Loma Linda University Children's Hospital

All Charges

Charge

Type

Price

EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility IP

$22,721.57

Service Code	APR-DRG 9501
Min. Negotiated Rate	$17,429.83
Max. Negotiated Rate	$22,721.57
Rate for Payer: IEHP Medi-Cal	$17,429.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$22,721.57

EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility IP

$46,762.59

Service Code	APR-DRG 9503
Min. Negotiated Rate	$35,871.83
Max. Negotiated Rate	$46,762.59
Rate for Payer: IEHP Medi-Cal	$35,871.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$46,762.59

EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility IP

$85,317.62

Service Code	APR-DRG 9504
Min. Negotiated Rate	$65,447.59
Max. Negotiated Rate	$85,317.62
Rate for Payer: IEHP Medi-Cal	$65,447.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$85,317.62

EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility IP

$31,058.60

Service Code	APR-DRG 8434
Min. Negotiated Rate	$23,825.21
Max. Negotiated Rate	$31,058.60
Rate for Payer: IEHP Medi-Cal	$23,825.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$31,058.60

EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility IP

$15,083.28

Service Code	APR-DRG 8433
Min. Negotiated Rate	$11,570.47
Max. Negotiated Rate	$15,083.28
Rate for Payer: IEHP Medi-Cal	$11,570.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,083.28

EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility IP

$11,130.24

Service Code	APR-DRG 8432
Min. Negotiated Rate	$8,538.06
Max. Negotiated Rate	$11,130.24
Rate for Payer: IEHP Medi-Cal	$8,538.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,130.24

EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility IP

$7,251.67

Service Code	APR-DRG 8431
Min. Negotiated Rate	$5,562.80
Max. Negotiated Rate	$7,251.67
Rate for Payer: IEHP Medi-Cal	$5,562.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$7,251.67

EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT

Facility IP

$24,950.80

Service Code	APR-DRG 8411
Min. Negotiated Rate	$19,139.89
Max. Negotiated Rate	$24,950.80
Rate for Payer: IEHP Medi-Cal	$19,139.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$24,950.80

EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT

Facility IP

$28,400.19

Service Code	APR-DRG 8412
Min. Negotiated Rate	$21,785.94
Max. Negotiated Rate	$28,400.19
Rate for Payer: IEHP Medi-Cal	$21,785.94
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$28,400.19

EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT

Facility IP

$97,011.82

Service Code	APR-DRG 8413
Min. Negotiated Rate	$74,418.27
Max. Negotiated Rate	$97,011.82
Rate for Payer: IEHP Medi-Cal	$74,418.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$97,011.82

EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT

Facility IP

$264,344.85

Service Code	APR-DRG 8414
Min. Negotiated Rate	$202,780.33
Max. Negotiated Rate	$264,344.85
Rate for Payer: IEHP Medi-Cal	$202,780.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$264,344.85

EXTERNAL HEART ASSIST SYSTEMS

Facility IP

$126,360.79

Service Code	APR-DRG 1784
Min. Negotiated Rate	$96,932.03
Max. Negotiated Rate	$126,360.79
Rate for Payer: IEHP Medi-Cal	$96,932.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$126,360.79

EXTERNAL HEART ASSIST SYSTEMS

Facility IP

$77,681.10

Service Code	APR-DRG 1781
Min. Negotiated Rate	$59,589.58
Max. Negotiated Rate	$77,681.10
Rate for Payer: IEHP Medi-Cal	$59,589.58
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$77,681.10

EXTERNAL HEART ASSIST SYSTEMS

Facility IP

$87,094.61

Service Code	APR-DRG 1782
Min. Negotiated Rate	$66,810.74
Max. Negotiated Rate	$87,094.61
Rate for Payer: IEHP Medi-Cal	$66,810.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$87,094.61

EXTERNAL HEART ASSIST SYSTEMS

Facility IP

$93,480.86

Service Code	APR-DRG 1783
Min. Negotiated Rate	$71,709.66
Max. Negotiated Rate	$93,480.86
Rate for Payer: IEHP Medi-Cal	$71,709.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$93,480.86

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility IP

$105,992.60

Service Code	APR-DRG 0093
Min. Negotiated Rate	$81,307.48
Max. Negotiated Rate	$105,992.60
Rate for Payer: IEHP Medi-Cal	$81,307.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$105,992.60

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility IP

$63,445.54

Service Code	APR-DRG 0091
Min. Negotiated Rate	$48,669.41
Max. Negotiated Rate	$63,445.54
Rate for Payer: IEHP Medi-Cal	$48,669.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$63,445.54

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility IP

$229,973.44

Service Code	APR-DRG 0094
Min. Negotiated Rate	$176,413.83
Max. Negotiated Rate	$229,973.44
Rate for Payer: IEHP Medi-Cal	$176,413.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$229,973.44

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility IP

$77,306.90

Service Code	APR-DRG 0092
Min. Negotiated Rate	$59,302.53
Max. Negotiated Rate	$77,306.90
Rate for Payer: IEHP Medi-Cal	$59,302.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$77,306.90

EYE INFECTIONS AND OTHER EYE DISORDERS

Facility IP

$30,021.14

Service Code	APR-DRG 0824
Min. Negotiated Rate	$23,029.37
Max. Negotiated Rate	$30,021.14
Rate for Payer: IEHP Medi-Cal	$23,029.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$30,021.14

EYE INFECTIONS AND OTHER EYE DISORDERS

Facility IP

$10,440.37

Service Code	APR-DRG 0822
Min. Negotiated Rate	$8,008.86
Max. Negotiated Rate	$10,440.37
Rate for Payer: IEHP Medi-Cal	$8,008.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10,440.37

EYE INFECTIONS AND OTHER EYE DISORDERS

Facility IP

$8,496.65

Service Code	APR-DRG 0821
Min. Negotiated Rate	$6,517.82
Max. Negotiated Rate	$8,496.65
Rate for Payer: IEHP Medi-Cal	$6,517.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$8,496.65

EYE INFECTIONS AND OTHER EYE DISORDERS

Facility IP

$15,195.00

Service Code	APR-DRG 0823
Min. Negotiated Rate	$11,656.17
Max. Negotiated Rate	$15,195.00
Rate for Payer: IEHP Medi-Cal	$11,656.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,195.00

EZETIMIBE 10 MG-SIMVASTATIN 20 MG TABLET [39221]

Facility IP

$13.67

Service Code	NDC 66582-312-31
Hospital Charge Code	1710951
Hospital Revenue Code	259
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$11.62
Rate for Payer: Blue Shield of California Commercial	$9.73
Rate for Payer: Blue Shield of California EPN	$7.00
Rate for Payer: Cash Price	$6.15
Rate for Payer: Cigna of CA HMO	$9.57
Rate for Payer: Cigna of CA PPO	$9.57
Rate for Payer: EPIC Health Plan Commercial	$5.47
Rate for Payer: Galaxy Health WC	$11.62
Rate for Payer: Global Benefits Group Commercial	$8.20
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$9.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$5.21
Rate for Payer: LLUH Dept of Risk Management WC	$3.28
Rate for Payer: Multiplan Commercial	$10.94
Rate for Payer: Networks By Design Commercial	$8.89
Rate for Payer: Prime Health Services Commercial	$11.62

EZETIMIBE 10 MG-SIMVASTATIN 20 MG TABLET [39221]

Facility OP

$13.67

Service Code	NDC 66582-312-31
Hospital Charge Code	1710951
Hospital Revenue Code	259
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$11.62
Rate for Payer: Aetna of CA HMO/PPO	$8.97
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$11.62
Rate for Payer: AlphaCare Medical Group Medi-Cal	$7.52
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$7.52
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$8.14
Rate for Payer: BCBS Transplant Transplant	$8.20
Rate for Payer: Blue Shield of California Commercial	$10.07
Rate for Payer: Blue Shield of California EPN	$7.98
Rate for Payer: Cash Price	$6.15
Rate for Payer: Cigna of CA HMO	$9.57
Rate for Payer: Cigna of CA PPO	$9.57
Rate for Payer: Dignity Health Commercial/Exchange	$11.62
Rate for Payer: Dignity Health Media	$11.62
Rate for Payer: Dignity Health Medi-Cal	$11.62
Rate for Payer: EPIC Health Plan Commercial	$5.47
Rate for Payer: EPIC Health Plan Transplant	$5.47
Rate for Payer: Galaxy Health WC	$11.62
Rate for Payer: Global Benefits Group Commercial	$8.20
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other	$10.25
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$9.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$5.21
Rate for Payer: LLUH Dept of Risk Management WC	$3.28
Rate for Payer: Multiplan Commercial	$10.94
Rate for Payer: Networks By Design Commercial	$8.89
Rate for Payer: Prime Health Services Commercial	$11.62
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior	$8.20
Rate for Payer: Temecula Valley Physicians Medical Group Commercial	$8.20
Rate for Payer: TriValley Medical Group Commercial/Senior	$8.20
Rate for Payer: United Healthcare All Other Commercial	$6.84
Rate for Payer: United Healthcare All Other HMO	$6.84
Rate for Payer: United Healthcare HMO Rider	$6.84
Rate for Payer: United Healthcare Select/Navigate/Core	$6.84
Rate for Payer: Vantage Medical Group Commercial/Exchange	$11.62
Rate for Payer: Vantage Medical Group Medi-Cal	$11.62
Rate for Payer: Vantage Medical Group Senior	$11.62

Price Transparency.

All Charges