Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

REPLACEMENT OF TISSUE EXPANDER WITH PERMANENT IMPLANT

Facility

$32,312.00

Service Code	CPT 11970
Hospital Revenue Code	360
Min. Negotiated Rate	$129.48
Max. Negotiated Rate	$32,312.00
Rate for Payer: Aetna of CA HMO/PPO	$32,312.00
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$13,999.05
Rate for Payer: Alpha Care Medical Group Medi-Cal	$10,265.97
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$9,332.70
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$9,104.00
Rate for Payer: Blue Shield of California Commercial	$2,942.61
Rate for Payer: Blue Shield of California Commercial	$4,454.70
Rate for Payer: Dignity Health Commercial/Exchange	$13,999.05
Rate for Payer: Dignity Health Medi-Cal	$10,265.97
Rate for Payer: Dignity Health Medicare Advantage	$9,332.70
Rate for Payer: EPIC Health Plan Commercial	$15,398.95
Rate for Payer: EPIC Health Plan Senior	$10,265.97
Rate for Payer: Heritage Provider Network Commercial/Senior	$15,305.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$129.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$9,332.70
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$146.43
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$13,065.78
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,759.20
Rate for Payer: Molina Healthcare of CA Medicare	$12,505.82
Rate for Payer: Multiplan WC	$14,462.30
Rate for Payer: Prime Health Services WC	$14,314.73
Rate for Payer: United Healthcare All Other HMO	$26,788.00
Rate for Payer: United Healthcare HMO Rider	$16,872.00
Rate for Payer: United Healthcare Select/Navigate/Core	$15,456.00
Rate for Payer: Upland Medical Group Pediatric	$9,332.70
Rate for Payer: Vantage Medical Group Commercial/Exchange	$13,999.05
Rate for Payer: Vantage Medical Group Medi-Cal	$10,265.97
Rate for Payer: Vantage Medical Group Senior	$9,332.70

REPLANTATION, DIGIT, EXCLUDING THUMB (INCLUDES DISTAL TIP TO SUBLIMIS TENDON INSERTION), COMPLETE AMPUTATION

Facility

$32,312.00

Service Code	CPT 20822
Hospital Revenue Code	360
Min. Negotiated Rate	$2,068.15
Max. Negotiated Rate	$32,312.00
Rate for Payer: Aetna of CA HMO/PPO	$32,312.00
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$3,102.22
Rate for Payer: Alpha Care Medical Group Medi-Cal	$2,274.97
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$2,068.15
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$9,759.00
Rate for Payer: Blue Shield of California Commercial	$7,730.00
Rate for Payer: Blue Shield of California Commercial	$11,702.17
Rate for Payer: Dignity Health Commercial/Exchange	$3,102.22
Rate for Payer: Dignity Health Medi-Cal	$2,274.97
Rate for Payer: Dignity Health Medicare Advantage	$2,068.15
Rate for Payer: EPIC Health Plan Commercial	$3,412.45
Rate for Payer: EPIC Health Plan Senior	$2,274.97
Rate for Payer: Heritage Provider Network Commercial/Senior	$3,391.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$3,206.75
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$2,068.15
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$3,626.68
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$2,895.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$2,605.87
Rate for Payer: Molina Healthcare of CA Medicare	$2,771.32
Rate for Payer: Multiplan WC	$3,240.00
Rate for Payer: Prime Health Services WC	$3,206.94
Rate for Payer: United Healthcare All Other HMO	$16,122.00
Rate for Payer: United Healthcare HMO Rider	$10,165.00
Rate for Payer: United Healthcare Select/Navigate/Core	$9,312.00
Rate for Payer: Upland Medical Group Pediatric	$2,068.15
Rate for Payer: Vantage Medical Group Commercial/Exchange	$3,102.22
Rate for Payer: Vantage Medical Group Medi-Cal	$2,274.97
Rate for Payer: Vantage Medical Group Senior	$2,068.15

RESPIRATORY FAILURE

Facility

$48,610.97

Service Code	APR-DRG 1334
Min. Negotiated Rate	$38,824.81
Max. Negotiated Rate	$48,610.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$38,824.81
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$48,610.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,494.02

RESPIRATORY FAILURE

Facility

$12,385.76

Service Code	APR-DRG 1331
Min. Negotiated Rate	$9,892.31
Max. Negotiated Rate	$12,385.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,892.31
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$12,385.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,081.99

RESPIRATORY FAILURE

Facility

$16,475.38

Service Code	APR-DRG 1332
Min. Negotiated Rate	$13,158.62
Max. Negotiated Rate	$16,475.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,158.62
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$16,475.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,741.12

RESPIRATORY FAILURE

Facility

$23,784.47

Service Code	APR-DRG 1333
Min. Negotiated Rate	$18,996.28
Max. Negotiated Rate	$23,784.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$18,996.28
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$23,784.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,280.84

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC

Facility

$96,568.58

Service Code	MSDRG 178
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$96,568.58
Rate for Payer: Aetna of CA HMO/PPO	$29,588.42
Rate for Payer: EPIC Health Plan Commercial	$96,568.58
Rate for Payer: EPIC Health Plan Senior	$64,379.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$58,526.41
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$81,936.97
Rate for Payer: Molina Healthcare of CA Medicare	$78,425.39
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

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC

Facility

$106,979.45

Service Code	MSDRG 177
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$106,979.45
Rate for Payer: Aetna of CA HMO/PPO	$47,374.81
Rate for Payer: EPIC Health Plan Commercial	$106,979.45
Rate for Payer: EPIC Health Plan Senior	$71,319.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$64,836.03
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$90,770.44
Rate for Payer: Molina Healthcare of CA Medicare	$86,880.28
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

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC

Facility

$92,646.97

Service Code	MSDRG 179
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$92,646.97
Rate for Payer: Aetna of CA HMO/PPO	$22,888.58
Rate for Payer: EPIC Health Plan Commercial	$92,646.97
Rate for Payer: EPIC Health Plan Senior	$61,764.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$56,149.68
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$78,609.55
Rate for Payer: Molina Healthcare of CA Medicare	$75,240.57
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

RESPIRATORY MALIGNANCY

Facility

$25,125.01

Service Code	APR-DRG 1363
Min. Negotiated Rate	$20,066.95
Max. Negotiated Rate	$25,125.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$20,066.95
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$25,125.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,480.27

RESPIRATORY MALIGNANCY

Facility

$14,207.59

Service Code	APR-DRG 1361
Min. Negotiated Rate	$11,347.38
Max. Negotiated Rate	$14,207.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,347.38
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$14,207.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,712.06

RESPIRATORY MALIGNANCY

Facility

$49,058.63

Service Code	APR-DRG 1364
Min. Negotiated Rate	$39,182.35
Max. Negotiated Rate	$49,058.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$39,182.35
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$49,058.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,894.56

RESPIRATORY MALIGNANCY

Facility

$18,299.93

Service Code	APR-DRG 1362
Min. Negotiated Rate	$14,615.86
Max. Negotiated Rate	$18,299.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$14,615.86
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$18,299.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,373.62

RESPIRATORY NEOPLASMS WITH CC

Facility

$98,254.33

Service Code	MSDRG 181
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$98,254.33
Rate for Payer: Aetna of CA HMO/PPO	$32,468.44
Rate for Payer: EPIC Health Plan Commercial	$98,254.33
Rate for Payer: EPIC Health Plan Senior	$65,502.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$59,548.08
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$83,367.31
Rate for Payer: Molina Healthcare of CA Medicare	$79,794.43
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

RESPIRATORY NEOPLASMS WITH MCC

Facility

$110,586.98

Service Code	MSDRG 180
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$110,586.98
Rate for Payer: Aetna of CA HMO/PPO	$53,538.06
Rate for Payer: EPIC Health Plan Commercial	$110,586.98
Rate for Payer: EPIC Health Plan Senior	$73,724.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$67,022.41
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$93,831.37
Rate for Payer: Molina Healthcare of CA Medicare	$89,810.03
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

RESPIRATORY NEOPLASMS WITHOUT CC/MCC

Facility

$92,625.67

Service Code	MSDRG 182
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$92,625.67
Rate for Payer: Aetna of CA HMO/PPO	$22,555.10
Rate for Payer: EPIC Health Plan Commercial	$92,625.67
Rate for Payer: EPIC Health Plan Senior	$61,750.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$56,136.77
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$78,591.48
Rate for Payer: Molina Healthcare of CA Medicare	$75,223.27
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

RESPIRATORY SIGNS AND SYMPTOMS

Facility

$93,576.78

Service Code	MSDRG 204
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$93,576.78
Rate for Payer: Aetna of CA HMO/PPO	$24,477.14
Rate for Payer: EPIC Health Plan Commercial	$93,576.78
Rate for Payer: EPIC Health Plan Senior	$62,384.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$56,713.20
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$79,398.48
Rate for Payer: Molina Healthcare of CA Medicare	$75,995.69
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

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$21,519.40

Service Code	APR-DRG 1443
Min. Negotiated Rate	$17,187.21
Max. Negotiated Rate	$21,519.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,187.21
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$21,519.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,254.20

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$10,727.08

Service Code	APR-DRG 1441
Min. Negotiated Rate	$8,567.55
Max. Negotiated Rate	$10,727.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,567.55
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$10,727.08
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,597.91

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$15,249.04

Service Code	APR-DRG 1442
Min. Negotiated Rate	$12,179.17
Max. Negotiated Rate	$15,249.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,179.17
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$15,249.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,643.88

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$44,388.22

Service Code	APR-DRG 1444
Min. Negotiated Rate	$35,452.17
Max. Negotiated Rate	$44,388.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$35,452.17
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$44,388.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$39,715.77

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS

Facility

$128,024.82

Service Code	MSDRG 208
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$128,024.82
Rate for Payer: Aetna of CA HMO/PPO	$83,329.59
Rate for Payer: EPIC Health Plan Commercial	$128,024.82
Rate for Payer: EPIC Health Plan Senior	$85,349.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$77,590.80
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$108,627.12
Rate for Payer: Molina Healthcare of CA Medicare	$103,971.67
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

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS

Facility

$75,032.41

Service Code	APR-DRG 1302
Min. Negotiated Rate	$59,927.20
Max. Negotiated Rate	$75,032.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$59,927.20
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$75,032.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$67,134.26

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS

Facility

$159,396.45

Service Code	APR-DRG 1304
Min. Negotiated Rate	$127,307.43
Max. Negotiated Rate	$159,396.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$127,307.43
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$159,396.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$142,617.88

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS

Facility

$91,953.71

Service Code	APR-DRG 1303
Min. Negotiated Rate	$73,441.98
Max. Negotiated Rate	$91,953.71
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$73,441.98
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$91,953.71
Rate for Payer: Molina Healthcare of CA Medi-Cal	$82,274.37

Know your out-of-pocket cost for care.

All Charges