Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS

Facility

$69,789.66

Service Code	APR-DRG 4054
Min. Negotiated Rate	$44,077.68
Max. Negotiated Rate	$69,789.66
Rate for Payer: Adventist Health Medi-Cal	$44,077.68
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$52,525.90
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$69,789.66

OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$18,033.05

Service Code	APR-DRG 6511
Min. Negotiated Rate	$11,389.30
Max. Negotiated Rate	$18,033.05
Rate for Payer: Adventist Health Medi-Cal	$11,389.30
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$13,572.24
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$18,033.05

OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$34,527.24

Service Code	APR-DRG 6513
Min. Negotiated Rate	$21,806.68
Max. Negotiated Rate	$34,527.24
Rate for Payer: Adventist Health Medi-Cal	$21,806.68
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$25,986.29
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$34,527.24

OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$73,195.66

Service Code	APR-DRG 6514
Min. Negotiated Rate	$46,228.84
Max. Negotiated Rate	$73,195.66
Rate for Payer: Adventist Health Medi-Cal	$46,228.84
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$55,089.36
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$73,195.66

OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$26,118.01

Service Code	APR-DRG 6512
Min. Negotiated Rate	$16,495.58
Max. Negotiated Rate	$26,118.01
Rate for Payer: Adventist Health Medi-Cal	$16,495.58
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$19,657.24
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$26,118.01

OTHER RESPIRATORY AND CHEST PROCEDURES

Facility

$44,324.26

Service Code	APR-DRG 1213
Min. Negotiated Rate	$27,994.27
Max. Negotiated Rate	$44,324.26
Rate for Payer: Adventist Health Medi-Cal	$27,994.27
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$33,359.84
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$44,324.26

OTHER RESPIRATORY AND CHEST PROCEDURES

Facility

$72,275.18

Service Code	APR-DRG 1214
Min. Negotiated Rate	$45,647.48
Max. Negotiated Rate	$72,275.18
Rate for Payer: Adventist Health Medi-Cal	$45,647.48
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$54,396.59
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$72,275.18

OTHER RESPIRATORY AND CHEST PROCEDURES

Facility

$28,643.79

Service Code	APR-DRG 1212
Min. Negotiated Rate	$18,090.82
Max. Negotiated Rate	$28,643.79
Rate for Payer: Adventist Health Medi-Cal	$18,090.82
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$21,558.22
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$28,643.79

OTHER RESPIRATORY AND CHEST PROCEDURES

Facility

$22,055.39

Service Code	APR-DRG 1211
Min. Negotiated Rate	$13,929.72
Max. Negotiated Rate	$22,055.39
Rate for Payer: Adventist Health Medi-Cal	$13,929.72
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$16,599.58
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$22,055.39

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$8,326.66

Service Code	APR-DRG 1431
Min. Negotiated Rate	$5,258.94
Max. Negotiated Rate	$8,326.66
Rate for Payer: Adventist Health Medi-Cal	$5,258.94
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$6,266.90
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$8,326.66

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$27,292.28

Service Code	APR-DRG 1434
Min. Negotiated Rate	$17,237.23
Max. Negotiated Rate	$27,292.28
Rate for Payer: Adventist Health Medi-Cal	$17,237.23
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$20,541.03
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$27,292.28

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$11,535.26

Service Code	APR-DRG 1432
Min. Negotiated Rate	$7,285.43
Max. Negotiated Rate	$11,535.26
Rate for Payer: Adventist Health Medi-Cal	$7,285.43
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$8,681.80
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$11,535.26

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$17,267.66

Service Code	APR-DRG 1433
Min. Negotiated Rate	$10,905.89
Max. Negotiated Rate	$17,267.66
Rate for Payer: Adventist Health Medi-Cal	$10,905.89
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$12,996.18
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$17,267.66

OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC

Facility

$48,190.09

Service Code	MSDRG 205
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$48,190.09
Rate for Payer: Aetna of CA HMO/PPO	$48,190.09
Rate for Payer: Anthem Blue Cross of CA Exchange	$31,128.83
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$43,581.46
Rate for Payer: EPIC Health Plan Commercial	$43,155.49
Rate for Payer: EPIC Health Plan Senior	$28,770.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,154.84
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$36,616.78
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$35,047.49
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$26,154.84
Rate for Payer: Prime Health Services Medicare	$27,724.13
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

$24,768.81

Service Code	MSDRG 206
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$24,768.81
Rate for Payer: Aetna of CA HMO/PPO	$24,768.81
Rate for Payer: Anthem Blue Cross of CA Exchange	$15,999.64
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$22,400.06
Rate for Payer: EPIC Health Plan Commercial	$22,904.13
Rate for Payer: EPIC Health Plan Senior	$15,269.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,881.29
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$19,433.81
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$18,600.93
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$13,881.29
Rate for Payer: Prime Health Services Medicare	$14,714.17
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

$47,463.68

Service Code	MSDRG 167
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$47,463.68
Rate for Payer: Aetna of CA HMO/PPO	$47,463.68
Rate for Payer: Anthem Blue Cross of CA Exchange	$30,659.60
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$42,924.53
Rate for Payer: EPIC Health Plan Commercial	$42,527.36
Rate for Payer: EPIC Health Plan Senior	$28,351.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,774.16
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$36,083.82
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$34,537.37
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$25,774.16
Rate for Payer: Prime Health Services Medicare	$27,320.61
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

$98,372.53

Service Code	MSDRG 166
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$98,372.53
Rate for Payer: Aetna of CA HMO/PPO	$98,372.53
Rate for Payer: Anthem Blue Cross of CA Exchange	$63,544.64
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$88,964.74
Rate for Payer: EPIC Health Plan Commercial	$86,546.03
Rate for Payer: EPIC Health Plan Senior	$57,697.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$52,452.14
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$73,433.00
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$70,285.87
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$52,452.14
Rate for Payer: Prime Health Services Medicare	$55,599.27
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

$35,962.28

Service Code	MSDRG 168
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$35,962.28
Rate for Payer: Aetna of CA HMO/PPO	$35,962.28
Rate for Payer: Anthem Blue Cross of CA Exchange	$23,230.17
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$32,523.05
Rate for Payer: EPIC Health Plan Commercial	$32,582.67
Rate for Payer: EPIC Health Plan Senior	$21,721.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,747.07
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$27,645.90
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$26,461.07
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$19,747.07
Rate for Payer: Prime Health Services Medicare	$20,931.89
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

$60,149.76

Service Code	APR-DRG 3094
Min. Negotiated Rate	$37,989.32
Max. Negotiated Rate	$60,149.76
Rate for Payer: Adventist Health Medi-Cal	$37,989.32
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$45,270.61
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$60,149.76

OTHER SIGNIFICANT HIP AND FEMUR SURGERY

Facility

$40,692.68

Service Code	APR-DRG 3093
Min. Negotiated Rate	$25,700.64
Max. Negotiated Rate	$40,692.68
Rate for Payer: Adventist Health Medi-Cal	$25,700.64
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$30,626.60
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$40,692.68

OTHER SIGNIFICANT HIP AND FEMUR SURGERY

Facility

$30,327.67

Service Code	APR-DRG 3092
Min. Negotiated Rate	$19,154.32
Max. Negotiated Rate	$30,327.67
Rate for Payer: Adventist Health Medi-Cal	$19,154.32
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$22,825.56
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$30,327.67

OTHER SIGNIFICANT HIP AND FEMUR SURGERY

Facility

$22,655.60

Service Code	APR-DRG 3091
Min. Negotiated Rate	$14,308.80
Max. Negotiated Rate	$22,655.60
Rate for Payer: Adventist Health Medi-Cal	$14,308.80
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$17,051.32
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$22,655.60

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS

Facility

$14,687.48

Service Code	APR-DRG 3853
Min. Negotiated Rate	$9,276.30
Max. Negotiated Rate	$14,687.48
Rate for Payer: Adventist Health Medi-Cal	$9,276.30
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$11,054.26
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$14,687.48

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS

Facility

$9,666.10

Service Code	APR-DRG 3852
Min. Negotiated Rate	$6,104.90
Max. Negotiated Rate	$9,666.10
Rate for Payer: Adventist Health Medi-Cal	$6,104.90
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$7,275.01
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$9,666.10

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS

Facility

$25,459.35

Service Code	APR-DRG 3854
Min. Negotiated Rate	$16,079.59
Max. Negotiated Rate	$25,459.35
Rate for Payer: Adventist Health Medi-Cal	$16,079.59
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$19,161.51
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$25,459.35

Know your out-of-pocket cost for care.

All Charges