Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MAJOR CHEST PROCEDURES WITH CC

Facility

$124,037.56

Service Code	MSDRG 164
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$124,037.56
Rate for Payer: Aetna of CA HMO/PPO	$76,517.58
Rate for Payer: EPIC Health Plan Commercial	$124,037.56
Rate for Payer: EPIC Health Plan Senior	$82,691.71
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$75,174.28
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$105,243.99
Rate for Payer: Molina Healthcare of CA Medicare	$100,733.54
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

MAJOR CHEST PROCEDURES WITH MCC

Facility

$158,778.38

Service Code	MSDRG 163
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$158,778.38
Rate for Payer: Aetna of CA HMO/PPO	$135,870.25
Rate for Payer: EPIC Health Plan Commercial	$158,778.38
Rate for Payer: EPIC Health Plan Senior	$105,852.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$96,229.32
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$134,721.05
Rate for Payer: Molina Healthcare of CA Medicare	$128,947.29
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

MAJOR CHEST PROCEDURES WITHOUT CC/MCC

Facility

$113,216.75

Service Code	MSDRG 165
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$113,216.75
Rate for Payer: Aetna of CA HMO/PPO	$58,030.89
Rate for Payer: EPIC Health Plan Commercial	$113,216.75
Rate for Payer: EPIC Health Plan Senior	$75,477.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$68,616.21
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$96,062.69
Rate for Payer: Molina Healthcare of CA Medicare	$91,945.72
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

MAJOR CHEST TRAUMA WITH CC

Facility

$98,131.89

Service Code	MSDRG 184
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$98,131.89
Rate for Payer: Aetna of CA HMO/PPO	$32,259.26
Rate for Payer: EPIC Health Plan Commercial	$98,131.89
Rate for Payer: EPIC Health Plan Senior	$65,421.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$59,473.87
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$83,263.42
Rate for Payer: Molina Healthcare of CA Medicare	$79,694.99
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

MAJOR CHEST TRAUMA WITH MCC

Facility

$106,397.43

Service Code	MSDRG 183
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$106,397.43
Rate for Payer: Aetna of CA HMO/PPO	$46,380.45
Rate for Payer: EPIC Health Plan Commercial	$106,397.43
Rate for Payer: EPIC Health Plan Senior	$70,931.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$64,483.29
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$90,276.61
Rate for Payer: Molina Healthcare of CA Medicare	$86,407.61
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

MAJOR CHEST TRAUMA WITHOUT CC/MCC

Facility

$93,205.94

Service Code	MSDRG 185
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$93,205.94
Rate for Payer: Aetna of CA HMO/PPO	$23,843.53
Rate for Payer: EPIC Health Plan Commercial	$93,205.94
Rate for Payer: EPIC Health Plan Senior	$62,137.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$56,488.45
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$79,083.83
Rate for Payer: Molina Healthcare of CA Medicare	$75,694.52
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

MAJOR CRANIAL OR FACIAL BONE PROCEDURES

Facility

$43,552.73

Service Code	APR-DRG 0892
Min. Negotiated Rate	$34,784.88
Max. Negotiated Rate	$43,552.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$34,784.88
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$43,552.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$38,968.23

MAJOR CRANIAL OR FACIAL BONE PROCEDURES

Facility

$152,406.71

Service Code	APR-DRG 0894
Min. Negotiated Rate	$121,724.84
Max. Negotiated Rate	$152,406.71
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$121,724.84
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$152,406.71
Rate for Payer: Molina Healthcare of CA Medi-Cal	$136,363.90

MAJOR CRANIAL OR FACIAL BONE PROCEDURES

Facility

$31,517.75

Service Code	APR-DRG 0891
Min. Negotiated Rate	$25,172.73
Max. Negotiated Rate	$31,517.75
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$25,172.73
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$31,517.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,200.09

MAJOR CRANIAL OR FACIAL BONE PROCEDURES

Facility

$81,998.89

Service Code	APR-DRG 0893
Min. Negotiated Rate	$65,491.22
Max. Negotiated Rate	$81,998.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$65,491.22
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$81,998.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$73,367.43

MAJOR ESOPHAGEAL DISORDERS

Facility

$60,390.95

Service Code	APR-DRG 2424
Min. Negotiated Rate	$48,233.30
Max. Negotiated Rate	$60,390.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$48,233.30
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$60,390.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$54,034.01

MAJOR ESOPHAGEAL DISORDERS

Facility

$24,695.38

Service Code	APR-DRG 2423
Min. Negotiated Rate	$19,723.81
Max. Negotiated Rate	$24,695.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$19,723.81
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$24,695.38
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,095.87

MAJOR ESOPHAGEAL DISORDERS

Facility

$13,367.37

Service Code	APR-DRG 2421
Min. Negotiated Rate	$10,676.31
Max. Negotiated Rate	$13,367.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,676.31
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$13,367.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,960.28

MAJOR ESOPHAGEAL DISORDERS

Facility

$17,043.67

Service Code	APR-DRG 2422
Min. Negotiated Rate	$13,612.51
Max. Negotiated Rate	$17,043.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,612.51
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$17,043.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,249.59

MAJOR ESOPHAGEAL DISORDERS WITH CC

Facility

$96,997.99

Service Code	MSDRG 369
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$96,997.99
Rate for Payer: Aetna of CA HMO/PPO	$30,322.06
Rate for Payer: EPIC Health Plan Commercial	$96,997.99
Rate for Payer: EPIC Health Plan Senior	$64,665.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$58,786.66
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$82,301.32
Rate for Payer: Molina Healthcare of CA Medicare	$78,774.12
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

MAJOR ESOPHAGEAL DISORDERS WITH MCC

Facility

$107,497.60

Service Code	MSDRG 368
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$107,497.60
Rate for Payer: Aetna of CA HMO/PPO	$48,260.04
Rate for Payer: EPIC Health Plan Commercial	$107,497.60
Rate for Payer: EPIC Health Plan Senior	$71,665.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$65,150.06
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$91,210.08
Rate for Payer: Molina Healthcare of CA Medicare	$87,301.08
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

MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC

Facility

$91,685.20

Service Code	MSDRG 370
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$91,685.20
Rate for Payer: Aetna of CA HMO/PPO	$21,245.45
Rate for Payer: EPIC Health Plan Commercial	$91,685.20
Rate for Payer: EPIC Health Plan Senior	$61,123.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$55,566.79
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$77,793.51
Rate for Payer: Molina Healthcare of CA Medicare	$74,459.50
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

MAJOR GASTROINTESTINAL AND PERITONEAL INFECTIONS

Facility

$22,797.42

Service Code	APR-DRG 2483
Min. Negotiated Rate	$18,207.94
Max. Negotiated Rate	$22,797.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$18,207.94
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$22,797.42
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,397.69

MAJOR GASTROINTESTINAL AND PERITONEAL INFECTIONS

Facility

$50,616.59

Service Code	APR-DRG 2484
Min. Negotiated Rate	$40,426.67
Max. Negotiated Rate	$50,616.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$40,426.67
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$50,616.59
Rate for Payer: Molina Healthcare of CA Medi-Cal	$45,288.53

MAJOR GASTROINTESTINAL AND PERITONEAL INFECTIONS

Facility

$15,624.27

Service Code	APR-DRG 2482
Min. Negotiated Rate	$12,478.86
Max. Negotiated Rate	$15,624.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,478.86
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$15,624.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,979.61

MAJOR GASTROINTESTINAL AND PERITONEAL INFECTIONS

Facility

$11,779.39

Service Code	APR-DRG 2481
Min. Negotiated Rate	$9,408.01
Max. Negotiated Rate	$11,779.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,408.01
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$11,779.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,539.46

MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC

Facility

$97,367.08

Service Code	MSDRG 372
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$97,367.08
Rate for Payer: Aetna of CA HMO/PPO	$30,952.64
Rate for Payer: EPIC Health Plan Commercial	$97,367.08
Rate for Payer: EPIC Health Plan Senior	$64,911.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$59,010.35
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$82,614.49
Rate for Payer: Molina Healthcare of CA Medicare	$79,073.87
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

MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC

Facility

$110,712.97

Service Code	MSDRG 371
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$110,712.97
Rate for Payer: Aetna of CA HMO/PPO	$53,753.30
Rate for Payer: EPIC Health Plan Commercial	$110,712.97
Rate for Payer: EPIC Health Plan Senior	$73,808.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$67,098.77
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$93,938.28
Rate for Payer: Molina Healthcare of CA Medicare	$89,912.35
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

MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC

Facility

$92,157.20

Service Code	MSDRG 373
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$92,157.20
Rate for Payer: Aetna of CA HMO/PPO	$22,051.86
Rate for Payer: EPIC Health Plan Commercial	$92,157.20
Rate for Payer: EPIC Health Plan Senior	$61,438.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$55,852.85
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$78,193.99
Rate for Payer: Molina Healthcare of CA Medicare	$74,842.82
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

MAJOR HEAD AND NECK PROCEDURES WITH CC

Facility

$117,952.86

Service Code	MSDRG 141
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$117,952.86
Rate for Payer: Aetna of CA HMO/PPO	$66,122.23
Rate for Payer: EPIC Health Plan Commercial	$117,952.86
Rate for Payer: EPIC Health Plan Senior	$78,635.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$71,486.58
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$100,081.21
Rate for Payer: Molina Healthcare of CA Medicare	$95,792.02
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

Know your out-of-pocket cost for care.

All Charges