Loma Linda University Medical Center

All Charges

Charge

Type

Price

INPATIENT MS-DRG 221: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility IP

$86,939.00

Service Code	MS-DRG 221
Min. Negotiated Rate	$28,410.00
Max. Negotiated Rate	$86,939.00
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: Cigna of CA HMO/PPO	$32,400.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$52,549.71
Rate for Payer: Humana Medicare	$52,549.71
Rate for Payer: IEHP Medicare Advantage	$52,549.71
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$62,008.66
Rate for Payer: Molina Healthcare of CA Medi-Cal	$66,212.63
Rate for Payer: Molina Healthcare of CA Medicare	$66,212.63
Rate for Payer: Multiplan WC	$77,222.21

INPATIENT MS-DRG 228: OTHER CARDIOTHORACIC PROCEDURES WITH MCC

Facility IP

$86,939.00

Service Code	MS-DRG 228
Min. Negotiated Rate	$28,410.00
Max. Negotiated Rate	$86,939.00
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: Cigna of CA HMO/PPO	$32,400.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$56,942.42
Rate for Payer: Humana Medicare	$56,942.42
Rate for Payer: IEHP Medicare Advantage	$56,942.42
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$67,192.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$71,747.45
Rate for Payer: Molina Healthcare of CA Medicare	$71,747.45
Rate for Payer: Multiplan WC	$80,432.46

INPATIENT MS-DRG 229: OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC

Facility IP

$86,939.00

Service Code	MS-DRG 229
Min. Negotiated Rate	$28,410.00
Max. Negotiated Rate	$86,939.00
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: Cigna of CA HMO/PPO	$32,400.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$36,008.11
Rate for Payer: Humana Medicare	$36,008.11
Rate for Payer: IEHP Medicare Advantage	$36,008.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,489.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$45,370.22
Rate for Payer: Molina Healthcare of CA Medicare	$45,370.22
Rate for Payer: Multiplan WC	$53,872.43

INPATIENT MS-DRG 231: CORONARY BYPASS WITH PTCA WITH MCC

Facility IP

$136,981.46

Service Code	MS-DRG 231
Min. Negotiated Rate	$23,752.00
Max. Negotiated Rate	$136,981.46
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: Cigna of CA HMO/PPO	$32,400.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$91,585.19
Rate for Payer: Heritage Provider Network Commercial	$26,116.00
Rate for Payer: Heritage Provider Network Senior	$23,752.00
Rate for Payer: Humana Medicare	$91,585.19
Rate for Payer: IEHP Medicare Advantage	$91,585.19
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$108,070.52
Rate for Payer: Molina Healthcare of CA Medi-Cal	$115,397.34
Rate for Payer: Molina Healthcare of CA Medicare	$115,397.34
Rate for Payer: Multiplan WC	$136,981.46

INPATIENT MS-DRG 232: CORONARY BYPASS WITH PTCA WITHOUT MCC

Facility IP

$95,602.39

Service Code	MS-DRG 232
Min. Negotiated Rate	$23,752.00
Max. Negotiated Rate	$95,602.39
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: Cigna of CA HMO/PPO	$32,400.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$67,188.30
Rate for Payer: Heritage Provider Network Commercial	$26,116.00
Rate for Payer: Heritage Provider Network Senior	$23,752.00
Rate for Payer: Humana Medicare	$67,188.30
Rate for Payer: IEHP Medicare Advantage	$67,188.30
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$79,282.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$84,657.26
Rate for Payer: Molina Healthcare of CA Medicare	$84,657.26
Rate for Payer: Multiplan WC	$95,602.39

INPATIENT MS-DRG 233: CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC

Facility IP

$126,400.86

Service Code	MS-DRG 233
Min. Negotiated Rate	$23,752.00
Max. Negotiated Rate	$126,400.86
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: Cigna of CA HMO/PPO	$32,400.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$88,031.39
Rate for Payer: Heritage Provider Network Commercial	$26,116.00
Rate for Payer: Heritage Provider Network Senior	$23,752.00
Rate for Payer: Humana Medicare	$88,031.39
Rate for Payer: IEHP Medicare Advantage	$88,031.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$103,877.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$110,919.55
Rate for Payer: Molina Healthcare of CA Medicare	$110,919.55
Rate for Payer: Multiplan WC	$126,400.86

INPATIENT MS-DRG 234: CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC

Facility IP

$86,939.00

Service Code	MS-DRG 234
Min. Negotiated Rate	$23,752.00
Max. Negotiated Rate	$86,939.00
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: Cigna of CA HMO/PPO	$32,400.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$58,735.08
Rate for Payer: Heritage Provider Network Commercial	$26,116.00
Rate for Payer: Heritage Provider Network Senior	$23,752.00
Rate for Payer: Humana Medicare	$58,735.08
Rate for Payer: IEHP Medicare Advantage	$58,735.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$69,307.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$74,006.20
Rate for Payer: Molina Healthcare of CA Medicare	$74,006.20
Rate for Payer: Multiplan WC	$84,643.16

INPATIENT MS-DRG 235: CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility IP

$97,759.96

Service Code	MS-DRG 235
Min. Negotiated Rate	$23,752.00
Max. Negotiated Rate	$97,759.96
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: Cigna of CA HMO/PPO	$32,400.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$66,422.59
Rate for Payer: Heritage Provider Network Commercial	$26,116.00
Rate for Payer: Heritage Provider Network Senior	$23,752.00
Rate for Payer: Humana Medicare	$66,422.59
Rate for Payer: IEHP Medicare Advantage	$66,422.59
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$78,378.66
Rate for Payer: Molina Healthcare of CA Medi-Cal	$83,692.46
Rate for Payer: Molina Healthcare of CA Medicare	$83,692.46
Rate for Payer: Multiplan WC	$97,759.96

INPATIENT MS-DRG 236: CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC

Facility IP

$86,939.00

Service Code	MS-DRG 236
Min. Negotiated Rate	$23,752.00
Max. Negotiated Rate	$86,939.00
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: Cigna of CA HMO/PPO	$32,400.00
Rate for Payer: EPIC Health Plan Commercial	$28,410.00
Rate for Payer: EPIC Health Plan Medicare	$45,710.12
Rate for Payer: Heritage Provider Network Commercial	$26,116.00
Rate for Payer: Heritage Provider Network Senior	$23,752.00
Rate for Payer: Humana Medicare	$45,710.12
Rate for Payer: IEHP Medicare Advantage	$45,710.12
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$53,937.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$57,594.75
Rate for Payer: Molina Healthcare of CA Medicare	$57,594.75
Rate for Payer: Multiplan WC	$66,561.64

INPATIENT MS-DRG 239: AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC

Facility IP

$75,892.09

Service Code	MS-DRG 239
Min. Negotiated Rate	$54,331.11
Max. Negotiated Rate	$75,892.09
Rate for Payer: EPIC Health Plan Medicare	$54,331.11
Rate for Payer: Humana Medicare	$54,331.11
Rate for Payer: IEHP Medicare Advantage	$54,331.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$64,110.71
Rate for Payer: Molina Healthcare of CA Medi-Cal	$68,457.20
Rate for Payer: Molina Healthcare of CA Medicare	$68,457.20
Rate for Payer: Multiplan WC	$75,892.09

INPATIENT MS-DRG 240: AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC

Facility IP

$44,297.18

Service Code	MS-DRG 240
Min. Negotiated Rate	$31,837.24
Max. Negotiated Rate	$44,297.18
Rate for Payer: EPIC Health Plan Medicare	$31,837.24
Rate for Payer: Humana Medicare	$31,837.24
Rate for Payer: IEHP Medicare Advantage	$31,837.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,567.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$40,114.92
Rate for Payer: Molina Healthcare of CA Medicare	$40,114.92
Rate for Payer: Multiplan WC	$44,297.18

INPATIENT MS-DRG 241: AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC

Facility IP

$25,278.86

Service Code	MS-DRG 241
Min. Negotiated Rate	$15,901.45
Max. Negotiated Rate	$25,278.86
Rate for Payer: EPIC Health Plan Medicare	$15,901.45
Rate for Payer: Humana Medicare	$15,901.45
Rate for Payer: IEHP Medicare Advantage	$15,901.45
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18,763.71
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,035.83
Rate for Payer: Molina Healthcare of CA Medicare	$20,035.83
Rate for Payer: Multiplan WC	$25,278.86

INPATIENT MS-DRG 242: PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC

Facility IP

$56,689.35

Service Code	MS-DRG 242
Min. Negotiated Rate	$7,571.00
Max. Negotiated Rate	$56,689.35
Rate for Payer: Aetna of CA Gatekeeper	$28,979.00
Rate for Payer: Cigna of CA HMO/PPO	$11,000.00
Rate for Payer: EPIC Health Plan Commercial	$8,850.00
Rate for Payer: EPIC Health Plan Medicare	$39,110.36
Rate for Payer: Heritage Provider Network Commercial	$8,325.00
Rate for Payer: Heritage Provider Network Senior	$7,571.00
Rate for Payer: Humana Medicare	$39,110.36
Rate for Payer: IEHP Medicare Advantage	$39,110.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$46,150.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$49,279.05
Rate for Payer: Molina Healthcare of CA Medicare	$49,279.05
Rate for Payer: Multiplan WC	$56,689.35

INPATIENT MS-DRG 243: PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC

Facility IP

$38,255.32

Service Code	MS-DRG 243
Min. Negotiated Rate	$7,571.00
Max. Negotiated Rate	$38,255.32
Rate for Payer: Aetna of CA Gatekeeper	$28,979.00
Rate for Payer: Cigna of CA HMO/PPO	$11,000.00
Rate for Payer: EPIC Health Plan Commercial	$8,850.00
Rate for Payer: EPIC Health Plan Medicare	$25,851.17
Rate for Payer: Heritage Provider Network Commercial	$8,325.00
Rate for Payer: Heritage Provider Network Senior	$7,571.00
Rate for Payer: Humana Medicare	$25,851.17
Rate for Payer: IEHP Medicare Advantage	$25,851.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,504.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$32,572.47
Rate for Payer: Molina Healthcare of CA Medicare	$32,572.47
Rate for Payer: Multiplan WC	$38,255.32

INPATIENT MS-DRG 244: PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC

Facility IP

$31,026.96

Service Code	MS-DRG 244
Min. Negotiated Rate	$7,571.00
Max. Negotiated Rate	$31,026.96
Rate for Payer: Aetna of CA Gatekeeper	$28,979.00
Rate for Payer: Cigna of CA HMO/PPO	$11,000.00
Rate for Payer: EPIC Health Plan Commercial	$8,850.00
Rate for Payer: EPIC Health Plan Medicare	$20,805.37
Rate for Payer: Heritage Provider Network Commercial	$8,325.00
Rate for Payer: Heritage Provider Network Senior	$7,571.00
Rate for Payer: Humana Medicare	$20,805.37
Rate for Payer: IEHP Medicare Advantage	$20,805.37
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,550.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,214.77
Rate for Payer: Molina Healthcare of CA Medicare	$26,214.77
Rate for Payer: Multiplan WC	$31,026.96

INPATIENT MS-DRG 245: AICD GENERATOR PROCEDURES

Facility IP

$79,578.89

Service Code	MS-DRG 245
Min. Negotiated Rate	$10,312.00
Max. Negotiated Rate	$79,578.89
Rate for Payer: Cigna of CA HMO/PPO	$11,000.00
Rate for Payer: EPIC Health Plan Commercial	$13,987.00
Rate for Payer: EPIC Health Plan Medicare	$51,229.99
Rate for Payer: Heritage Provider Network Commercial	$11,338.00
Rate for Payer: Heritage Provider Network Senior	$10,312.00
Rate for Payer: Humana Medicare	$51,229.99
Rate for Payer: IEHP Medicare Advantage	$51,229.99
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$60,451.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$64,549.79
Rate for Payer: Molina Healthcare of CA Medicare	$64,549.79
Rate for Payer: Multiplan WC	$79,578.89

INPATIENT MS-DRG 250: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC

Facility IP

$39,490.79

Service Code	MS-DRG 250
Min. Negotiated Rate	$8,633.00
Max. Negotiated Rate	$39,490.79
Rate for Payer: Aetna of CA Gatekeeper	$14,118.00
Rate for Payer: Cigna of CA HMO/PPO	$11,000.00
Rate for Payer: EPIC Health Plan Commercial	$8,633.00
Rate for Payer: EPIC Health Plan Medicare	$26,675.45
Rate for Payer: Humana Medicare	$26,675.45
Rate for Payer: IEHP Medicare Advantage	$26,675.45
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,477.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$33,611.07
Rate for Payer: Molina Healthcare of CA Medicare	$33,611.07
Rate for Payer: Multiplan WC	$39,490.79

INPATIENT MS-DRG 251: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC

Facility IP

$26,525.76

Service Code	MS-DRG 251
Min. Negotiated Rate	$9,725.00
Max. Negotiated Rate	$26,525.76
Rate for Payer: Aetna of CA Gatekeeper	$14,118.00
Rate for Payer: EPIC Health Plan Commercial	$9,725.00
Rate for Payer: EPIC Health Plan Medicare	$18,073.58
Rate for Payer: Humana Medicare	$18,073.58
Rate for Payer: IEHP Medicare Advantage	$18,073.58
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,326.82
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,772.71
Rate for Payer: Molina Healthcare of CA Medicare	$22,772.71
Rate for Payer: Multiplan WC	$26,525.76

INPATIENT MS-DRG 252: OTHER VASCULAR PROCEDURES WITH MCC

Facility IP

$54,564.42

Service Code	MS-DRG 252
Min. Negotiated Rate	$37,969.68
Max. Negotiated Rate	$54,564.42
Rate for Payer: EPIC Health Plan Medicare	$37,969.68
Rate for Payer: Humana Medicare	$37,969.68
Rate for Payer: IEHP Medicare Advantage	$37,969.68
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$44,804.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$47,841.80
Rate for Payer: Molina Healthcare of CA Medicare	$47,841.80
Rate for Payer: Multiplan WC	$54,564.42

INPATIENT MS-DRG 253: OTHER VASCULAR PROCEDURES WITH CC

Facility IP

$43,641.10

Service Code	MS-DRG 253
Min. Negotiated Rate	$28,930.92
Max. Negotiated Rate	$43,641.10
Rate for Payer: EPIC Health Plan Medicare	$28,930.92
Rate for Payer: Humana Medicare	$28,930.92
Rate for Payer: IEHP Medicare Advantage	$28,930.92
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,138.49
Rate for Payer: Molina Healthcare of CA Medi-Cal	$36,452.96
Rate for Payer: Molina Healthcare of CA Medicare	$36,452.96
Rate for Payer: Multiplan WC	$43,641.10

INPATIENT MS-DRG 254: OTHER VASCULAR PROCEDURES WITHOUT CC/MCC

Facility IP

$29,842.09

Service Code	MS-DRG 254
Min. Negotiated Rate	$19,742.39
Max. Negotiated Rate	$29,842.09
Rate for Payer: EPIC Health Plan Medicare	$19,742.39
Rate for Payer: Humana Medicare	$19,742.39
Rate for Payer: IEHP Medicare Advantage	$19,742.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$23,296.02
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,875.41
Rate for Payer: Molina Healthcare of CA Medicare	$24,875.41
Rate for Payer: Multiplan WC	$29,842.09

INPATIENT MS-DRG 255: UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC

Facility IP

$41,871.95

Service Code	MS-DRG 255
Min. Negotiated Rate	$31,141.34
Max. Negotiated Rate	$41,871.95
Rate for Payer: EPIC Health Plan Medicare	$31,141.34
Rate for Payer: Humana Medicare	$31,141.34
Rate for Payer: IEHP Medicare Advantage	$31,141.34
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,746.78
Rate for Payer: Molina Healthcare of CA Medi-Cal	$39,238.09
Rate for Payer: Molina Healthcare of CA Medicare	$39,238.09
Rate for Payer: Multiplan WC	$41,871.95

INPATIENT MS-DRG 256: UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC

Facility IP

$26,638.37

Service Code	MS-DRG 256
Min. Negotiated Rate	$18,668.13
Max. Negotiated Rate	$26,638.37
Rate for Payer: EPIC Health Plan Medicare	$18,668.13
Rate for Payer: Humana Medicare	$18,668.13
Rate for Payer: IEHP Medicare Advantage	$18,668.13
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,028.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,521.84
Rate for Payer: Molina Healthcare of CA Medicare	$23,521.84
Rate for Payer: Multiplan WC	$26,638.37

INPATIENT MS-DRG 257: UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC

Facility IP

$17,115.34

Service Code	MS-DRG 257
Min. Negotiated Rate	$11,363.48
Max. Negotiated Rate	$17,115.34
Rate for Payer: EPIC Health Plan Medicare	$11,363.48
Rate for Payer: Humana Medicare	$11,363.48
Rate for Payer: IEHP Medicare Advantage	$11,363.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,408.91
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,317.98
Rate for Payer: Molina Healthcare of CA Medicare	$14,317.98
Rate for Payer: Multiplan WC	$17,115.34

INPATIENT MS-DRG 258: CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC

Facility IP

$46,534.72

Service Code	MS-DRG 258
Min. Negotiated Rate	$8,850.00
Max. Negotiated Rate	$46,534.72
Rate for Payer: Aetna of CA Gatekeeper	$28,979.00
Rate for Payer: Cigna of CA HMO/PPO	$11,000.00
Rate for Payer: EPIC Health Plan Commercial	$8,850.00
Rate for Payer: EPIC Health Plan Medicare	$30,704.44
Rate for Payer: Humana Medicare	$30,704.44
Rate for Payer: IEHP Medicare Advantage	$30,704.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,231.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,687.59
Rate for Payer: Molina Healthcare of CA Medicare	$38,687.59
Rate for Payer: Multiplan WC	$46,534.72

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