Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

OTHER O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS

Facility

$19,126.75

Service Code	APR-DRG 6811
Min. Negotiated Rate	$12,080.05
Max. Negotiated Rate	$19,126.75
Rate for Payer: Adventist Health Medi-Cal	$12,080.05
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$14,395.40
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$19,126.75

OTHER O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS

Facility

$25,143.14

Service Code	APR-DRG 6812
Min. Negotiated Rate	$15,879.88
Max. Negotiated Rate	$25,143.14
Rate for Payer: Adventist Health Medi-Cal	$15,879.88
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$18,923.52
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$25,143.14

OTHER O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS

Facility

$81,387.37

Service Code	APR-DRG 6814
Min. Negotiated Rate	$51,402.55
Max. Negotiated Rate	$81,387.37
Rate for Payer: Adventist Health Medi-Cal	$51,402.55
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$61,254.71
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$81,387.37

OTHER O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS

Facility

$39,192.12

Service Code	APR-DRG 6813
Min. Negotiated Rate	$24,752.92
Max. Negotiated Rate	$39,192.12
Rate for Payer: Adventist Health Medi-Cal	$24,752.92
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$29,497.22
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$39,192.12

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$110,905.63

Service Code	MSDRG 958
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$110,905.63
Rate for Payer: Aetna of CA HMO/PPO	$110,905.63
Rate for Payer: Anthem Blue Cross of CA Exchange	$71,640.51
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$100,299.25
Rate for Payer: EPIC Health Plan Commercial	$97,382.85
Rate for Payer: EPIC Health Plan Senior	$64,921.90
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$59,019.91
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$82,627.87
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$79,086.68
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$59,019.91
Rate for Payer: Prime Health Services Medicare	$62,561.10
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 FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$200,548.15

Service Code	MSDRG 957
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$200,548.15
Rate for Payer: Aetna of CA HMO/PPO	$200,548.15
Rate for Payer: Anthem Blue Cross of CA Exchange	$129,545.92
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$181,368.86
Rate for Payer: EPIC Health Plan Commercial	$174,892.76
Rate for Payer: EPIC Health Plan Senior	$116,595.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$105,995.61
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$148,393.85
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$142,034.12
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$105,995.61
Rate for Payer: Prime Health Services Medicare	$112,355.35
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 FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$77,485.77

Service Code	MSDRG 959
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$77,485.77
Rate for Payer: Aetna of CA HMO/PPO	$77,485.77
Rate for Payer: Anthem Blue Cross of CA Exchange	$50,052.64
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$70,075.47
Rate for Payer: EPIC Health Plan Commercial	$68,486.15
Rate for Payer: EPIC Health Plan Senior	$45,657.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$41,506.76
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$58,109.46
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$55,619.06
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$41,506.76
Rate for Payer: Prime Health Services Medicare	$43,997.17
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

$48,924.39

Service Code	MSDRG 803
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$48,924.39
Rate for Payer: Aetna of CA HMO/PPO	$48,924.39
Rate for Payer: Anthem Blue Cross of CA Exchange	$31,603.16
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$44,245.54
Rate for Payer: EPIC Health Plan Commercial	$43,790.39
Rate for Payer: EPIC Health Plan Senior	$29,193.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,539.63
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$37,155.48
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$35,563.10
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$26,539.63
Rate for Payer: Prime Health Services Medicare	$28,132.01
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

$104,857.53

Service Code	MSDRG 802
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$104,857.53
Rate for Payer: Aetna of CA HMO/PPO	$104,857.53
Rate for Payer: Anthem Blue Cross of CA Exchange	$67,733.68
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$94,829.55
Rate for Payer: EPIC Health Plan Commercial	$92,153.31
Rate for Payer: EPIC Health Plan Senior	$61,435.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$55,850.49
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$78,190.69
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$74,839.66
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$55,850.49
Rate for Payer: Prime Health Services Medicare	$59,201.52
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

$35,688.56

Service Code	MSDRG 804
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$35,688.56
Rate for Payer: Aetna of CA HMO/PPO	$35,688.56
Rate for Payer: Anthem Blue Cross of CA Exchange	$23,053.36
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$32,275.51
Rate for Payer: EPIC Health Plan Commercial	$32,345.97
Rate for Payer: EPIC Health Plan Senior	$21,563.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,603.62
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$27,445.07
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$26,268.85
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$19,603.62
Rate for Payer: Prime Health Services Medicare	$20,779.84
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

$48,741.38

Service Code	APR-DRG 0293
Min. Negotiated Rate	$30,784.03
Max. Negotiated Rate	$48,741.38
Rate for Payer: Adventist Health Medi-Cal	$30,784.03
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$36,684.30
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$48,741.38

OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$68,061.50

Service Code	APR-DRG 0294
Min. Negotiated Rate	$42,986.21
Max. Negotiated Rate	$68,061.50
Rate for Payer: Adventist Health Medi-Cal	$42,986.21
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$51,225.23
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$68,061.50

OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$32,708.42

Service Code	APR-DRG 0292
Min. Negotiated Rate	$20,657.95
Max. Negotiated Rate	$32,708.42
Rate for Payer: Adventist Health Medi-Cal	$20,657.95
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$24,617.39
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$32,708.42

OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

Facility

$26,138.15

Service Code	APR-DRG 0291
Min. Negotiated Rate	$16,508.30
Max. Negotiated Rate	$26,138.15
Rate for Payer: Adventist Health Medi-Cal	$16,508.30
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$19,672.40
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$26,138.15

OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES

Facility

$23,537.83

Service Code	APR-DRG 1821
Min. Negotiated Rate	$14,866.00
Max. Negotiated Rate	$23,537.83
Rate for Payer: Adventist Health Medi-Cal	$14,866.00
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$17,715.31
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$23,537.83

OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES

Facility

$29,094.97

Service Code	APR-DRG 1822
Min. Negotiated Rate	$18,375.77
Max. Negotiated Rate	$29,094.97
Rate for Payer: Adventist Health Medi-Cal	$18,375.77
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$21,897.79
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$29,094.97

OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES

Facility

$37,490.12

Service Code	APR-DRG 1823
Min. Negotiated Rate	$23,677.97
Max. Negotiated Rate	$37,490.12
Rate for Payer: Adventist Health Medi-Cal	$23,677.97
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$28,216.25
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$37,490.12

OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES

Facility

$59,722.76

Service Code	APR-DRG 1824
Min. Negotiated Rate	$37,719.64
Max. Negotiated Rate	$59,722.76
Rate for Payer: Adventist Health Medi-Cal	$37,719.64
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$44,949.23
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$59,722.76

OTHER PNEUMONIA

Facility

$7,744.55

Service Code	APR-DRG 1391
Min. Negotiated Rate	$4,891.30
Max. Negotiated Rate	$7,744.55
Rate for Payer: Adventist Health Medi-Cal	$4,891.30
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$5,828.79
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$7,744.55

OTHER PNEUMONIA

Facility

$15,223.26

Service Code	APR-DRG 1393
Min. Negotiated Rate	$9,614.69
Max. Negotiated Rate	$15,223.26
Rate for Payer: Adventist Health Medi-Cal	$9,614.69
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$11,457.50
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$15,223.26

OTHER PNEUMONIA

Facility

$23,759.39

Service Code	APR-DRG 1394
Min. Negotiated Rate	$15,005.93
Max. Negotiated Rate	$23,759.39
Rate for Payer: Adventist Health Medi-Cal	$15,005.93
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$17,882.06
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$23,759.39

OTHER PNEUMONIA

Facility

$10,594.65

Service Code	APR-DRG 1392
Min. Negotiated Rate	$6,691.36
Max. Negotiated Rate	$10,594.65
Rate for Payer: Adventist Health Medi-Cal	$6,691.36
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$7,973.87
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$10,594.65

OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS

Facility

$23,394.81

Service Code	APR-DRG 4052
Min. Negotiated Rate	$14,775.67
Max. Negotiated Rate	$23,394.81
Rate for Payer: Adventist Health Medi-Cal	$14,775.67
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$17,607.68
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$23,394.81

OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS

Facility

$18,818.57

Service Code	APR-DRG 4051
Min. Negotiated Rate	$11,885.41
Max. Negotiated Rate	$18,818.57
Rate for Payer: Adventist Health Medi-Cal	$11,885.41
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$14,163.45
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$18,818.57

OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS

Facility

$34,865.63

Service Code	APR-DRG 4053
Min. Negotiated Rate	$22,020.40
Max. Negotiated Rate	$34,865.63
Rate for Payer: Adventist Health Medi-Cal	$22,020.40
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$26,240.97
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$34,865.63

Know your out-of-pocket cost for care.

All Charges