Loma Linda University Medical Center

All Charges

Charge

Type

Price

INPATIENT MS-DRG 309: CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC

Facility IP

$12,038.03

Service Code	MS-DRG 309
Min. Negotiated Rate	$8,590.03
Max. Negotiated Rate	$12,038.03
Rate for Payer: EPIC Health Plan Medicare	$8,590.03
Rate for Payer: Humana Medicare	$8,590.03
Rate for Payer: IEHP Medicare Advantage	$8,590.03
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,136.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,823.44
Rate for Payer: Molina Healthcare of CA Medicare	$10,823.44
Rate for Payer: Multiplan WC	$12,038.03

INPATIENT MS-DRG 310: CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC

Facility IP

$8,995.87

Service Code	MS-DRG 310
Min. Negotiated Rate	$6,431.41
Max. Negotiated Rate	$8,995.87
Rate for Payer: EPIC Health Plan Medicare	$6,431.41
Rate for Payer: Humana Medicare	$6,431.41
Rate for Payer: IEHP Medicare Advantage	$6,431.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$7,589.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,103.58
Rate for Payer: Molina Healthcare of CA Medicare	$8,103.58
Rate for Payer: Multiplan WC	$8,995.87

INPATIENT MS-DRG 311: ANGINA PECTORIS

Facility IP

$10,903.74

Service Code	MS-DRG 311
Min. Negotiated Rate	$8,065.31
Max. Negotiated Rate	$10,903.74
Rate for Payer: EPIC Health Plan Medicare	$8,065.31
Rate for Payer: Humana Medicare	$8,065.31
Rate for Payer: IEHP Medicare Advantage	$8,065.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,517.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,162.29
Rate for Payer: Molina Healthcare of CA Medicare	$10,162.29
Rate for Payer: Multiplan WC	$10,903.74

INPATIENT MS-DRG 312: SYNCOPE AND COLLAPSE

Facility IP

$13,916.51

Service Code	MS-DRG 312
Min. Negotiated Rate	$9,927.79
Max. Negotiated Rate	$13,916.51
Rate for Payer: EPIC Health Plan Medicare	$9,927.79
Rate for Payer: Humana Medicare	$9,927.79
Rate for Payer: IEHP Medicare Advantage	$9,927.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$11,714.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,509.02
Rate for Payer: Molina Healthcare of CA Medicare	$12,509.02
Rate for Payer: Multiplan WC	$13,916.51

INPATIENT MS-DRG 313: CHEST PAIN

Facility IP

$11,806.27

Service Code	MS-DRG 313
Min. Negotiated Rate	$8,352.43
Max. Negotiated Rate	$11,806.27
Rate for Payer: EPIC Health Plan Medicare	$8,352.43
Rate for Payer: Humana Medicare	$8,352.43
Rate for Payer: IEHP Medicare Advantage	$8,352.43
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,855.87
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,524.06
Rate for Payer: Molina Healthcare of CA Medicare	$10,524.06
Rate for Payer: Multiplan WC	$11,806.27

INPATIENT MS-DRG 314: OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC

Facility IP

$33,989.13

Service Code	MS-DRG 314
Min. Negotiated Rate	$23,778.13
Max. Negotiated Rate	$33,989.13
Rate for Payer: EPIC Health Plan Medicare	$23,778.13
Rate for Payer: Humana Medicare	$23,778.13
Rate for Payer: IEHP Medicare Advantage	$23,778.13
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$28,058.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,960.44
Rate for Payer: Molina Healthcare of CA Medicare	$29,960.44
Rate for Payer: Multiplan WC	$33,989.13

INPATIENT MS-DRG 315: OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC

Facility IP

$15,806.43

Service Code	MS-DRG 315
Min. Negotiated Rate	$11,096.60
Max. Negotiated Rate	$15,806.43
Rate for Payer: EPIC Health Plan Medicare	$11,096.60
Rate for Payer: Humana Medicare	$11,096.60
Rate for Payer: IEHP Medicare Advantage	$11,096.60
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$13,093.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,981.72
Rate for Payer: Molina Healthcare of CA Medicare	$13,981.72
Rate for Payer: Multiplan WC	$15,806.43

INPATIENT MS-DRG 316: OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility IP

$11,130.60

Service Code	MS-DRG 316
Min. Negotiated Rate	$8,004.49
Max. Negotiated Rate	$11,130.60
Rate for Payer: EPIC Health Plan Medicare	$8,004.49
Rate for Payer: Humana Medicare	$8,004.49
Rate for Payer: IEHP Medicare Advantage	$8,004.49
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$9,445.30
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,085.66
Rate for Payer: Molina Healthcare of CA Medicare	$10,085.66
Rate for Payer: Multiplan WC	$11,130.60

INPATIENT MS-DRG 319: OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC

Facility IP

$70,285.98

Service Code	MS-DRG 319
Min. Negotiated Rate	$49,321.34
Max. Negotiated Rate	$70,285.98
Rate for Payer: EPIC Health Plan Medicare	$49,321.34
Rate for Payer: Humana Medicare	$49,321.34
Rate for Payer: IEHP Medicare Advantage	$49,321.34
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$58,199.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$62,144.89
Rate for Payer: Molina Healthcare of CA Medicare	$62,144.89
Rate for Payer: Multiplan WC	$70,285.98

INPATIENT MS-DRG 320: OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC

Facility IP

$40,334.56

Service Code	MS-DRG 320
Min. Negotiated Rate	$25,270.14
Max. Negotiated Rate	$40,334.56
Rate for Payer: EPIC Health Plan Medicare	$25,270.14
Rate for Payer: Humana Medicare	$25,270.14
Rate for Payer: IEHP Medicare Advantage	$25,270.14
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,818.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,840.38
Rate for Payer: Molina Healthcare of CA Medicare	$31,840.38
Rate for Payer: Multiplan WC	$40,334.56

INPATIENT MS-DRG 321: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES

Facility IP

$41,044.25

Service Code	MS-DRG 321
Min. Negotiated Rate	$32,574.80
Max. Negotiated Rate	$41,044.25
Rate for Payer: EPIC Health Plan Medicare	$32,574.80
Rate for Payer: Humana Medicare	$32,574.80
Rate for Payer: IEHP Medicare Advantage	$32,574.80
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$38,438.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$41,044.25
Rate for Payer: Molina Healthcare of CA Medicare	$41,044.25

INPATIENT MS-DRG 322: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC

Facility IP

$26,128.23

Service Code	MS-DRG 322
Min. Negotiated Rate	$20,736.69
Max. Negotiated Rate	$26,128.23
Rate for Payer: EPIC Health Plan Medicare	$20,736.69
Rate for Payer: Humana Medicare	$20,736.69
Rate for Payer: IEHP Medicare Advantage	$20,736.69
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$24,469.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,128.23
Rate for Payer: Molina Healthcare of CA Medicare	$26,128.23

INPATIENT MS-DRG 323: CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC

Facility IP

$58,996.54

Service Code	MS-DRG 323
Min. Negotiated Rate	$46,822.65
Max. Negotiated Rate	$58,996.54
Rate for Payer: EPIC Health Plan Medicare	$46,822.65
Rate for Payer: Humana Medicare	$46,822.65
Rate for Payer: IEHP Medicare Advantage	$46,822.65
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$55,250.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$58,996.54
Rate for Payer: Molina Healthcare of CA Medicare	$58,996.54

INPATIENT MS-DRG 324: CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC

Facility IP

$42,376.52

Service Code	MS-DRG 324
Min. Negotiated Rate	$33,632.16
Max. Negotiated Rate	$42,376.52
Rate for Payer: EPIC Health Plan Medicare	$33,632.16
Rate for Payer: Humana Medicare	$33,632.16
Rate for Payer: IEHP Medicare Advantage	$33,632.16
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$39,685.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,376.52
Rate for Payer: Molina Healthcare of CA Medicare	$42,376.52

INPATIENT MS-DRG 325: CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE

Facility IP

$37,775.30

Service Code	MS-DRG 325
Min. Negotiated Rate	$29,980.40
Max. Negotiated Rate	$37,775.30
Rate for Payer: EPIC Health Plan Medicare	$29,980.40
Rate for Payer: Humana Medicare	$29,980.40
Rate for Payer: IEHP Medicare Advantage	$29,980.40
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,376.87
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,775.30
Rate for Payer: Molina Healthcare of CA Medicare	$37,775.30

INPATIENT MS-DRG 326: STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC

Facility IP

$83,541.52

Service Code	MS-DRG 326
Min. Negotiated Rate	$57,396.20
Max. Negotiated Rate	$83,541.52
Rate for Payer: EPIC Health Plan Medicare	$57,396.20
Rate for Payer: Humana Medicare	$57,396.20
Rate for Payer: IEHP Medicare Advantage	$57,396.20
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$67,727.52
Rate for Payer: Molina Healthcare of CA Medi-Cal	$72,319.21
Rate for Payer: Molina Healthcare of CA Medicare	$72,319.21
Rate for Payer: Multiplan WC	$83,541.52

INPATIENT MS-DRG 327: STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC

Facility IP

$41,801.77

Service Code	MS-DRG 327
Min. Negotiated Rate	$28,326.23
Max. Negotiated Rate	$41,801.77
Rate for Payer: EPIC Health Plan Medicare	$28,326.23
Rate for Payer: Humana Medicare	$28,326.23
Rate for Payer: IEHP Medicare Advantage	$28,326.23
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$33,424.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,691.05
Rate for Payer: Molina Healthcare of CA Medicare	$35,691.05
Rate for Payer: Multiplan WC	$41,801.77

INPATIENT MS-DRG 328: STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC

Facility IP

$27,054.54

Service Code	MS-DRG 328
Min. Negotiated Rate	$18,190.69
Max. Negotiated Rate	$27,054.54
Rate for Payer: EPIC Health Plan Medicare	$18,190.69
Rate for Payer: Humana Medicare	$18,190.69
Rate for Payer: IEHP Medicare Advantage	$18,190.69
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,465.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,920.27
Rate for Payer: Molina Healthcare of CA Medicare	$22,920.27
Rate for Payer: Multiplan WC	$27,054.54

INPATIENT MS-DRG 329: MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC

Facility IP

$75,454.70

Service Code	MS-DRG 329
Min. Negotiated Rate	$51,065.59
Max. Negotiated Rate	$75,454.70
Rate for Payer: EPIC Health Plan Medicare	$51,065.59
Rate for Payer: Humana Medicare	$51,065.59
Rate for Payer: IEHP Medicare Advantage	$51,065.59
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$60,257.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$64,342.64
Rate for Payer: Molina Healthcare of CA Medicare	$64,342.64
Rate for Payer: Multiplan WC	$75,454.70

INPATIENT MS-DRG 330: MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC

Facility IP

$40,073.42

Service Code	MS-DRG 330
Min. Negotiated Rate	$26,915.30
Max. Negotiated Rate	$40,073.42
Rate for Payer: EPIC Health Plan Medicare	$26,915.30
Rate for Payer: Humana Medicare	$26,915.30
Rate for Payer: IEHP Medicare Advantage	$26,915.30
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,760.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$33,913.28
Rate for Payer: Molina Healthcare of CA Medicare	$33,913.28
Rate for Payer: Multiplan WC	$40,073.42

INPATIENT MS-DRG 331: MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC

Facility IP

$27,888.52

Service Code	MS-DRG 331
Min. Negotiated Rate	$19,031.86
Max. Negotiated Rate	$27,888.52
Rate for Payer: EPIC Health Plan Medicare	$19,031.86
Rate for Payer: Humana Medicare	$19,031.86
Rate for Payer: IEHP Medicare Advantage	$19,031.86
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$22,457.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,980.14
Rate for Payer: Molina Healthcare of CA Medicare	$23,980.14
Rate for Payer: Multiplan WC	$27,888.52

INPATIENT MS-DRG 332: RECTAL RESECTION WITH MCC

Facility IP

$66,266.24

Service Code	MS-DRG 332
Min. Negotiated Rate	$41,353.44
Max. Negotiated Rate	$66,266.24
Rate for Payer: EPIC Health Plan Medicare	$41,353.44
Rate for Payer: Humana Medicare	$41,353.44
Rate for Payer: IEHP Medicare Advantage	$41,353.44
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$48,797.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$52,105.33
Rate for Payer: Molina Healthcare of CA Medicare	$52,105.33
Rate for Payer: Multiplan WC	$66,266.24

INPATIENT MS-DRG 333: RECTAL RESECTION WITH CC

Facility IP

$36,445.37

Service Code	MS-DRG 333
Min. Negotiated Rate	$23,620.49
Max. Negotiated Rate	$36,445.37
Rate for Payer: EPIC Health Plan Medicare	$23,620.49
Rate for Payer: Humana Medicare	$23,620.49
Rate for Payer: IEHP Medicare Advantage	$23,620.49
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,872.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,761.82
Rate for Payer: Molina Healthcare of CA Medicare	$29,761.82
Rate for Payer: Multiplan WC	$36,445.37

INPATIENT MS-DRG 334: RECTAL RESECTION WITHOUT CC/MCC

Facility IP

$27,981.55

Service Code	MS-DRG 334
Min. Negotiated Rate	$18,278.53
Max. Negotiated Rate	$27,981.55
Rate for Payer: EPIC Health Plan Medicare	$18,278.53
Rate for Payer: Humana Medicare	$18,278.53
Rate for Payer: IEHP Medicare Advantage	$18,278.53
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$21,568.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,030.95
Rate for Payer: Molina Healthcare of CA Medicare	$23,030.95
Rate for Payer: Multiplan WC	$27,981.55

INPATIENT MS-DRG 335: PERITONEAL ADHESIOLYSIS WITH MCC

Facility IP

$60,121.56

Service Code	MS-DRG 335
Min. Negotiated Rate	$40,460.48
Max. Negotiated Rate	$60,121.56
Rate for Payer: EPIC Health Plan Medicare	$40,460.48
Rate for Payer: Humana Medicare	$40,460.48
Rate for Payer: IEHP Medicare Advantage	$40,460.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$47,743.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$50,980.20
Rate for Payer: Molina Healthcare of CA Medicare	$50,980.20
Rate for Payer: Multiplan WC	$60,121.56

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