Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

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

Facility

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

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

Facility

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

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