Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

HIP AND FEMUR FRACTURE REPAIR

Facility

$37,279.63

Service Code	APR-DRG 3082
Min. Negotiated Rate	$29,774.66
Max. Negotiated Rate	$37,279.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$29,774.66
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$37,279.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$33,355.46

HIP AND FEMUR FRACTURE REPAIR

Facility

$46,742.30

Service Code	APR-DRG 3083
Min. Negotiated Rate	$37,332.34
Max. Negotiated Rate	$46,742.30
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$37,332.34
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$46,742.30
Rate for Payer: Molina Healthcare of CA Medi-Cal	$41,822.06

HIP AND FEMUR FRACTURE REPAIR

Facility

$30,014.05

Service Code	APR-DRG 3081
Min. Negotiated Rate	$23,971.75
Max. Negotiated Rate	$30,014.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$23,971.75
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$30,014.05
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,854.68

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC

Facility

$116,416.15

Service Code	MSDRG 481
Min. Negotiated Rate	$21,830.00
Max. Negotiated Rate	$116,416.15
Rate for Payer: Aetna of CA HMO/PPO	$63,496.86
Rate for Payer: EPIC Health Plan Commercial	$116,416.15
Rate for Payer: EPIC Health Plan Senior	$77,610.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$70,555.24
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$98,777.34
Rate for Payer: Molina Healthcare of CA Medicare	$94,544.02
Rate for Payer: United Healthcare All Other Commercial	$74,534.00
Rate for Payer: United Healthcare All Other HMO	$74,534.00
Rate for Payer: United Healthcare HMO Rider	$23,828.00
Rate for Payer: United Healthcare Select/Navigate/Core	$21,830.00

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC

Facility

$130,927.88

Service Code	MSDRG 480
Min. Negotiated Rate	$24,564.00
Max. Negotiated Rate	$130,927.88
Rate for Payer: Aetna of CA HMO/PPO	$88,289.29
Rate for Payer: EPIC Health Plan Commercial	$130,927.88
Rate for Payer: EPIC Health Plan Senior	$87,285.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$79,350.23
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$111,090.32
Rate for Payer: Molina Healthcare of CA Medicare	$106,329.31
Rate for Payer: United Healthcare All Other Commercial	$56,679.00
Rate for Payer: United Healthcare All Other HMO	$56,679.00
Rate for Payer: United Healthcare HMO Rider	$30,970.00
Rate for Payer: United Healthcare Select/Navigate/Core	$28,371.00

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC

Facility

$108,191.42

Service Code	MSDRG 482
Min. Negotiated Rate	$18,472.00
Max. Negotiated Rate	$108,191.42
Rate for Payer: Aetna of CA HMO/PPO	$49,445.40
Rate for Payer: EPIC Health Plan Commercial	$108,191.42
Rate for Payer: EPIC Health Plan Senior	$72,127.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$65,570.56
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$91,798.78
Rate for Payer: Molina Healthcare of CA Medicare	$87,864.55
Rate for Payer: United Healthcare All Other Commercial	$60,760.00
Rate for Payer: United Healthcare All Other HMO	$60,760.00
Rate for Payer: United Healthcare HMO Rider	$20,163.00
Rate for Payer: United Healthcare Select/Navigate/Core	$18,472.00

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC

Facility

$130,180.81

Service Code	MSDRG 521
Min. Negotiated Rate	$52,540.00
Max. Negotiated Rate	$130,180.81
Rate for Payer: Aetna of CA HMO/PPO	$87,012.98
Rate for Payer: EPIC Health Plan Commercial	$130,180.81
Rate for Payer: EPIC Health Plan Senior	$86,787.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$78,897.46
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$110,456.44
Rate for Payer: Molina Healthcare of CA Medicare	$105,722.60
Rate for Payer: United Healthcare All Other Commercial	$59,995.00
Rate for Payer: United Healthcare All Other HMO	$59,995.00
Rate for Payer: United Healthcare HMO Rider	$54,441.00
Rate for Payer: United Healthcare Select/Navigate/Core	$52,540.00

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC

Facility

$116,827.82

Service Code	MSDRG 522
Min. Negotiated Rate	$32,854.00
Max. Negotiated Rate	$116,827.82
Rate for Payer: Aetna of CA HMO/PPO	$64,200.19
Rate for Payer: EPIC Health Plan Commercial	$116,827.82
Rate for Payer: EPIC Health Plan Senior	$77,885.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$70,804.74
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$99,126.64
Rate for Payer: Molina Healthcare of CA Medicare	$94,878.35
Rate for Payer: United Healthcare All Other Commercial	$75,160.00
Rate for Payer: United Healthcare All Other HMO	$75,160.00
Rate for Payer: United Healthcare HMO Rider	$35,860.00
Rate for Payer: United Healthcare Select/Navigate/Core	$32,854.00

HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC

Facility

$187,871.03

Service Code	MSDRG 969
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$187,871.03
Rate for Payer: Aetna of CA HMO/PPO	$185,573.33
Rate for Payer: EPIC Health Plan Commercial	$187,871.03
Rate for Payer: EPIC Health Plan Senior	$125,247.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$113,861.23
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$159,405.72
Rate for Payer: Molina Healthcare of CA Medicare	$152,574.05
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC

Facility

$126,049.82

Service Code	MSDRG 970
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$126,049.82
Rate for Payer: Aetna of CA HMO/PPO	$79,955.42
Rate for Payer: EPIC Health Plan Commercial	$126,049.82
Rate for Payer: EPIC Health Plan Senior	$84,033.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$76,393.83
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$106,951.36
Rate for Payer: Molina Healthcare of CA Medicare	$102,367.73
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

HIV WITH MAJOR HIV RELATED CONDITION

Facility

$52,234.50

Service Code	APR-DRG 8924
Min. Negotiated Rate	$41,718.87
Max. Negotiated Rate	$52,234.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$41,718.87
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$52,234.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,736.13

HIV WITH MAJOR HIV RELATED CONDITION

Facility

$17,119.82

Service Code	APR-DRG 8922
Min. Negotiated Rate	$13,673.33
Max. Negotiated Rate	$17,119.82
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,673.33
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$17,119.82
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,317.73

HIV WITH MAJOR HIV RELATED CONDITION

Facility

$24,407.15

Service Code	APR-DRG 8923
Min. Negotiated Rate	$19,493.61
Max. Negotiated Rate	$24,407.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$19,493.61
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$24,407.15
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,837.98

HIV WITH MAJOR HIV RELATED CONDITION

Facility

$13,636.57

Service Code	APR-DRG 8921
Min. Negotiated Rate	$10,891.31
Max. Negotiated Rate	$13,636.57
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,891.31
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$13,636.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,201.14

HIV WITH MAJOR RELATED CONDITION WITH CC

Facility

$102,229.17

Service Code	MSDRG 975
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$102,229.17
Rate for Payer: Aetna of CA HMO/PPO	$39,259.22
Rate for Payer: EPIC Health Plan Commercial	$102,229.17
Rate for Payer: EPIC Health Plan Senior	$68,152.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$61,957.07
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$86,739.90
Rate for Payer: Molina Healthcare of CA Medicare	$83,022.47
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

HIV WITH MAJOR RELATED CONDITION WITH MCC

Facility

$130,461.19

Service Code	MSDRG 974
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$130,461.19
Rate for Payer: Aetna of CA HMO/PPO	$87,491.98
Rate for Payer: EPIC Health Plan Commercial	$130,461.19
Rate for Payer: EPIC Health Plan Senior	$86,974.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$79,067.39
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$110,694.35
Rate for Payer: Molina Healthcare of CA Medicare	$105,950.30
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC

Facility

$95,267.87

Service Code	MSDRG 976
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$95,267.87
Rate for Payer: Aetna of CA HMO/PPO	$27,117.66
Rate for Payer: EPIC Health Plan Commercial	$95,267.87
Rate for Payer: EPIC Health Plan Senior	$63,511.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$57,738.10
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$80,833.34
Rate for Payer: Molina Healthcare of CA Medicare	$77,369.05
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS

Facility

$15,178.34

Service Code	APR-DRG 8901
Min. Negotiated Rate	$12,122.70
Max. Negotiated Rate	$15,178.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,122.70
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$15,178.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,580.62

HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS

Facility

$33,701.23

Service Code	APR-DRG 8903
Min. Negotiated Rate	$26,916.64
Max. Negotiated Rate	$33,701.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$26,916.64
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$33,701.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,153.73

HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS

Facility

$20,864.09

Service Code	APR-DRG 8902
Min. Negotiated Rate	$16,663.82
Max. Negotiated Rate	$20,864.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16,663.82
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$20,864.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,667.87

HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS

Facility

$82,114.50

Service Code	APR-DRG 8904
Min. Negotiated Rate	$65,583.56
Max. Negotiated Rate	$82,114.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$65,583.56
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$82,114.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$73,470.87

HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS

Facility

$51,624.69

Service Code	APR-DRG 8934
Min. Negotiated Rate	$41,231.83
Max. Negotiated Rate	$51,624.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$41,231.83
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$51,624.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,190.51

HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS

Facility

$14,536.61

Service Code	APR-DRG 8931
Min. Negotiated Rate	$11,610.16
Max. Negotiated Rate	$14,536.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,610.16
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$14,536.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,006.44

HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS

Facility

$18,966.12

Service Code	APR-DRG 8932
Min. Negotiated Rate	$15,147.94
Max. Negotiated Rate	$18,966.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$15,147.94
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$18,966.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,969.69

HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS

Facility

$23,392.90

Service Code	APR-DRG 8933
Min. Negotiated Rate	$18,683.54
Max. Negotiated Rate	$23,392.90
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$18,683.54
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$23,392.90
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,930.49

Know your out-of-pocket cost for care.

All Charges