Loma Linda University Medical Center

All Charges

Charge

Type

Price

INPATIENT MS-DRG 284: ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC

Facility IP

$12,002.12

Service Code	MS-DRG 284
Min. Negotiated Rate	$8,533.73
Max. Negotiated Rate	$12,002.12
Rate for Payer: EPIC Health Plan Medicare	$8,533.73
Rate for Payer: Humana Medicare	$8,533.73
Rate for Payer: IEHP Medicare Advantage	$8,533.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,069.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,752.50
Rate for Payer: Molina Healthcare of CA Medicare	$10,752.50
Rate for Payer: Multiplan WC	$12,002.12

INPATIENT MS-DRG 285: ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC

Facility IP

$8,842.46

Service Code	MS-DRG 285
Min. Negotiated Rate	$5,707.36
Max. Negotiated Rate	$8,842.46
Rate for Payer: EPIC Health Plan Medicare	$5,707.36
Rate for Payer: Humana Medicare	$5,707.36
Rate for Payer: IEHP Medicare Advantage	$5,707.36
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$6,734.68
Rate for Payer: Molina Healthcare of CA Medi-Cal	$7,191.27
Rate for Payer: Molina Healthcare of CA Medicare	$7,191.27
Rate for Payer: Multiplan WC	$8,842.46

INPATIENT MS-DRG 286: CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC

Facility IP

$34,615.84

Service Code	MS-DRG 286
Min. Negotiated Rate	$8,633.00
Max. Negotiated Rate	$34,615.84
Rate for Payer: Aetna of CA Gatekeeper	$10,558.00
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	$24,477.41
Rate for Payer: Humana Medicare	$24,477.41
Rate for Payer: IEHP Medicare Advantage	$24,477.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,883.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,841.54
Rate for Payer: Molina Healthcare of CA Medicare	$30,841.54
Rate for Payer: Multiplan WC	$34,615.84

INPATIENT MS-DRG 287: CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC

Facility IP

$17,955.84

Service Code	MS-DRG 287
Min. Negotiated Rate	$8,633.00
Max. Negotiated Rate	$17,955.84
Rate for Payer: Aetna of CA Gatekeeper	$10,558.00
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	$12,383.69
Rate for Payer: Humana Medicare	$12,383.69
Rate for Payer: IEHP Medicare Advantage	$12,383.69
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,612.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,603.45
Rate for Payer: Molina Healthcare of CA Medicare	$15,603.45
Rate for Payer: Multiplan WC	$17,955.84

INPATIENT MS-DRG 288: ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC

Facility IP

$44,008.30

Service Code	MS-DRG 288
Min. Negotiated Rate	$29,402.72
Max. Negotiated Rate	$44,008.30
Rate for Payer: EPIC Health Plan Medicare	$29,402.72
Rate for Payer: Humana Medicare	$29,402.72
Rate for Payer: IEHP Medicare Advantage	$29,402.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,695.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,047.43
Rate for Payer: Molina Healthcare of CA Medicare	$37,047.43
Rate for Payer: Multiplan WC	$44,008.30

INPATIENT MS-DRG 289: ACUTE AND SUBACUTE ENDOCARDITIS WITH CC

Facility IP

$26,228.72

Service Code	MS-DRG 289
Min. Negotiated Rate	$16,843.95
Max. Negotiated Rate	$26,228.72
Rate for Payer: EPIC Health Plan Medicare	$16,843.95
Rate for Payer: Humana Medicare	$16,843.95
Rate for Payer: IEHP Medicare Advantage	$16,843.95
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$19,875.86
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,223.38
Rate for Payer: Molina Healthcare of CA Medicare	$21,223.38
Rate for Payer: Multiplan WC	$26,228.72

INPATIENT MS-DRG 290: ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC

Facility IP

$19,677.66

Service Code	MS-DRG 290
Min. Negotiated Rate	$12,423.10
Max. Negotiated Rate	$19,677.66
Rate for Payer: EPIC Health Plan Medicare	$12,423.10
Rate for Payer: Humana Medicare	$12,423.10
Rate for Payer: IEHP Medicare Advantage	$12,423.10
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,659.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,653.11
Rate for Payer: Molina Healthcare of CA Medicare	$15,653.11
Rate for Payer: Multiplan WC	$19,677.66

INPATIENT MS-DRG 291: HEART FAILURE AND SHOCK WITH MCC

Facility IP

$20,887.01

Service Code	MS-DRG 291
Min. Negotiated Rate	$14,661.68
Max. Negotiated Rate	$20,887.01
Rate for Payer: EPIC Health Plan Medicare	$14,661.68
Rate for Payer: Humana Medicare	$14,661.68
Rate for Payer: IEHP Medicare Advantage	$14,661.68
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$17,300.78
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,473.72
Rate for Payer: Molina Healthcare of CA Medicare	$18,473.72
Rate for Payer: Multiplan WC	$20,887.01

INPATIENT MS-DRG 292: HEART FAILURE AND SHOCK WITH CC

Facility IP

$14,081.36

Service Code	MS-DRG 292
Min. Negotiated Rate	$9,848.96
Max. Negotiated Rate	$14,081.36
Rate for Payer: EPIC Health Plan Medicare	$9,848.96
Rate for Payer: Humana Medicare	$9,848.96
Rate for Payer: IEHP Medicare Advantage	$9,848.96
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,621.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,409.69
Rate for Payer: Molina Healthcare of CA Medicare	$12,409.69
Rate for Payer: Multiplan WC	$14,081.36

INPATIENT MS-DRG 293: HEART FAILURE AND SHOCK WITHOUT CC/MCC

Facility IP

$9,144.39

Service Code	MS-DRG 293
Min. Negotiated Rate	$6,527.10
Max. Negotiated Rate	$9,144.39
Rate for Payer: EPIC Health Plan Medicare	$6,527.10
Rate for Payer: Humana Medicare	$6,527.10
Rate for Payer: IEHP Medicare Advantage	$6,527.10
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$7,701.98
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,224.15
Rate for Payer: Molina Healthcare of CA Medicare	$8,224.15
Rate for Payer: Multiplan WC	$9,144.39

INPATIENT MS-DRG 294: DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC

Facility IP

$18,842.05

Service Code	MS-DRG 294
Min. Negotiated Rate	$12,519.93
Max. Negotiated Rate	$18,842.05
Rate for Payer: EPIC Health Plan Medicare	$12,519.93
Rate for Payer: Humana Medicare	$12,519.93
Rate for Payer: IEHP Medicare Advantage	$12,519.93
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,773.52
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,775.11
Rate for Payer: Molina Healthcare of CA Medicare	$15,775.11
Rate for Payer: Multiplan WC	$18,842.05

INPATIENT MS-DRG 295: DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC

Facility IP

$14,455.09

Service Code	MS-DRG 295
Min. Negotiated Rate	$9,180.08
Max. Negotiated Rate	$14,455.09
Rate for Payer: EPIC Health Plan Medicare	$9,180.08
Rate for Payer: Humana Medicare	$9,180.08
Rate for Payer: IEHP Medicare Advantage	$9,180.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,832.49
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,566.90
Rate for Payer: Molina Healthcare of CA Medicare	$11,566.90
Rate for Payer: Multiplan WC	$14,455.09

INPATIENT MS-DRG 296: CARDIAC ARREST, UNEXPLAINED WITH MCC

Facility IP

$26,737.92

Service Code	MS-DRG 296
Min. Negotiated Rate	$18,257.15
Max. Negotiated Rate	$26,737.92
Rate for Payer: EPIC Health Plan Medicare	$18,257.15
Rate for Payer: Humana Medicare	$18,257.15
Rate for Payer: IEHP Medicare Advantage	$18,257.15
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,543.44
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,004.01
Rate for Payer: Molina Healthcare of CA Medicare	$23,004.01
Rate for Payer: Multiplan WC	$26,737.92

INPATIENT MS-DRG 297: CARDIAC ARREST, UNEXPLAINED WITH CC

Facility IP

$10,595.00

Service Code	MS-DRG 297
Min. Negotiated Rate	$8,408.73
Max. Negotiated Rate	$10,595.00
Rate for Payer: EPIC Health Plan Medicare	$8,408.73
Rate for Payer: Humana Medicare	$8,408.73
Rate for Payer: IEHP Medicare Advantage	$8,408.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,922.30
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,595.00
Rate for Payer: Molina Healthcare of CA Medicare	$10,595.00
Rate for Payer: Multiplan WC	$10,384.76

INPATIENT MS-DRG 298: CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC

Facility IP

$7,972.57

Service Code	MS-DRG 298
Min. Negotiated Rate	$5,155.60
Max. Negotiated Rate	$7,972.57
Rate for Payer: EPIC Health Plan Medicare	$5,155.60
Rate for Payer: Humana Medicare	$5,155.60
Rate for Payer: IEHP Medicare Advantage	$5,155.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$6,083.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$6,496.06
Rate for Payer: Molina Healthcare of CA Medicare	$6,496.06
Rate for Payer: Multiplan WC	$7,972.57

INPATIENT MS-DRG 299: PERIPHERAL VASCULAR DISORDERS WITH MCC

Facility IP

$25,100.98

Service Code	MS-DRG 299
Min. Negotiated Rate	$17,953.10
Max. Negotiated Rate	$25,100.98
Rate for Payer: EPIC Health Plan Medicare	$17,953.10
Rate for Payer: Humana Medicare	$17,953.10
Rate for Payer: IEHP Medicare Advantage	$17,953.10
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,184.66
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,620.91
Rate for Payer: Molina Healthcare of CA Medicare	$22,620.91
Rate for Payer: Multiplan WC	$25,100.98

INPATIENT MS-DRG 300: PERIPHERAL VASCULAR DISORDERS WITH CC

Facility IP

$16,828.10

Service Code	MS-DRG 300
Min. Negotiated Rate	$12,219.27
Max. Negotiated Rate	$16,828.10
Rate for Payer: EPIC Health Plan Medicare	$12,219.27
Rate for Payer: Humana Medicare	$12,219.27
Rate for Payer: IEHP Medicare Advantage	$12,219.27
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$14,418.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,396.28
Rate for Payer: Molina Healthcare of CA Medicare	$15,396.28
Rate for Payer: Multiplan WC	$16,828.10

INPATIENT MS-DRG 301: PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC

Facility IP

$11,688.76

Service Code	MS-DRG 301
Min. Negotiated Rate	$8,197.04
Max. Negotiated Rate	$11,688.76
Rate for Payer: EPIC Health Plan Medicare	$8,197.04
Rate for Payer: Humana Medicare	$8,197.04
Rate for Payer: IEHP Medicare Advantage	$8,197.04
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,672.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,328.27
Rate for Payer: Molina Healthcare of CA Medicare	$10,328.27
Rate for Payer: Multiplan WC	$11,688.76

INPATIENT MS-DRG 302: ATHEROSCLEROSIS WITH MCC

Facility IP

$19,679.29

Service Code	MS-DRG 302
Min. Negotiated Rate	$12,828.47
Max. Negotiated Rate	$19,679.29
Rate for Payer: EPIC Health Plan Medicare	$12,828.47
Rate for Payer: Humana Medicare	$12,828.47
Rate for Payer: IEHP Medicare Advantage	$12,828.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,137.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,163.87
Rate for Payer: Molina Healthcare of CA Medicare	$16,163.87
Rate for Payer: Multiplan WC	$19,679.29

INPATIENT MS-DRG 303: ATHEROSCLEROSIS WITHOUT MCC

Facility IP

$11,034.31

Service Code	MS-DRG 303
Min. Negotiated Rate	$7,614.87
Max. Negotiated Rate	$11,034.31
Rate for Payer: EPIC Health Plan Medicare	$7,614.87
Rate for Payer: Humana Medicare	$7,614.87
Rate for Payer: IEHP Medicare Advantage	$7,614.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,985.55
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,594.74
Rate for Payer: Molina Healthcare of CA Medicare	$9,594.74
Rate for Payer: Multiplan WC	$11,034.31

INPATIENT MS-DRG 304: HYPERTENSION WITH MCC

Facility IP

$17,929.73

Service Code	MS-DRG 304
Min. Negotiated Rate	$13,142.63
Max. Negotiated Rate	$17,929.73
Rate for Payer: EPIC Health Plan Medicare	$13,142.63
Rate for Payer: Humana Medicare	$13,142.63
Rate for Payer: IEHP Medicare Advantage	$13,142.63
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$15,508.30
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,559.71
Rate for Payer: Molina Healthcare of CA Medicare	$16,559.71
Rate for Payer: Multiplan WC	$17,929.73

INPATIENT MS-DRG 305: HYPERTENSION WITHOUT MCC

Facility IP

$12,168.58

Service Code	MS-DRG 305
Min. Negotiated Rate	$8,689.13
Max. Negotiated Rate	$12,168.58
Rate for Payer: EPIC Health Plan Medicare	$8,689.13
Rate for Payer: Humana Medicare	$8,689.13
Rate for Payer: IEHP Medicare Advantage	$8,689.13
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,253.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,948.30
Rate for Payer: Molina Healthcare of CA Medicare	$10,948.30
Rate for Payer: Multiplan WC	$12,168.58

INPATIENT MS-DRG 306: CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC

Facility IP

$24,085.83

Service Code	MS-DRG 306
Min. Negotiated Rate	$17,509.44
Max. Negotiated Rate	$24,085.83
Rate for Payer: EPIC Health Plan Medicare	$17,509.44
Rate for Payer: Humana Medicare	$17,509.44
Rate for Payer: IEHP Medicare Advantage	$17,509.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$20,661.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,061.89
Rate for Payer: Molina Healthcare of CA Medicare	$22,061.89
Rate for Payer: Multiplan WC	$24,085.83

INPATIENT MS-DRG 307: CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC

Facility IP

$14,874.53

Service Code	MS-DRG 307
Min. Negotiated Rate	$10,818.47
Max. Negotiated Rate	$14,874.53
Rate for Payer: EPIC Health Plan Medicare	$10,818.47
Rate for Payer: Humana Medicare	$10,818.47
Rate for Payer: IEHP Medicare Advantage	$10,818.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$12,765.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,631.27
Rate for Payer: Molina Healthcare of CA Medicare	$13,631.27
Rate for Payer: Multiplan WC	$14,874.53

INPATIENT MS-DRG 308: CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC

Facility IP

$19,137.45

Service Code	MS-DRG 308
Min. Negotiated Rate	$13,741.70
Max. Negotiated Rate	$19,137.45
Rate for Payer: EPIC Health Plan Medicare	$13,741.70
Rate for Payer: Humana Medicare	$13,741.70
Rate for Payer: IEHP Medicare Advantage	$13,741.70
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$16,215.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,314.54
Rate for Payer: Molina Healthcare of CA Medicare	$17,314.54
Rate for Payer: Multiplan WC	$19,137.45

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