Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

OTHER RESPIRATORY AND CHEST PROCEDURES

Facility

$38,669.12

Service Code	APR-DRG 1212
Min. Negotiated Rate	$30,884.42
Max. Negotiated Rate	$38,669.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$30,884.42
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$38,669.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,598.69

OTHER RESPIRATORY AND CHEST PROCEDURES

Facility

$59,837.76

Service Code	APR-DRG 1213
Min. Negotiated Rate	$47,791.48
Max. Negotiated Rate	$59,837.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$47,791.48
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$59,837.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$53,539.05

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

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$47,761.48

Service Code	APR-DRG 1434
Min. Negotiated Rate	$38,146.34
Max. Negotiated Rate	$47,761.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$38,146.34
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$47,761.48
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,733.95

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$15,572.61

Service Code	APR-DRG 1432
Min. Negotiated Rate	$12,437.60
Max. Negotiated Rate	$15,572.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,437.60
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$15,572.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,933.39

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$11,240.99

Service Code	APR-DRG 1431
Min. Negotiated Rate	$8,978.00
Max. Negotiated Rate	$11,240.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,978.00
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$11,240.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,057.73

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$23,311.33

Service Code	APR-DRG 1433
Min. Negotiated Rate	$18,618.39
Max. Negotiated Rate	$23,311.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$18,618.39
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$23,311.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,857.50

OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC

Facility

$111,740.41

Service Code	MSDRG 205
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$111,740.41
Rate for Payer: Aetna of CA HMO/PPO	$55,508.60
Rate for Payer: EPIC Health Plan Commercial	$111,740.41
Rate for Payer: EPIC Health Plan Senior	$74,493.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$67,721.46
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$94,810.04
Rate for Payer: Molina Healthcare of CA Medicare	$90,746.76
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

OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC

Facility

$95,949.27

Service Code	MSDRG 206
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$95,949.27
Rate for Payer: Aetna of CA HMO/PPO	$28,530.39
Rate for Payer: EPIC Health Plan Commercial	$95,949.27
Rate for Payer: EPIC Health Plan Senior	$63,966.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$58,151.07
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$81,411.50
Rate for Payer: Molina Healthcare of CA Medicare	$77,922.43
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

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC

Facility

$111,250.62

Service Code	MSDRG 167
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$111,250.62
Rate for Payer: Aetna of CA HMO/PPO	$54,671.87
Rate for Payer: EPIC Health Plan Commercial	$111,250.62
Rate for Payer: EPIC Health Plan Senior	$74,167.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$67,424.62
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$94,394.47
Rate for Payer: Molina Healthcare of CA Medicare	$90,348.99
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 RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC

Facility

$145,574.43

Service Code	MSDRG 166
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$145,574.43
Rate for Payer: Aetna of CA HMO/PPO	$113,312.11
Rate for Payer: EPIC Health Plan Commercial	$145,574.43
Rate for Payer: EPIC Health Plan Senior	$97,049.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$88,226.93
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$123,517.70
Rate for Payer: Molina Healthcare of CA Medicare	$118,224.09
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 RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$103,496.13

Service Code	MSDRG 168
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$103,496.13
Rate for Payer: Aetna of CA HMO/PPO	$41,423.78
Rate for Payer: EPIC Health Plan Commercial	$103,496.13
Rate for Payer: EPIC Health Plan Senior	$68,997.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$62,724.93
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$87,814.90
Rate for Payer: Molina Healthcare of CA Medicare	$84,051.41
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 SIGNIFICANT HIP AND FEMUR SURGERY

Facility

$40,942.34

Service Code	APR-DRG 3092
Min. Negotiated Rate	$32,700.00
Max. Negotiated Rate	$40,942.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$32,700.00
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$40,942.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$36,632.62

OTHER SIGNIFICANT HIP AND FEMUR SURGERY

Facility

$54,935.12

Service Code	APR-DRG 3093
Min. Negotiated Rate	$43,875.81
Max. Negotiated Rate	$54,935.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$43,875.81
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$54,935.12
Rate for Payer: Molina Healthcare of CA Medi-Cal	$49,152.47

OTHER SIGNIFICANT HIP AND FEMUR SURGERY

Facility

$105,262.07

Service Code	APR-DRG 3094
Min. Negotiated Rate	$84,071.15
Max. Negotiated Rate	$105,262.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$84,071.15
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$105,262.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$94,181.85

OTHER SIGNIFICANT HIP AND FEMUR SURGERY

Facility

$30,585.08

Service Code	APR-DRG 3091
Min. Negotiated Rate	$24,427.82
Max. Negotiated Rate	$30,585.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$24,427.82
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$30,585.08
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,365.60

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS

Facility

$9,579.59

Service Code	APR-DRG 3851
Min. Negotiated Rate	$7,651.07
Max. Negotiated Rate	$9,579.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,651.07
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$9,579.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,571.21

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS

Facility

$13,049.24

Service Code	APR-DRG 3852
Min. Negotiated Rate	$10,422.22
Max. Negotiated Rate	$13,049.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,422.22
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$13,049.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,675.63

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS

Facility

$19,828.10

Service Code	APR-DRG 3853
Min. Negotiated Rate	$15,836.39
Max. Negotiated Rate	$19,828.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$15,836.39
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$19,828.10
Rate for Payer: Molina Healthcare of CA Medi-Cal	$17,740.93

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS

Facility

$44,553.88

Service Code	APR-DRG 3854
Min. Negotiated Rate	$35,584.48
Max. Negotiated Rate	$44,553.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$35,584.48
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$44,553.88
Rate for Payer: Molina Healthcare of CA Medi-Cal	$39,864.00

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC

Facility

$109,912.67

Service Code	MSDRG 580
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$109,912.67
Rate for Payer: Aetna of CA HMO/PPO	$52,386.05
Rate for Payer: EPIC Health Plan Commercial	$109,912.67
Rate for Payer: EPIC Health Plan Senior	$73,275.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$66,613.74
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$93,259.24
Rate for Payer: Molina Healthcare of CA Medicare	$89,262.41
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 SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC

Facility

$136,716.24

Service Code	MSDRG 579
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$136,716.24
Rate for Payer: Aetna of CA HMO/PPO	$98,178.37
Rate for Payer: EPIC Health Plan Commercial	$136,716.24
Rate for Payer: EPIC Health Plan Senior	$91,144.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$82,858.33
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$116,001.66
Rate for Payer: Molina Healthcare of CA Medicare	$111,030.16
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 SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC

Facility

$104,857.17

Service Code	MSDRG 581
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$104,857.17
Rate for Payer: Aetna of CA HMO/PPO	$43,749.02
Rate for Payer: EPIC Health Plan Commercial	$104,857.17
Rate for Payer: EPIC Health Plan Senior	$69,904.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$63,549.80
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$88,969.72
Rate for Payer: Molina Healthcare of CA Medicare	$85,156.73
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

OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES

Facility

$21,772.29

Service Code	APR-DRG 3642
Min. Negotiated Rate	$17,389.18
Max. Negotiated Rate	$21,772.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,389.18
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$21,772.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,480.47

OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES

Facility

$16,140.92

Service Code	APR-DRG 3641
Min. Negotiated Rate	$12,891.50
Max. Negotiated Rate	$16,140.92
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,891.50
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$16,140.92
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,441.87

Know your out-of-pocket cost for care.

All Charges