188.08
Rate for Payer: EPIC Health Plan Medicare	$19,795.32
Rate for Payer: Humana Medicare	$19,795.32
Rate for Payer: IEHP Medicare Advantage	$19,795.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,358.48
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,942.10
Rate for Payer: Molina Healthcare of CA Medicare	$24,942.10
Rate for Payer: Multiplan WC	$30,188.08

INPATIENT MS-DRG 052: SPINAL DISORDERS AND INJURIES WITH CC/MCC

Facility IP

$29,055.43

Service Code	MS-DRG 052
Min. Negotiated Rate	$22,100.33
Max. Negotiated Rate	$29,055.43
Rate for Payer: EPIC Health Plan Medicare	$22,100.33
Rate for Payer: Humana Medicare	$22,100.33
Rate for Payer: IEHP Medicare Advantage	$22,100.33
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,078.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,846.42
Rate for Payer: Molina Healthcare of CA Medicare	$27,846.42
Rate for Payer: Multiplan WC	$29,055.43

INPATIENT MS-DRG 053: SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC

Facility IP

$16,692.63

Service Code	MS-DRG 053
Min. Negotiated Rate	$11,282.41
Max. Negotiated Rate	$16,692.63
Rate for Payer: EPIC Health Plan Medicare	$11,282.41
Rate for Payer: Humana Medicare	$11,282.41
Rate for Payer: IEHP Medicare Advantage	$11,282.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,313.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,215.84
Rate for Payer: Molina Healthcare of CA Medicare	$14,215.84
Rate for Payer: Multiplan WC	$16,692.63

INPATIENT MS-DRG 054: NERVOUS SYSTEM NEOPLASMS WITH MCC

Facility IP

$22,636.57

Service Code	MS-DRG 054
Min. Negotiated Rate	$16,796.65
Max. Negotiated Rate	$22,636.57
Rate for Payer: EPIC Health Plan Medicare	$16,796.65
Rate for Payer: Humana Medicare	$16,796.65
Rate for Payer: IEHP Medicare Advantage	$16,796.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,820.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,163.78
Rate for Payer: Molina Healthcare of CA Medicare	$21,163.78
Rate for Payer: Multiplan WC	$22,636.57

INPATIENT MS-DRG 055: NERVOUS SYSTEM NEOPLASMS WITHOUT MCC

Facility IP

$16,455.98

Service Code	MS-DRG 055
Min. Negotiated Rate	$12,289.09
Max. Negotiated Rate	$16,455.98
Rate for Payer: EPIC Health Plan Medicare	$12,289.09
Rate for Payer: Humana Medicare	$12,289.09
Rate for Payer: IEHP Medicare Advantage	$12,289.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,501.13
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,484.25
Rate for Payer: Molina Healthcare of CA Medicare	$15,484.25
Rate for Payer: Multiplan WC	$16,455.98

INPATIENT MS-DRG 056: DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC

Facility IP

$36,407.83

Service Code	MS-DRG 056
Min. Negotiated Rate	$27,161.91
Max. Negotiated Rate	$36,407.83
Rate for Payer: EPIC Health Plan Medicare	$27,161.91
Rate for Payer: Humana Medicare	$27,161.91
Rate for Payer: IEHP Medicare Advantage	$27,161.91
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,051.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,224.01
Rate for Payer: Molina Healthcare of CA Medicare	$34,224.01
Rate for Payer: Multiplan WC	$36,407.83

INPATIENT MS-DRG 057: DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC

Facility IP

$21,241.17

Service Code	MS-DRG 057
Min. Negotiated Rate	$15,554.61
Max. Negotiated Rate	$21,241.17
Rate for Payer: EPIC Health Plan Medicare	$15,554.61
Rate for Payer: Humana Medicare	$15,554.61
Rate for Payer: IEHP Medicare Advantage	$15,554.61
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,354.44
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,598.81
Rate for Payer: Molina Healthcare of CA Medicare	$19,598.81
Rate for Payer: Multiplan WC	$21,241.17

INPATIENT MS-DRG 058: MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC

Facility IP

$28,157.81

Service Code	MS-DRG 058
Min. Negotiated Rate	$19,661.32
Max. Negotiated Rate	$28,157.81
Rate for Payer: EPIC Health Plan Medicare	$19,661.32
Rate for Payer: Humana Medicare	$19,661.32
Rate for Payer: IEHP Medicare Advantage	$19,661.32
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,200.36
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,773.26
Rate for Payer: Molina Healthcare of CA Medicare	$24,773.26
Rate for Payer: Multiplan WC	$28,157.81

INPATIENT MS-DRG 059: MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC

Facility IP

$18,662.52

Service Code	MS-DRG 059
Min. Negotiated Rate	$13,572.78
Max. Negotiated Rate	$18,662.52
Rate for Payer: EPIC Health Plan Medicare	$13,572.78
Rate for Payer: Humana Medicare	$13,572.78
Rate for Payer: IEHP Medicare Advantage	$13,572.78
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,015.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,101.70
Rate for Payer: Molina Healthcare of CA Medicare	$17,101.70
Rate for Payer: Multiplan WC	$18,662.52

INPATIENT MS-DRG 060: MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC

Facility IP

$14,791.30

Service Code	MS-DRG 060
Min. Negotiated Rate	$10,309.52
Max. Negotiated Rate	$14,791.30
Rate for Payer: EPIC Health Plan Medicare	$10,309.52
Rate for Payer: Humana Medicare	$10,309.52
Rate for Payer: IEHP Medicare Advantage	$10,309.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,165.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,990.00
Rate for Payer: Molina Healthcare of CA Medicare	$12,990.00
Rate for Payer: Multiplan WC	$14,791.30

INPATIENT MS-DRG 061: ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC

Facility IP

$47,861.58

Service Code	MS-DRG 061
Min. Negotiated Rate	$31,765.17
Max. Negotiated Rate	$47,861.58
Rate for Payer: EPIC Health Plan Medicare	$31,765.17
Rate for Payer: Humana Medicare	$31,765.17
Rate for Payer: IEHP Medicare Advantage	$31,765.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,482.90
Rate for Payer: Molina Healthcare of CA Medi-Cal	$40,024.11
Rate for Payer: Molina Healthcare of CA Medicare	$40,024.11
Rate for Payer: Multiplan WC	$47,861.58

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