Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

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

Facility

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

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

Facility

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

$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: Inland Empire Health Plan (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

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