Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 29.00: SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR 9+ FUS W MCC

Facility

$129,739.72

Service Code	MSDRG 456
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$129,739.72
Rate for Payer: Cigna of CA HMO/PPO	$21,600.00

MS-DRG 29.00: SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR 9+ FUS W/O CC/MCC

Facility

$64,773.79

Service Code	MSDRG 458
Min. Negotiated Rate	$3,928.00
Max. Negotiated Rate	$64,773.79
Rate for Payer: Cigna of CA HMO/PPO	$21,600.00

MS-DRG 29.00: SPINAL FUSION EXCEPT CERVICAL W MCC

Facility

$28,410.00

Service Code	MSDRG 459
Min. Negotiated Rate	$21,600.00
Max. Negotiated Rate	$28,410.00
Rate for Payer: Cigna of CA HMO/PPO	$21,600.00

MS-DRG 29.00: SPINAL FUSION EXCEPT CERVICAL W/O MCC

Facility

$28,410.00

Service Code	MSDRG 460
Min. Negotiated Rate	$21,600.00
Max. Negotiated Rate	$28,410.00
Rate for Payer: Cigna of CA HMO/PPO	$21,600.00

MS-DRG 29.00: VAGINAL DELIVERY W COMPLICATING DIAGNOSES

Facility

$6,829.00

Service Code	MSDRG 774
Min. Negotiated Rate	$4,895.00
Max. Negotiated Rate	$6,829.00
Rate for Payer: Cigna of CA HMO/PPO	$4,895.00

MS-DRG 29.00: VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES

Facility

$6,829.00

Service Code	MSDRG 775
Min. Negotiated Rate	$4,895.00
Max. Negotiated Rate	$6,829.00
Rate for Payer: Cigna of CA HMO/PPO	$4,895.00

MS-DRG 29.00: VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C

Facility

$17,156.53

Service Code	MSDRG 768
Min. Negotiated Rate	$4,895.00
Max. Negotiated Rate	$17,156.53
Rate for Payer: Cigna of CA HMO/PPO	$4,895.00

MS-DRG 29.00: VAGINAL DELIVERY W STERILIZATION &/OR D&C

Facility

$6,829.00

Service Code	MSDRG 767
Min. Negotiated Rate	$4,895.00
Max. Negotiated Rate	$6,829.00
Rate for Payer: Cigna of CA HMO/PPO	$4,895.00

MS-DRG 33.00: ACUTE ISCHEMIC STROKE W USE OF THROMBOLYTIC AGENT W CC

Facility

$27,684.21

Service Code	MSDRG 062
Min. Negotiated Rate	$18,576.00
Max. Negotiated Rate	$27,684.21
Rate for Payer: EPIC Health Plan Commercial	$18,576.00

MS-DRG 33.00: ACUTE ISCHEMIC STROKE W USE OF THROMBOLYTIC AGENT W/O CC/MCC

Facility

$22,257.61

Service Code	MSDRG 063
Min. Negotiated Rate	$16,610.16
Max. Negotiated Rate	$22,257.61
Rate for Payer: EPIC Health Plan Commercial	$18,576.00

MS-DRG 33.00: AICD GENERATOR PROCEDURES

Facility

$70,759.37

Service Code	MSDRG 245
Min. Negotiated Rate	$10,312.00
Max. Negotiated Rate	$70,759.37
Rate for Payer: EPIC Health Plan Commercial	$13,987.00

MS-DRG 33.00: AICD LEAD PROCEDURES

Facility

$56,260.74

Service Code	MSDRG 265
Min. Negotiated Rate	$10,312.00
Max. Negotiated Rate	$56,260.74
Rate for Payer: EPIC Health Plan Commercial	$13,987.00

MS-DRG 33.00: BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W MCC

Facility

$85,509.84

Service Code	MSDRG 461
Min. Negotiated Rate	$9,944.00
Max. Negotiated Rate	$85,509.84
Rate for Payer: EPIC Health Plan Commercial	$24,040.00

MS-DRG 33.00: BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W/O MCC

Facility

$41,547.14

Service Code	MSDRG 462
Min. Negotiated Rate	$9,944.00
Max. Negotiated Rate	$41,547.14
Rate for Payer: EPIC Health Plan Commercial	$24,040.00

MS-DRG 33.00: CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK W MCC

Facility

$13,987.00

Service Code	MSDRG 222
Min. Negotiated Rate	$13,987.00
Max. Negotiated Rate	$13,987.00
Rate for Payer: EPIC Health Plan Commercial	$13,987.00

MS-DRG 33.00: CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK W/O MCC

Facility

$13,987.00

Service Code	MSDRG 223
Min. Negotiated Rate	$11,000.00
Max. Negotiated Rate	$13,987.00
Rate for Payer: EPIC Health Plan Commercial	$13,987.00

MS-DRG 33.00: CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK W MCC

Facility

$13,987.00

Service Code	MSDRG 224
Min. Negotiated Rate	$11,000.00
Max. Negotiated Rate	$13,987.00
Rate for Payer: EPIC Health Plan Commercial	$13,987.00

MS-DRG 33.00: CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK W/O MCC

Facility

$13,987.00

Service Code	MSDRG 225
Min. Negotiated Rate	$11,000.00
Max. Negotiated Rate	$13,987.00
Rate for Payer: EPIC Health Plan Commercial	$13,987.00

MS-DRG 33.00: CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W MCC

Facility

$13,987.00

Service Code	MSDRG 226
Min. Negotiated Rate	$11,000.00
Max. Negotiated Rate	$13,987.00
Rate for Payer: EPIC Health Plan Commercial	$13,987.00

MS-DRG 33.00: CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W/O MCC

Facility

$13,987.00

Service Code	MSDRG 227
Min. Negotiated Rate	$11,000.00
Max. Negotiated Rate	$13,987.00
Rate for Payer: EPIC Health Plan Commercial	$13,987.00

MS-DRG 33.00: CARDIAC PACEMAKER DEVICE REPLACEMENT W MCC

Facility

$48,950.01

Service Code	MSDRG 258
Min. Negotiated Rate	$8,850.00
Max. Negotiated Rate	$48,950.01
Rate for Payer: EPIC Health Plan Commercial	$8,850.00

MS-DRG 33.00: CARDIAC PACEMAKER DEVICE REPLACEMENT W/O MCC

Facility

$31,751.86

Service Code	MSDRG 259
Min. Negotiated Rate	$8,850.00
Max. Negotiated Rate	$31,751.86
Rate for Payer: EPIC Health Plan Commercial	$8,850.00

MS-DRG 33.00: CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W CC

Facility

$29,731.09

Service Code	MSDRG 261
Min. Negotiated Rate	$8,850.00
Max. Negotiated Rate	$29,731.09
Rate for Payer: EPIC Health Plan Commercial	$8,850.00

MS-DRG 33.00: CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W MCC

Facility

$50,649.88

Service Code	MSDRG 260
Min. Negotiated Rate	$8,850.00
Max. Negotiated Rate	$50,649.88
Rate for Payer: EPIC Health Plan Commercial	$8,850.00

MS-DRG 33.00: CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W/O CC/MCC

Facility

$25,729.46

Service Code	MSDRG 262
Min. Negotiated Rate	$8,850.00
Max. Negotiated Rate	$25,729.46
Rate for Payer: EPIC Health Plan Commercial	$8,850.00

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All Charges