Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$12,100.92

Service Code	APR-DRG 7921
Min. Negotiated Rate	$12,100.92
Max. Negotiated Rate	$12,100.92
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,100.92

EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$17,326.12

Service Code	APR-DRG 9502
Min. Negotiated Rate	$17,326.12
Max. Negotiated Rate	$17,326.12
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,326.12

EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$26,233.42

Service Code	APR-DRG 9503
Min. Negotiated Rate	$26,233.42
Max. Negotiated Rate	$26,233.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$26,233.42

EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$12,746.60

Service Code	APR-DRG 9501
Min. Negotiated Rate	$12,746.60
Max. Negotiated Rate	$12,746.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,746.60

EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$47,862.46

Service Code	APR-DRG 9504
Min. Negotiated Rate	$47,862.46
Max. Negotiated Rate	$47,862.46
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$47,862.46

EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility

$4,068.13

Service Code	APR-DRG 8431
Min. Negotiated Rate	$4,068.13
Max. Negotiated Rate	$4,068.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$4,068.13

EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility

$6,243.97

Service Code	APR-DRG 8432
Min. Negotiated Rate	$6,243.97
Max. Negotiated Rate	$6,243.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,243.97

EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility

$8,461.59

Service Code	APR-DRG 8433
Min. Negotiated Rate	$8,461.59
Max. Negotiated Rate	$8,461.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,461.59

EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility

$17,423.62

Service Code	APR-DRG 8434
Min. Negotiated Rate	$17,423.62
Max. Negotiated Rate	$17,423.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,423.62

EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT

Facility

$15,932.27

Service Code	APR-DRG 8412
Min. Negotiated Rate	$15,932.27
Max. Negotiated Rate	$15,932.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$15,932.27

EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT

Facility

$148,295.22

Service Code	APR-DRG 8414
Min. Negotiated Rate	$148,295.22
Max. Negotiated Rate	$148,295.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$148,295.22

EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT

Facility

$13,997.19

Service Code	APR-DRG 8411
Min. Negotiated Rate	$13,997.19
Max. Negotiated Rate	$13,997.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,997.19

EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT

Facility

$54,422.80

Service Code	APR-DRG 8413
Min. Negotiated Rate	$54,422.80
Max. Negotiated Rate	$54,422.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$54,422.80

EXTERNAL HEART ASSIST SYSTEMS

Facility

$70,887.33

Service Code	APR-DRG 1784
Min. Negotiated Rate	$70,887.33
Max. Negotiated Rate	$70,887.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$70,887.33

EXTERNAL HEART ASSIST SYSTEMS

Facility

$52,441.96

Service Code	APR-DRG 1783
Min. Negotiated Rate	$52,441.96
Max. Negotiated Rate	$52,441.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$52,441.96

EXTERNAL HEART ASSIST SYSTEMS

Facility

$43,578.43

Service Code	APR-DRG 1781
Min. Negotiated Rate	$43,578.43
Max. Negotiated Rate	$43,578.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$43,578.43

EXTERNAL HEART ASSIST SYSTEMS

Facility

$48,859.34

Service Code	APR-DRG 1782
Min. Negotiated Rate	$48,859.34
Max. Negotiated Rate	$48,859.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$48,859.34

Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; without endoscopic cyclophotocoagulation

Facility

$9,792.00

Service Code	CPT 66982
Min. Negotiated Rate	$313.62
Max. Negotiated Rate	$9,792.00
Rate for Payer: Aetna of CA Gatekeeper	$5,088.00
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$4,367.44
Rate for Payer: Alpha Care Medical Group Medi-Cal	$3,202.79
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$2,911.63
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$9,792.00
Rate for Payer: Dignity Health Commercial/Exchange	$4,367.44
Rate for Payer: Dignity Health Medi-Cal	$3,202.79
Rate for Payer: Dignity Health Senior	$2,911.63
Rate for Payer: EPIC Health Plan Medicare	$2,911.63
Rate for Payer: Humana Medicare	$2,911.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$313.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$2,911.63
Rate for Payer: Kaiser Permanente of CA Commercial	$5,532.10
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$3,435.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$3,668.65
Rate for Payer: Molina Healthcare of CA Medicare	$3,668.65
Rate for Payer: TriValley Medical Group Commercial	$3,202.79
Rate for Payer: TriValley Medical Group Senior	$2,911.63
Rate for Payer: Vantage Medical Group Commercial/Exchange	$4,367.44
Rate for Payer: Vantage Medical Group Medi-Cal	$3,202.79
Rate for Payer: Vantage Medical Group Senior	$2,911.63

Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more

Facility

$12,407.40

Service Code	CPT 66991
Min. Negotiated Rate	$926.94
Max. Negotiated Rate	$12,407.40
Rate for Payer: Aetna of CA Gatekeeper	$5,245.00
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$9,795.32
Rate for Payer: Alpha Care Medical Group Medi-Cal	$7,183.23
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$6,530.21
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$9,792.00
Rate for Payer: Dignity Health Commercial/Exchange	$9,795.32
Rate for Payer: Dignity Health Medi-Cal	$7,183.23
Rate for Payer: Dignity Health Senior	$6,530.21
Rate for Payer: EPIC Health Plan Medicare	$6,530.21
Rate for Payer: Humana Medicare	$6,530.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$926.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$6,530.21
Rate for Payer: Kaiser Permanente of CA Commercial	$12,407.40
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$7,705.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,228.06
Rate for Payer: Molina Healthcare of CA Medicare	$8,228.06
Rate for Payer: TriValley Medical Group Commercial	$7,183.23
Rate for Payer: TriValley Medical Group Senior	$6,530.21
Rate for Payer: Vantage Medical Group Commercial/Exchange	$9,795.32
Rate for Payer: Vantage Medical Group Medi-Cal	$7,183.23
Rate for Payer: Vantage Medical Group Senior	$6,530.21

Facility

$9,792.00

Service Code	CPT 66984
Min. Negotiated Rate	$313.62
Max. Negotiated Rate	$9,792.00
Rate for Payer: Aetna of CA Gatekeeper	$5,088.00
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$4,367.44
Rate for Payer: Alpha Care Medical Group Medi-Cal	$3,202.79
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$2,911.63
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$9,792.00
Rate for Payer: Dignity Health Commercial/Exchange	$4,367.44
Rate for Payer: Dignity Health Medi-Cal	$3,202.79
Rate for Payer: Dignity Health Senior	$2,911.63
Rate for Payer: EPIC Health Plan Medicare	$2,911.63
Rate for Payer: Humana Medicare	$2,911.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$313.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$2,911.63
Rate for Payer: Kaiser Permanente of CA Commercial	$5,532.10
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$3,435.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$3,668.65
Rate for Payer: Molina Healthcare of CA Medicare	$3,668.65
Rate for Payer: TriValley Medical Group Commercial	$3,202.79
Rate for Payer: TriValley Medical Group Senior	$2,911.63
Rate for Payer: Vantage Medical Group Commercial/Exchange	$4,367.44
Rate for Payer: Vantage Medical Group Medi-Cal	$3,202.79
Rate for Payer: Vantage Medical Group Senior	$2,911.63

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$129,013.14

Service Code	APR-DRG 0094
Min. Negotiated Rate	$129,013.14
Max. Negotiated Rate	$129,013.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$129,013.14

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$35,592.40

Service Code	APR-DRG 0091
Min. Negotiated Rate	$35,592.40
Max. Negotiated Rate	$35,592.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$35,592.40

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$43,368.51

Service Code	APR-DRG 0092
Min. Negotiated Rate	$43,368.51
Max. Negotiated Rate	$43,368.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$43,368.51

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$59,460.96

Service Code	APR-DRG 0093
Min. Negotiated Rate	$59,460.96
Max. Negotiated Rate	$59,460.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$59,460.96

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), percutaneous, 6 years and older (includes fluoroscopic guidance, when performed)

Facility

$9,616.00

Service Code	CPT 33952
Min. Negotiated Rate	$458.23
Max. Negotiated Rate	$9,616.00
Rate for Payer: Aetna of CA Gatekeeper	$921.50
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$5,505.00
Rate for Payer: EPIC Health Plan Commercial	$9,616.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$458.23

Know your out-of-pocket cost for care.

All Charges