Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$42,930.04

Service Code	APR-DRG 9502
Min. Negotiated Rate	$34,287.55
Max. Negotiated Rate	$42,930.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$34,287.55
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$42,930.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,411.09

EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$148,776.14

Service Code	APR-DRG 9504
Min. Negotiated Rate	$118,825.15
Max. Negotiated Rate	$148,776.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$118,825.15
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$148,776.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$133,115.49

EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$66,831.44

Service Code	APR-DRG 9503
Min. Negotiated Rate	$53,377.21
Max. Negotiated Rate	$66,831.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$53,377.21
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$66,831.44
Rate for Payer: Molina Healthcare of CA Medi-Cal	$59,796.55

EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$31,846.76

Service Code	APR-DRG 9501
Min. Negotiated Rate	$25,435.50
Max. Negotiated Rate	$31,846.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$25,435.50
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$31,846.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,494.47

EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility

$15,238.15

Service Code	APR-DRG 8432
Min. Negotiated Rate	$12,170.47
Max. Negotiated Rate	$15,238.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,170.47
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$15,238.15
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,634.14

EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility

$56,418.47

Service Code	APR-DRG 8434
Min. Negotiated Rate	$45,060.54
Max. Negotiated Rate	$56,418.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$45,060.54
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$56,418.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$50,479.68

EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility

$29,981.41

Service Code	APR-DRG 8433
Min. Negotiated Rate	$23,945.68
Max. Negotiated Rate	$29,981.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$23,945.68
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$29,981.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,825.47

EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility

$11,591.77

Service Code	APR-DRG 8431
Min. Negotiated Rate	$9,258.16
Max. Negotiated Rate	$11,591.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,258.16
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$11,591.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,371.58

EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT

Facility

$38,530.44

Service Code	APR-DRG 8411
Min. Negotiated Rate	$30,773.66
Max. Negotiated Rate	$38,530.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$30,773.66
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$38,530.44
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,474.61

EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT

Facility

$575,284.39

Service Code	APR-DRG 8414
Min. Negotiated Rate	$459,470.56
Max. Negotiated Rate	$575,284.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$459,470.56
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$575,284.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$514,728.14

EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT

Facility

$134,201.26

Service Code	APR-DRG 8413
Min. Negotiated Rate	$107,184.42
Max. Negotiated Rate	$134,201.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$107,184.42
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$134,201.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$120,074.81

EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT

Facility

$70,056.34

Service Code	APR-DRG 8412
Min. Negotiated Rate	$55,952.90
Max. Negotiated Rate	$70,056.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$55,952.90
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$70,056.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$62,681.99

EXTERNAL HEART ASSIST DEVICES

Facility

$137,752.47

Service Code	APR-DRG 1783
Min. Negotiated Rate	$110,020.72
Max. Negotiated Rate	$137,752.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$110,020.72
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$137,752.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$123,252.21

EXTERNAL HEART ASSIST DEVICES

Facility

$111,047.63

Service Code	APR-DRG 1782
Min. Negotiated Rate	$88,691.99
Max. Negotiated Rate	$111,047.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$88,691.99
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$111,047.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$99,358.40

EXTERNAL HEART ASSIST DEVICES

Facility

$220,210.38

Service Code	APR-DRG 1784
Min. Negotiated Rate	$175,878.55
Max. Negotiated Rate	$220,210.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$175,878.55
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$220,210.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$197,030.34

EXTERNAL HEART ASSIST DEVICES

Facility

$101,884.08

Service Code	APR-DRG 1781
Min. Negotiated Rate	$81,373.21
Max. Negotiated Rate	$101,884.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$81,373.21
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$101,884.08
Rate for Payer: Molina Healthcare of CA Medi-Cal	$91,159.44

EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION); WITHOUT ENDOSCOPIC CYCLOPHOTOCOAGULATION

Facility

$32,312.00

Service Code	CPT 66984
Hospital Revenue Code	360
Min. Negotiated Rate	$337.75
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	$4,452.38
Rate for Payer: Alpha Care Medical Group Medi-Cal	$3,265.07
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$2,968.25
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,924.00
Rate for Payer: Blue Shield of California Commercial	$8,472.51
Rate for Payer: Blue Shield of California Commercial	$5,596.61
Rate for Payer: Dignity Health Commercial/Exchange	$4,452.38
Rate for Payer: Dignity Health Medi-Cal	$3,265.07
Rate for Payer: Dignity Health Medicare Advantage	$2,968.25
Rate for Payer: EPIC Health Plan Commercial	$4,897.61
Rate for Payer: EPIC Health Plan Senior	$3,265.07
Rate for Payer: Heritage Provider Network Commercial/Senior	$4,867.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$337.75
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$2,968.25
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$381.98
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$4,155.55
Rate for Payer: Molina Healthcare of CA Medi-Cal	$3,739.99
Rate for Payer: Molina Healthcare of CA Medicare	$3,977.45
Rate for Payer: Multiplan WC	$4,617.28
Rate for Payer: Prime Health Services WC	$4,570.16
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	$2,968.25
Rate for Payer: Vantage Medical Group Commercial/Exchange	$4,452.38
Rate for Payer: Vantage Medical Group Medi-Cal	$3,265.07
Rate for Payer: Vantage Medical Group Senior	$2,968.25

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$154,986.48

Service Code	APR-DRG 0092
Min. Negotiated Rate	$123,785.25
Max. Negotiated Rate	$154,986.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$123,785.25
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$154,986.48
Rate for Payer: Molina Healthcare of CA Medi-Cal	$138,672.11

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$647,173.34

Service Code	APR-DRG 0094
Min. Negotiated Rate	$516,887.13
Max. Negotiated Rate	$647,173.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$516,887.13
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$647,173.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$579,049.83

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$125,396.62

Service Code	APR-DRG 0091
Min. Negotiated Rate	$100,152.30
Max. Negotiated Rate	$125,396.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$100,152.30
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$125,396.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$112,196.97

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$282,433.35

Service Code	APR-DRG 0093
Min. Negotiated Rate	$225,575.05
Max. Negotiated Rate	$282,433.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$225,575.05
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$282,433.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$252,703.52

EXTRACRANIAL PROCEDURES WITH CC

Facility

$108,042.36

Service Code	MSDRG 038
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$108,042.36
Rate for Payer: Aetna of CA HMO/PPO	$49,190.74
Rate for Payer: EPIC Health Plan Commercial	$108,042.36
Rate for Payer: EPIC Health Plan Senior	$72,028.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$65,480.22
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$91,672.31
Rate for Payer: Molina Healthcare of CA Medicare	$87,743.49
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

EXTRACRANIAL PROCEDURES WITH MCC

Facility

$137,667.35

Service Code	MSDRG 037
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$137,667.35
Rate for Payer: Aetna of CA HMO/PPO	$99,803.30
Rate for Payer: EPIC Health Plan Commercial	$137,667.35
Rate for Payer: EPIC Health Plan Senior	$91,778.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$83,434.76
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$116,808.66
Rate for Payer: Molina Healthcare of CA Medicare	$111,802.58
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

EXTRACRANIAL PROCEDURES WITHOUT CC/MCC

Facility

$100,108.67

Service Code	MSDRG 039
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$100,108.67
Rate for Payer: Aetna of CA HMO/PPO	$35,636.46
Rate for Payer: EPIC Health Plan Commercial	$100,108.67
Rate for Payer: EPIC Health Plan Senior	$66,739.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$60,671.92
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$84,940.69
Rate for Payer: Molina Healthcare of CA Medicare	$81,300.37
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

EXTRAOCULAR PROCEDURES EXCEPT ORBIT

Facility

$106,486.13

Service Code	MSDRG 115
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$106,486.13
Rate for Payer: Aetna of CA HMO/PPO	$46,532.03
Rate for Payer: EPIC Health Plan Commercial	$106,486.13
Rate for Payer: EPIC Health Plan Senior	$70,990.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$64,537.05
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$90,351.87
Rate for Payer: Molina Healthcare of CA Medicare	$86,479.65
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

Know your out-of-pocket cost for care.

All Charges