Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$6,277.79

Service Code	APR-DRG 1432
Min. Negotiated Rate	$6,277.79
Max. Negotiated Rate	$6,277.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,277.79

OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$8,981.92

Service Code	APR-DRG 1433
Min. Negotiated Rate	$8,981.92
Max. Negotiated Rate	$8,981.92
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,981.92

OTHER SIGNIFICANT HIP AND FEMUR SURGERY

Facility

$12,039.24

Service Code	APR-DRG 3091
Min. Negotiated Rate	$12,039.24
Max. Negotiated Rate	$12,039.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,039.24

OTHER SIGNIFICANT HIP AND FEMUR SURGERY

Facility

$36,426.13

Service Code	APR-DRG 3094
Min. Negotiated Rate	$36,426.13
Max. Negotiated Rate	$36,426.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$36,426.13

OTHER SIGNIFICANT HIP AND FEMUR SURGERY

Facility

$22,772.18

Service Code	APR-DRG 3093
Min. Negotiated Rate	$22,772.18
Max. Negotiated Rate	$22,772.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$22,772.18

OTHER SIGNIFICANT HIP AND FEMUR SURGERY

Facility

$16,011.85

Service Code	APR-DRG 3092
Min. Negotiated Rate	$16,011.85
Max. Negotiated Rate	$16,011.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16,011.85

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS

Facility

$7,675.62

Service Code	APR-DRG 3853
Min. Negotiated Rate	$7,675.62
Max. Negotiated Rate	$7,675.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,675.62

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS

Facility

$4,943.64

Service Code	APR-DRG 3852
Min. Negotiated Rate	$4,943.64
Max. Negotiated Rate	$4,943.64
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$4,943.64

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS

Facility

$15,399.00

Service Code	APR-DRG 3854
Min. Negotiated Rate	$15,399.00
Max. Negotiated Rate	$15,399.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$15,399.00

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DISORDERS

Facility

$3,747.77

Service Code	APR-DRG 3851
Min. Negotiated Rate	$3,747.77
Max. Negotiated Rate	$3,747.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$3,747.77

OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES

Facility

$26,131.94

Service Code	APR-DRG 3644
Min. Negotiated Rate	$26,131.94
Max. Negotiated Rate	$26,131.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$26,131.94

OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES

Facility

$9,155.03

Service Code	APR-DRG 3642
Min. Negotiated Rate	$9,155.03
Max. Negotiated Rate	$9,155.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,155.03

OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES

Facility

$6,626.01

Service Code	APR-DRG 3641
Min. Negotiated Rate	$6,626.01
Max. Negotiated Rate	$6,626.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,626.01

OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES

Facility

$14,619.99

Service Code	APR-DRG 3643
Min. Negotiated Rate	$14,619.99
Max. Negotiated Rate	$14,619.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$14,619.99

OTHER SMALL AND LARGE BOWEL PROCEDURES

Facility

$19,470.11

Service Code	APR-DRG 2233
Min. Negotiated Rate	$19,470.11
Max. Negotiated Rate	$19,470.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$19,470.11

OTHER SMALL AND LARGE BOWEL PROCEDURES

Facility

$13,852.93

Service Code	APR-DRG 2232
Min. Negotiated Rate	$13,852.93
Max. Negotiated Rate	$13,852.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,852.93

OTHER SMALL AND LARGE BOWEL PROCEDURES

Facility

$9,157.02

Service Code	APR-DRG 2231
Min. Negotiated Rate	$9,157.02
Max. Negotiated Rate	$9,157.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,157.02

OTHER SMALL AND LARGE BOWEL PROCEDURES

Facility

$34,359.72

Service Code	APR-DRG 2234
Min. Negotiated Rate	$34,359.72
Max. Negotiated Rate	$34,359.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$34,359.72

OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$6,653.87

Service Code	APR-DRG 2221
Min. Negotiated Rate	$6,653.87
Max. Negotiated Rate	$6,653.87
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,653.87

OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$35,749.60

Service Code	APR-DRG 2224
Min. Negotiated Rate	$35,749.60
Max. Negotiated Rate	$35,749.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$35,749.60

OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$11,225.41

Service Code	APR-DRG 2222
Min. Negotiated Rate	$11,225.41
Max. Negotiated Rate	$11,225.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,225.41

OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$16,767.97

Service Code	APR-DRG 2223
Min. Negotiated Rate	$16,767.97
Max. Negotiated Rate	$16,767.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16,767.97

Otolaryngologic examination under general anesthesia

Facility

$3,237.00

Service Code	CPT 92502
Min. Negotiated Rate	$96.35
Max. Negotiated Rate	$3,237.00
Rate for Payer: Aetna of CA Gatekeeper	$223.63
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$1,031.16
Rate for Payer: Alpha Care Medical Group Medi-Cal	$756.18
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$687.44
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$3,237.00
Rate for Payer: Dignity Health Commercial/Exchange	$1,031.16
Rate for Payer: Dignity Health Medi-Cal	$756.18
Rate for Payer: Dignity Health Senior	$687.44
Rate for Payer: EPIC Health Plan Medicare	$687.44
Rate for Payer: Humana Medicare	$687.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$96.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$687.44
Rate for Payer: Kaiser Permanente of CA Commercial	$1,306.14
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$811.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$866.17
Rate for Payer: Molina Healthcare of CA Medicare	$866.17
Rate for Payer: TriValley Medical Group Commercial	$756.18
Rate for Payer: TriValley Medical Group Senior	$687.44
Rate for Payer: Vantage Medical Group Commercial/Exchange	$1,031.16
Rate for Payer: Vantage Medical Group Medi-Cal	$756.18
Rate for Payer: Vantage Medical Group Senior	$687.44

Otoplasty, protruding ear, with or without size reduction

Facility

$7,643.11

Service Code	CPT 69300
Min. Negotiated Rate	$580.79
Max. Negotiated Rate	$7,643.11
Rate for Payer: Aetna of CA Gatekeeper	$3,728.00
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$6,034.04
Rate for Payer: Alpha Care Medical Group Medi-Cal	$4,424.96
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$4,022.69
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$4,547.00
Rate for Payer: Dignity Health Commercial/Exchange	$6,034.04
Rate for Payer: Dignity Health Medi-Cal	$4,424.96
Rate for Payer: Dignity Health Senior	$4,022.69
Rate for Payer: EPIC Health Plan Medicare	$4,022.69
Rate for Payer: Humana Medicare	$4,022.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$580.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$4,022.69
Rate for Payer: Kaiser Permanente of CA Commercial	$7,643.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$4,746.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$5,068.59
Rate for Payer: Molina Healthcare of CA Medicare	$5,068.59
Rate for Payer: TriValley Medical Group Commercial	$4,424.96
Rate for Payer: TriValley Medical Group Senior	$4,022.69
Rate for Payer: Vantage Medical Group Commercial/Exchange	$6,034.04
Rate for Payer: Vantage Medical Group Medi-Cal	$4,424.96
Rate for Payer: Vantage Medical Group Senior	$4,022.69

Outdated MS-DRG 222

Facility

$124,959.75

Service Code	MS-DRG 222
Min. Negotiated Rate	$13,987.00
Max. Negotiated Rate	$124,959.75
Rate for Payer: Aetna of CA Gatekeeper	$28,979.00
Rate for Payer: EPIC Health Plan Commercial	$13,987.00
Rate for Payer: Multiplan WC	$124,959.75

Know your out-of-pocket cost for care.

All Charges