Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

CARDIAC PACEMAKER AND DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT

Facility

$18,763.20

Service Code	APR-DRG 1771
Min. Negotiated Rate	$14,393.35
Max. Negotiated Rate	$18,763.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$14,393.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$18,763.20

CARDIAC PACEMAKER AND DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT

Facility

$36,394.94

Service Code	APR-DRG 1773
Min. Negotiated Rate	$27,918.75
Max. Negotiated Rate	$36,394.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$27,918.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$36,394.94

CARDIAC PACEMAKER AND DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT

Facility

$27,086.06

Service Code	APR-DRG 1772
Min. Negotiated Rate	$20,777.86
Max. Negotiated Rate	$27,086.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$20,777.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$27,086.06

CARDIAC PACEMAKER AND DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT

Facility

$50,215.52

Service Code	APR-DRG 1774
Min. Negotiated Rate	$38,520.59
Max. Negotiated Rate	$50,215.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$38,520.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$50,215.52

CARDIAC STRUCTURAL AND VALVULAR DISORDERS

Facility

$6,794.13

Service Code	APR-DRG 2001
Min. Negotiated Rate	$5,211.82
Max. Negotiated Rate	$6,794.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$5,211.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$6,794.13

CARDIAC STRUCTURAL AND VALVULAR DISORDERS

Facility

$10,060.84

Service Code	APR-DRG 2002
Min. Negotiated Rate	$7,717.72
Max. Negotiated Rate	$10,060.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,717.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10,060.84

CARDIAC STRUCTURAL AND VALVULAR DISORDERS

Facility

$22,577.93

Service Code	APR-DRG 2004
Min. Negotiated Rate	$17,319.65
Max. Negotiated Rate	$22,577.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,319.65
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$22,577.93

CARDIAC STRUCTURAL AND VALVULAR DISORDERS

Facility

$14,549.46

Service Code	APR-DRG 2003
Min. Negotiated Rate	$11,160.97
Max. Negotiated Rate	$14,549.46
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,160.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,549.46

CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$81,148.20

Service Code	APR-DRG 1622
Min. Negotiated Rate	$62,249.21
Max. Negotiated Rate	$81,148.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$62,249.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$81,148.20

CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$102,390.72

Service Code	APR-DRG 1623
Min. Negotiated Rate	$78,544.46
Max. Negotiated Rate	$102,390.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$78,544.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$102,390.72

CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$149,492.04

Service Code	APR-DRG 1624
Min. Negotiated Rate	$114,676.13
Max. Negotiated Rate	$149,492.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$114,676.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$149,492.04

CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$69,248.29

Service Code	APR-DRG 1621
Min. Negotiated Rate	$53,120.73
Max. Negotiated Rate	$69,248.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$53,120.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$69,248.29

CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$127,208.52

Service Code	APR-DRG 1634
Min. Negotiated Rate	$97,582.32
Max. Negotiated Rate	$127,208.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$97,582.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$127,208.52

CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$84,686.27

Service Code	APR-DRG 1633
Min. Negotiated Rate	$64,963.28
Max. Negotiated Rate	$84,686.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$64,963.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$84,686.27

CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$67,020.83

Service Code	APR-DRG 1632
Min. Negotiated Rate	$51,412.03
Max. Negotiated Rate	$67,020.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$51,412.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$67,020.83

CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$60,567.21

Service Code	APR-DRG 1631
Min. Negotiated Rate	$46,461.43
Max. Negotiated Rate	$60,567.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$46,461.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$60,567.21

CARDIOMYOPATHY

Facility

$9,693.72

Service Code	APR-DRG 2052
Min. Negotiated Rate	$7,436.11
Max. Negotiated Rate	$9,693.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,436.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$9,693.72

CARDIOMYOPATHY

Facility

$25,789.65

Service Code	APR-DRG 2054
Min. Negotiated Rate	$19,783.38
Max. Negotiated Rate	$25,789.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$19,783.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$25,789.65

CARDIOMYOPATHY

Facility

$7,780.18

Service Code	APR-DRG 2051
Min. Negotiated Rate	$5,968.21
Max. Negotiated Rate	$7,780.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$5,968.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$7,780.18

CARDIOMYOPATHY

Facility

$14,349.07

Service Code	APR-DRG 2053
Min. Negotiated Rate	$11,007.24
Max. Negotiated Rate	$14,349.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,007.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,349.07

CARFILZOMIB 10 MG INTRAVENOUS SOLUTION [222456]

Facility

$595.84

Service Code	CPT J9047
Hospital Charge Code	ERX222456
Hospital Revenue Code	636
Min. Negotiated Rate	$47.08
Max. Negotiated Rate	$506.46
Rate for Payer: Aetna of CA HMO/PPO	$92.74
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$58.86
Rate for Payer: Alpha Care Medical Group Medi-Cal	$51.79
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$51.79
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$58.85
Rate for Payer: Blue Distinction Transplant	$357.50
Rate for Payer: Blue Shield of California Commercial	$439.13
Rate for Payer: Blue Shield of California EPN	$48.71
Rate for Payer: Cash Price	$268.13
Rate for Payer: Cash Price	$268.13
Rate for Payer: Cigna of CA HMO	$417.09
Rate for Payer: Cigna of CA PPO	$417.09
Rate for Payer: Dignity Health Commercial/Exchange	$70.63
Rate for Payer: Dignity Health Media	$47.08
Rate for Payer: Dignity Health Medi-Cal	$51.79
Rate for Payer: EPIC Health Plan Commercial	$63.56
Rate for Payer: EPIC Health Plan Medicare/Senior	$47.08
Rate for Payer: EPIC Health Plan Transplant	$47.08
Rate for Payer: Galaxy Health WC	$506.46
Rate for Payer: Global Benefits Group Commercial	$357.50
Rate for Payer: Health Plan of Nevada (Sierra) Other	$446.88
Rate for Payer: Heritage Provider Network Commercial	$77.22
Rate for Payer: Heritage Provider Network Transplant	$77.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$76.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant	$76.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$47.08
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$397.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$97.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$47.08
Rate for Payer: LLUH Dept of Risk Management WC	$143.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$59.33
Rate for Payer: Molina Healthcare of CA Medicare	$63.09
Rate for Payer: Multiplan Commercial	$476.67
Rate for Payer: Networks By Design Commercial	$297.92
Rate for Payer: Prime Health Services Commercial	$506.46
Rate for Payer: Temecula Valley Physicians Medical Group Commercial	$357.50
Rate for Payer: TriValley Medical Group Commercial/Senior	$357.50
Rate for Payer: United Healthcare All Other Commercial	$297.92
Rate for Payer: United Healthcare All Other HMO	$297.92
Rate for Payer: United Healthcare HMO Rider	$297.92
Rate for Payer: United Healthcare Select/Navigate/Core	$297.92
Rate for Payer: Vantage Medical Group Commercial/Exchange	$70.63
Rate for Payer: Vantage Medical Group Medi-Cal	$51.79
Rate for Payer: Vantage Medical Group Senior	$47.08

CARFILZOMIB 10 MG INTRAVENOUS SOLUTION [222456]

Facility

$595.84

Service Code	CPT J9047
Hospital Charge Code	ERX222456
Hospital Revenue Code	636
Min. Negotiated Rate	$143.00
Max. Negotiated Rate	$506.46
Rate for Payer: Blue Shield of California Commercial	$424.24
Rate for Payer: Blue Shield of California EPN	$305.07
Rate for Payer: Cash Price	$268.13
Rate for Payer: Cigna of CA HMO	$417.09
Rate for Payer: Cigna of CA PPO	$417.09
Rate for Payer: EPIC Health Plan Commercial	$238.34
Rate for Payer: EPIC Health Plan Transplant	$238.34
Rate for Payer: Galaxy Health WC	$506.46
Rate for Payer: Global Benefits Group Commercial	$357.50
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$397.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$227.02
Rate for Payer: LLUH Dept of Risk Management WC	$143.00
Rate for Payer: Multiplan Commercial	$476.67
Rate for Payer: Networks By Design Commercial	$297.92
Rate for Payer: Prime Health Services Commercial	$506.46
Rate for Payer: United Healthcare All Other Commercial	$224.99
Rate for Payer: United Healthcare All Other HMO	$219.75
Rate for Payer: United Healthcare HMO Rider	$214.98
Rate for Payer: United Healthcare Select/Navigate/Core	$196.63

CARFILZOMIB 30 MG INTRAVENOUS SOLUTION [214890]

Facility

$1,787.52

Service Code	CPT J9047
Hospital Charge Code	ERX214890
Hospital Revenue Code	636
Min. Negotiated Rate	$429.00
Max. Negotiated Rate	$1,519.39
Rate for Payer: Blue Shield of California Commercial	$1,272.71
Rate for Payer: Blue Shield of California EPN	$915.21
Rate for Payer: Cash Price	$804.38
Rate for Payer: Cigna of CA HMO	$1,251.26
Rate for Payer: Cigna of CA PPO	$1,251.26
Rate for Payer: EPIC Health Plan Commercial	$715.01
Rate for Payer: EPIC Health Plan Transplant	$715.01
Rate for Payer: Galaxy Health WC	$1,519.39
Rate for Payer: Global Benefits Group Commercial	$1,072.51
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$1,192.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$681.05
Rate for Payer: LLUH Dept of Risk Management WC	$429.00
Rate for Payer: Multiplan Commercial	$1,430.02
Rate for Payer: Networks By Design Commercial	$893.76
Rate for Payer: Prime Health Services Commercial	$1,519.39
Rate for Payer: United Healthcare All Other Commercial	$674.97
Rate for Payer: United Healthcare All Other HMO	$659.24
Rate for Payer: United Healthcare HMO Rider	$644.94
Rate for Payer: United Healthcare Select/Navigate/Core	$589.88

CARFILZOMIB 30 MG INTRAVENOUS SOLUTION [214890]

Facility

$1,787.52

Service Code	CPT J9047
Hospital Charge Code	ERX214890
Hospital Revenue Code	636
Min. Negotiated Rate	$47.08
Max. Negotiated Rate	$1,519.39
Rate for Payer: Aetna of CA HMO/PPO	$92.74
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$58.86
Rate for Payer: Alpha Care Medical Group Medi-Cal	$51.79
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$51.79
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$58.85
Rate for Payer: Blue Distinction Transplant	$1,072.51
Rate for Payer: Blue Shield of California Commercial	$1,317.40
Rate for Payer: Blue Shield of California EPN	$48.71
Rate for Payer: Cash Price	$804.38
Rate for Payer: Cash Price	$804.38
Rate for Payer: Cigna of CA HMO	$1,251.26
Rate for Payer: Cigna of CA PPO	$1,251.26
Rate for Payer: Dignity Health Commercial/Exchange	$70.63
Rate for Payer: Dignity Health Media	$47.08
Rate for Payer: Dignity Health Medi-Cal	$51.79
Rate for Payer: EPIC Health Plan Commercial	$63.56
Rate for Payer: EPIC Health Plan Medicare/Senior	$47.08
Rate for Payer: EPIC Health Plan Transplant	$47.08
Rate for Payer: Galaxy Health WC	$1,519.39
Rate for Payer: Global Benefits Group Commercial	$1,072.51
Rate for Payer: Health Plan of Nevada (Sierra) Other	$1,340.64
Rate for Payer: Heritage Provider Network Commercial	$77.22
Rate for Payer: Heritage Provider Network Transplant	$77.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$76.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant	$76.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$47.08
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$1,192.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$97.94
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$47.08
Rate for Payer: LLUH Dept of Risk Management WC	$429.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$59.33
Rate for Payer: Molina Healthcare of CA Medicare	$63.09
Rate for Payer: Multiplan Commercial	$1,430.02
Rate for Payer: Networks By Design Commercial	$893.76
Rate for Payer: Prime Health Services Commercial	$1,519.39
Rate for Payer: Temecula Valley Physicians Medical Group Commercial	$1,072.51
Rate for Payer: TriValley Medical Group Commercial/Senior	$1,072.51
Rate for Payer: United Healthcare All Other Commercial	$893.76
Rate for Payer: United Healthcare All Other HMO	$893.76
Rate for Payer: United Healthcare HMO Rider	$893.76
Rate for Payer: United Healthcare Select/Navigate/Core	$893.76
Rate for Payer: Vantage Medical Group Commercial/Exchange	$70.63
Rate for Payer: Vantage Medical Group Medi-Cal	$51.79
Rate for Payer: Vantage Medical Group Senior	$47.08

CARFILZOMIB 60 MG INTRAVENOUS SOLUTION [196893]

Facility

$3,575.04

Service Code	NDC 76075-101-01
Hospital Charge Code	1755799
Hospital Revenue Code	636
Min. Negotiated Rate	$858.01
Max. Negotiated Rate	$3,038.78
Rate for Payer: Aetna of CA HMO/PPO	$2,344.87
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$3,038.78
Rate for Payer: Alpha Care Medical Group Medi-Cal	$1,966.27
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$1,966.27
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$2,130.01
Rate for Payer: Blue Distinction Transplant	$2,145.02
Rate for Payer: Blue Shield of California Commercial	$2,634.80
Rate for Payer: Blue Shield of California EPN	$2,087.82
Rate for Payer: Cash Price	$1,608.77
Rate for Payer: Cigna of CA HMO	$2,502.53
Rate for Payer: Cigna of CA PPO	$2,502.53
Rate for Payer: Dignity Health Commercial/Exchange	$3,038.78
Rate for Payer: Dignity Health Media	$3,038.78
Rate for Payer: Dignity Health Medi-Cal	$3,038.78
Rate for Payer: EPIC Health Plan Commercial	$1,430.02
Rate for Payer: EPIC Health Plan Transplant	$1,430.02
Rate for Payer: Galaxy Health WC	$3,038.78
Rate for Payer: Global Benefits Group Commercial	$2,145.02
Rate for Payer: Health Plan of Nevada (Sierra) Other	$2,681.28
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$2,384.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$1,362.09
Rate for Payer: LLUH Dept of Risk Management WC	$858.01
Rate for Payer: Multiplan Commercial	$2,860.03
Rate for Payer: Networks By Design Commercial	$1,787.52
Rate for Payer: Prime Health Services Commercial	$3,038.78
Rate for Payer: Temecula Valley Physicians Medical Group Commercial	$2,145.02
Rate for Payer: TriValley Medical Group Commercial/Senior	$2,145.02
Rate for Payer: United Healthcare All Other Commercial	$1,787.52
Rate for Payer: United Healthcare All Other HMO	$1,787.52
Rate for Payer: United Healthcare HMO Rider	$1,787.52
Rate for Payer: United Healthcare Select/Navigate/Core	$1,787.52
Rate for Payer: Vantage Medical Group Commercial/Exchange	$3,038.78
Rate for Payer: Vantage Medical Group Medi-Cal	$3,038.78
Rate for Payer: Vantage Medical Group Senior	$3,038.78

Know your out-of-pocket cost for care.

All Charges