Loma Linda University Medical Center

All Charges

Charge

Type

Price

INPATIENT MS-DRG 259: CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC

Facility IP

$32,544.76

Service Code	MS-DRG 259
Min. Negotiated Rate	$8,850.00
Max. Negotiated Rate	$32,544.76
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	$21,223.14
Rate for Payer: Humana Medicare	$21,223.14
Rate for Payer: IEHP Medicare Advantage	$21,223.14
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,043.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,741.16
Rate for Payer: Molina Healthcare of CA Medicare	$26,741.16
Rate for Payer: Multiplan WC	$32,544.76

INPATIENT MS-DRG 260: CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC

Facility IP

$57,098.99

Service Code	MS-DRG 260
Min. Negotiated Rate	$8,850.00
Max. Negotiated Rate	$57,098.99
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	$37,535.04
Rate for Payer: Humana Medicare	$37,535.04
Rate for Payer: IEHP Medicare Advantage	$37,535.04
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$44,291.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$47,294.15
Rate for Payer: Molina Healthcare of CA Medicare	$47,294.15
Rate for Payer: Multiplan WC	$57,098.99

INPATIENT MS-DRG 261: CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC

Facility IP

$31,185.27

Service Code	MS-DRG 261
Min. Negotiated Rate	$8,850.00
Max. Negotiated Rate	$31,185.27
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	$21,394.30
Rate for Payer: Humana Medicare	$21,394.30
Rate for Payer: IEHP Medicare Advantage	$21,394.30
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$25,245.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,956.82
Rate for Payer: Molina Healthcare of CA Medicare	$26,956.82
Rate for Payer: Multiplan WC	$31,185.27

INPATIENT MS-DRG 262: CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC

Facility IP

$28,979.00

Service Code	MS-DRG 262
Min. Negotiated Rate	$8,850.00
Max. Negotiated Rate	$28,979.00
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	$18,731.21
Rate for Payer: Humana Medicare	$18,731.21
Rate for Payer: IEHP Medicare Advantage	$18,731.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,102.83
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,601.32
Rate for Payer: Molina Healthcare of CA Medicare	$23,601.32
Rate for Payer: Multiplan WC	$27,366.26

INPATIENT MS-DRG 263: VEIN LIGATION AND STRIPPING

Facility IP

$45,468.99

Service Code	MS-DRG 263
Min. Negotiated Rate	$32,017.39
Max. Negotiated Rate	$45,468.99
Rate for Payer: EPIC Health Plan Medicare	$32,017.39
Rate for Payer: Humana Medicare	$32,017.39
Rate for Payer: IEHP Medicare Advantage	$32,017.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$37,780.52
Rate for Payer: Molina Healthcare of CA Medi-Cal	$40,341.91
Rate for Payer: Molina Healthcare of CA Medicare	$40,341.91
Rate for Payer: Multiplan WC	$45,468.99

INPATIENT MS-DRG 264: OTHER CIRCULATORY SYSTEM O.R. PROCEDURES

Facility IP

$54,016.05

Service Code	MS-DRG 264
Min. Negotiated Rate	$36,981.02
Max. Negotiated Rate	$54,016.05
Rate for Payer: EPIC Health Plan Medicare	$36,981.02
Rate for Payer: Humana Medicare	$36,981.02
Rate for Payer: IEHP Medicare Advantage	$36,981.02
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$43,637.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,596.09
Rate for Payer: Molina Healthcare of CA Medicare	$46,596.09
Rate for Payer: Multiplan WC	$54,016.05

INPATIENT MS-DRG 265: AICD LEAD PROCEDURES

Facility IP

$55,197.66

Service Code	MS-DRG 265
Min. Negotiated Rate	$10,312.00
Max. Negotiated Rate	$55,197.66
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	$39,999.93
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	$39,999.93
Rate for Payer: IEHP Medicare Advantage	$39,999.93
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$47,199.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$50,399.91
Rate for Payer: Molina Healthcare of CA Medicare	$50,399.91
Rate for Payer: Multiplan WC	$55,197.66

INPATIENT MS-DRG 266: ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC

Facility IP

$107,726.91

Service Code	MS-DRG 266
Min. Negotiated Rate	$70,538.28
Max. Negotiated Rate	$107,726.91
Rate for Payer: EPIC Health Plan Medicare	$70,538.28
Rate for Payer: Humana Medicare	$70,538.28
Rate for Payer: IEHP Medicare Advantage	$70,538.28
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$83,235.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$88,878.23
Rate for Payer: Molina Healthcare of CA Medicare	$88,878.23
Rate for Payer: Multiplan WC	$107,726.91

INPATIENT MS-DRG 267: ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC

Facility IP

$84,223.72

Service Code	MS-DRG 267
Min. Negotiated Rate	$55,157.63
Max. Negotiated Rate	$84,223.72
Rate for Payer: EPIC Health Plan Medicare	$55,157.63
Rate for Payer: Humana Medicare	$55,157.63
Rate for Payer: IEHP Medicare Advantage	$55,157.63
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$65,086.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$69,498.61
Rate for Payer: Molina Healthcare of CA Medicare	$69,498.61
Rate for Payer: Multiplan WC	$84,223.72

INPATIENT MS-DRG 268: AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC

Facility IP

$112,951.11

Service Code	MS-DRG 268
Min. Negotiated Rate	$77,391.38
Max. Negotiated Rate	$112,951.11
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: EPIC Health Plan Medicare	$77,391.38
Rate for Payer: Humana Medicare	$77,391.38
Rate for Payer: IEHP Medicare Advantage	$77,391.38
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$91,321.83
Rate for Payer: Molina Healthcare of CA Medi-Cal	$97,513.14
Rate for Payer: Molina Healthcare of CA Medicare	$97,513.14
Rate for Payer: Multiplan WC	$112,951.11

INPATIENT MS-DRG 269: AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC

Facility IP

$86,939.00

Service Code	MS-DRG 269
Min. Negotiated Rate	$47,032.09
Max. Negotiated Rate	$86,939.00
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: EPIC Health Plan Medicare	$47,032.09
Rate for Payer: Humana Medicare	$47,032.09
Rate for Payer: IEHP Medicare Advantage	$47,032.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$55,497.87
Rate for Payer: Molina Healthcare of CA Medi-Cal	$59,260.43
Rate for Payer: Molina Healthcare of CA Medicare	$59,260.43
Rate for Payer: Multiplan WC	$69,791.47

INPATIENT MS-DRG 270: OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC

Facility IP

$86,939.00

Service Code	MS-DRG 270
Min. Negotiated Rate	$57,147.36
Max. Negotiated Rate	$86,939.00
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: EPIC Health Plan Medicare	$57,147.36
Rate for Payer: Humana Medicare	$57,147.36
Rate for Payer: IEHP Medicare Advantage	$57,147.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$67,433.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$72,005.67
Rate for Payer: Molina Healthcare of CA Medicare	$72,005.67
Rate for Payer: Multiplan WC	$83,440.34

INPATIENT MS-DRG 271: OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC

Facility IP

$86,939.00

Service Code	MS-DRG 271
Min. Negotiated Rate	$39,122.74
Max. Negotiated Rate	$86,939.00
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: EPIC Health Plan Medicare	$39,122.74
Rate for Payer: Humana Medicare	$39,122.74
Rate for Payer: IEHP Medicare Advantage	$39,122.74
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$46,164.83
Rate for Payer: Molina Healthcare of CA Medi-Cal	$49,294.65
Rate for Payer: Molina Healthcare of CA Medicare	$49,294.65
Rate for Payer: Multiplan WC	$56,857.45

INPATIENT MS-DRG 272: OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC

Facility IP

$86,939.00

Service Code	MS-DRG 272
Min. Negotiated Rate	$27,674.25
Max. Negotiated Rate	$86,939.00
Rate for Payer: Aetna of CA Gatekeeper	$86,939.00
Rate for Payer: EPIC Health Plan Medicare	$27,674.25
Rate for Payer: Humana Medicare	$27,674.25
Rate for Payer: IEHP Medicare Advantage	$27,674.25
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,655.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,869.56
Rate for Payer: Molina Healthcare of CA Medicare	$34,869.56
Rate for Payer: Multiplan WC	$42,374.62

INPATIENT MS-DRG 273: PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC

Facility IP

$65,494.28

Service Code	MS-DRG 273
Min. Negotiated Rate	$14,118.00
Max. Negotiated Rate	$65,494.28
Rate for Payer: Aetna of CA Gatekeeper	$14,118.00
Rate for Payer: EPIC Health Plan Medicare	$44,086.36
Rate for Payer: Humana Medicare	$44,086.36
Rate for Payer: IEHP Medicare Advantage	$44,086.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$52,021.90
Rate for Payer: Molina Healthcare of CA Medi-Cal	$55,548.81
Rate for Payer: Molina Healthcare of CA Medicare	$55,548.81
Rate for Payer: Multiplan WC	$65,494.28

INPATIENT MS-DRG 274: PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC

Facility IP

$54,828.81

Service Code	MS-DRG 274
Min. Negotiated Rate	$14,118.00
Max. Negotiated Rate	$54,828.81
Rate for Payer: Aetna of CA Gatekeeper	$14,118.00
Rate for Payer: EPIC Health Plan Medicare	$36,697.24
Rate for Payer: Humana Medicare	$36,697.24
Rate for Payer: IEHP Medicare Advantage	$36,697.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$43,302.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,238.52
Rate for Payer: Molina Healthcare of CA Medicare	$46,238.52
Rate for Payer: Multiplan WC	$54,828.81

INPATIENT MS-DRG 275: CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC

Facility IP

$100,082.62

Service Code	MS-DRG 275
Min. Negotiated Rate	$79,430.65
Max. Negotiated Rate	$100,082.62
Rate for Payer: EPIC Health Plan Medicare	$79,430.65
Rate for Payer: Humana Medicare	$79,430.65
Rate for Payer: IEHP Medicare Advantage	$79,430.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$93,728.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$100,082.62
Rate for Payer: Molina Healthcare of CA Medicare	$100,082.62

INPATIENT MS-DRG 276: CARDIAC DEFIBRILLATOR IMPLANT WITH MCC

Facility IP

$88,368.88

Service Code	MS-DRG 276
Min. Negotiated Rate	$70,134.03
Max. Negotiated Rate	$88,368.88
Rate for Payer: EPIC Health Plan Medicare	$70,134.03
Rate for Payer: Humana Medicare	$70,134.03
Rate for Payer: IEHP Medicare Advantage	$70,134.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$82,758.16
Rate for Payer: Molina Healthcare of CA Medi-Cal	$88,368.88
Rate for Payer: Molina Healthcare of CA Medicare	$88,368.88

INPATIENT MS-DRG 277: CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC

Facility IP

$68,110.99

Service Code	MS-DRG 277
Min. Negotiated Rate	$54,056.34
Max. Negotiated Rate	$68,110.99
Rate for Payer: EPIC Health Plan Medicare	$54,056.34
Rate for Payer: Humana Medicare	$54,056.34
Rate for Payer: IEHP Medicare Advantage	$54,056.34
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$63,786.48
Rate for Payer: Molina Healthcare of CA Medi-Cal	$68,110.99
Rate for Payer: Molina Healthcare of CA Medicare	$68,110.99

INPATIENT MS-DRG 278: ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC

Facility IP

$63,542.43

Service Code	MS-DRG 278
Min. Negotiated Rate	$50,430.50
Max. Negotiated Rate	$63,542.43
Rate for Payer: EPIC Health Plan Medicare	$50,430.50
Rate for Payer: Humana Medicare	$50,430.50
Rate for Payer: IEHP Medicare Advantage	$50,430.50
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$59,507.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$63,542.43
Rate for Payer: Molina Healthcare of CA Medicare	$63,542.43

INPATIENT MS-DRG 279: ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC

Facility IP

$45,668.16

Service Code	MS-DRG 279
Min. Negotiated Rate	$36,244.57
Max. Negotiated Rate	$45,668.16
Rate for Payer: EPIC Health Plan Medicare	$36,244.57
Rate for Payer: Humana Medicare	$36,244.57
Rate for Payer: IEHP Medicare Advantage	$36,244.57
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$42,768.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$45,668.16
Rate for Payer: Molina Healthcare of CA Medicare	$45,668.16

INPATIENT MS-DRG 280: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC

Facility IP

$26,217.29

Service Code	MS-DRG 280
Min. Negotiated Rate	$18,069.09
Max. Negotiated Rate	$26,217.29
Rate for Payer: EPIC Health Plan Medicare	$18,069.09
Rate for Payer: Humana Medicare	$18,069.09
Rate for Payer: IEHP Medicare Advantage	$18,069.09
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,321.53
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,767.05
Rate for Payer: Molina Healthcare of CA Medicare	$22,767.05
Rate for Payer: Multiplan WC	$26,217.29

INPATIENT MS-DRG 281: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC

Facility IP

$14,992.04

Service Code	MS-DRG 281
Min. Negotiated Rate	$10,485.17
Max. Negotiated Rate	$14,992.04
Rate for Payer: EPIC Health Plan Medicare	$10,485.17
Rate for Payer: Humana Medicare	$10,485.17
Rate for Payer: IEHP Medicare Advantage	$10,485.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,372.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,211.31
Rate for Payer: Molina Healthcare of CA Medicare	$13,211.31
Rate for Payer: Multiplan WC	$14,992.04

INPATIENT MS-DRG 282: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC

Facility IP

$11,696.93

Service Code	MS-DRG 282
Min. Negotiated Rate	$8,290.51
Max. Negotiated Rate	$11,696.93
Rate for Payer: EPIC Health Plan Medicare	$8,290.51
Rate for Payer: Humana Medicare	$8,290.51
Rate for Payer: IEHP Medicare Advantage	$8,290.51
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,782.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,446.04
Rate for Payer: Molina Healthcare of CA Medicare	$10,446.04
Rate for Payer: Multiplan WC	$11,696.93

INPATIENT MS-DRG 283: ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC

Facility IP

$31,312.57

Service Code	MS-DRG 283
Min. Negotiated Rate	$22,403.23
Max. Negotiated Rate	$31,312.57
Rate for Payer: EPIC Health Plan Medicare	$22,403.23
Rate for Payer: Humana Medicare	$22,403.23
Rate for Payer: IEHP Medicare Advantage	$22,403.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,435.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,228.07
Rate for Payer: Molina Healthcare of CA Medicare	$28,228.07
Rate for Payer: Multiplan WC	$31,312.57

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