Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$131,492.15

Service Code	MSDRG 959
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$131,492.15
Rate for Payer: Aetna of CA HMO/PPO	$89,253.34
Rate for Payer: EPIC Health Plan Commercial	$131,492.15
Rate for Payer: EPIC Health Plan Senior	$87,661.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$79,692.21
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$111,569.09
Rate for Payer: Molina Healthcare of CA Medicare	$106,787.56
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

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC

Facility

$112,235.48

Service Code	MSDRG 803
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$112,235.48
Rate for Payer: Aetna of CA HMO/PPO	$56,354.41
Rate for Payer: EPIC Health Plan Commercial	$112,235.48
Rate for Payer: EPIC Health Plan Senior	$74,823.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$68,021.50
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$95,230.10
Rate for Payer: Molina Healthcare of CA Medicare	$91,148.81
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

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC

Facility

$149,946.75

Service Code	MSDRG 802
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$149,946.75
Rate for Payer: Aetna of CA HMO/PPO	$120,781.98
Rate for Payer: EPIC Health Plan Commercial	$149,946.75
Rate for Payer: EPIC Health Plan Senior	$99,964.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$90,876.82
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$127,227.55
Rate for Payer: Molina Healthcare of CA Medicare	$121,774.94
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

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC

Facility

$103,311.60

Service Code	MSDRG 804
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$103,311.60
Rate for Payer: Aetna of CA HMO/PPO	$41,108.50
Rate for Payer: EPIC Health Plan Commercial	$103,311.60
Rate for Payer: EPIC Health Plan Senior	$68,874.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$62,613.09
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$87,658.33
Rate for Payer: Molina Healthcare of CA Medicare	$83,901.54
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

OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$119,107.62

Service Code	APR-DRG 0294
Min. Negotiated Rate	$95,129.37
Max. Negotiated Rate	$119,107.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$95,129.37
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$119,107.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$106,569.97

OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$35,286.50

Service Code	APR-DRG 0291
Min. Negotiated Rate	$28,182.77
Max. Negotiated Rate	$35,286.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$28,182.77
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$35,286.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,572.13

OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$65,800.88

Service Code	APR-DRG 0293
Min. Negotiated Rate	$52,554.12
Max. Negotiated Rate	$65,800.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$52,554.12
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$65,800.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$58,874.47

OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$44,156.38

Service Code	APR-DRG 0292
Min. Negotiated Rate	$35,267.00
Max. Negotiated Rate	$44,156.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$35,267.00
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$44,156.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$39,508.34

OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES

Facility

$31,776.06

Service Code	APR-DRG 1821
Min. Negotiated Rate	$25,379.03
Max. Negotiated Rate	$31,776.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$25,379.03
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$31,776.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,431.21

OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES

Facility

$104,514.80

Service Code	APR-DRG 1824
Min. Negotiated Rate	$83,474.32
Max. Negotiated Rate	$104,514.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$83,474.32
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$104,514.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$93,513.24

OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES

Facility

$39,278.22

Service Code	APR-DRG 1822
Min. Negotiated Rate	$31,370.90
Max. Negotiated Rate	$39,278.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$31,370.90
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$39,278.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,143.68

OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES

Facility

$50,611.67

Service Code	APR-DRG 1823
Min. Negotiated Rate	$40,422.74
Max. Negotiated Rate	$50,611.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$40,422.74
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$50,611.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$45,284.12

OTHER PNEUMONIA

Facility

$14,302.76

Service Code	APR-DRG 1392
Min. Negotiated Rate	$11,423.39
Max. Negotiated Rate	$14,302.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,423.39
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$14,302.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,797.21

OTHER PNEUMONIA

Facility

$20,551.39

Service Code	APR-DRG 1393
Min. Negotiated Rate	$16,414.07
Max. Negotiated Rate	$20,551.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16,414.07
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$20,551.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,388.08

OTHER PNEUMONIA

Facility

$41,578.92

Service Code	APR-DRG 1394
Min. Negotiated Rate	$33,208.42
Max. Negotiated Rate	$41,578.92
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$33,208.42
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$41,578.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,202.19

OTHER PNEUMONIA

Facility

$10,455.15

Service Code	APR-DRG 1391
Min. Negotiated Rate	$8,350.36
Max. Negotiated Rate	$10,455.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,350.36
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$10,455.15
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,354.61

OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS

Facility

$31,583.00

Service Code	APR-DRG 4052
Min. Negotiated Rate	$25,224.84
Max. Negotiated Rate	$31,583.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$25,224.84
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$31,583.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,258.47

OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS

Facility

$47,068.61

Service Code	APR-DRG 4053
Min. Negotiated Rate	$37,592.95
Max. Negotiated Rate	$47,068.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$37,592.95
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$47,068.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,114.01

OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS

Facility

$25,405.07

Service Code	APR-DRG 4051
Min. Negotiated Rate	$20,290.63
Max. Negotiated Rate	$25,405.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$20,290.63
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$25,405.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,730.85

OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS

Facility

$122,131.92

Service Code	APR-DRG 4054
Min. Negotiated Rate	$97,544.84
Max. Negotiated Rate	$122,131.92
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$97,544.84
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$122,131.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$109,275.93

OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$128,092.41

Service Code	APR-DRG 6514
Min. Negotiated Rate	$102,305.39
Max. Negotiated Rate	$128,092.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$102,305.39
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$128,092.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$114,609.00

OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$35,259.31

Service Code	APR-DRG 6512
Min. Negotiated Rate	$28,161.05
Max. Negotiated Rate	$35,259.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$28,161.05
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$35,259.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,547.80

OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$24,344.60

Service Code	APR-DRG 6511
Min. Negotiated Rate	$19,443.65
Max. Negotiated Rate	$24,344.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$19,443.65
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$24,344.60
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,782.01

OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$46,611.79

Service Code	APR-DRG 6513
Min. Negotiated Rate	$37,228.10
Max. Negotiated Rate	$46,611.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$37,228.10
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$46,611.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$41,705.28

OTHER RESPIRATORY AND CHEST PROCEDURES

Facility

$126,481.56

Service Code	APR-DRG 1214
Min. Negotiated Rate	$101,018.82
Max. Negotiated Rate	$126,481.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$101,018.82
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$126,481.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$113,167.71

Know your out-of-pocket cost for care.

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