Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MAJOR HEAD AND NECK PROCEDURES WITH MCC

Facility

$154,936.63

Service Code	MSDRG 140
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$154,936.63
Rate for Payer: Aetna of CA HMO/PPO	$129,306.83
Rate for Payer: EPIC Health Plan Commercial	$154,936.63
Rate for Payer: EPIC Health Plan Senior	$103,291.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$93,900.99
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$131,461.39
Rate for Payer: Molina Healthcare of CA Medicare	$125,827.33
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 HEAD AND NECK PROCEDURES WITHOUT CC/MCC

Facility

$107,577.48

Service Code	MSDRG 142
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$107,577.48
Rate for Payer: Aetna of CA HMO/PPO	$48,396.46
Rate for Payer: EPIC Health Plan Commercial	$107,577.48
Rate for Payer: EPIC Health Plan Senior	$71,718.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$65,198.47
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$91,277.86
Rate for Payer: Molina Healthcare of CA Medicare	$87,365.95
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 HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC

Facility

$101,712.80

Service Code	MSDRG 809
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$101,712.80
Rate for Payer: Aetna of CA HMO/PPO	$38,377.02
Rate for Payer: EPIC Health Plan Commercial	$101,712.80
Rate for Payer: EPIC Health Plan Senior	$67,808.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$61,644.12
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$86,301.77
Rate for Payer: Molina Healthcare of CA Medicare	$82,603.12
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 HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC

Facility

$118,428.40

Service Code	MSDRG 808
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$118,428.40
Rate for Payer: Aetna of CA HMO/PPO	$66,934.70
Rate for Payer: EPIC Health Plan Commercial	$118,428.40
Rate for Payer: EPIC Health Plan Senior	$78,952.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$71,774.79
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$100,484.71
Rate for Payer: Molina Healthcare of CA Medicare	$96,178.22
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 HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC

Facility

$97,821.36

Service Code	MSDRG 810
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$97,821.36
Rate for Payer: Aetna of CA HMO/PPO	$31,728.73
Rate for Payer: EPIC Health Plan Commercial	$97,821.36
Rate for Payer: EPIC Health Plan Senior	$65,214.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$59,285.67
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$82,999.94
Rate for Payer: Molina Healthcare of CA Medicare	$79,442.80
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 HEMATOLOGIC OR IMMUNOLOGIC DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION

Facility

$12,652.23

Service Code	APR-DRG 6601
Min. Negotiated Rate	$10,105.14
Max. Negotiated Rate	$12,652.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,105.14
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$12,652.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,320.42

MAJOR HEMATOLOGIC OR IMMUNOLOGIC DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION

Facility

$16,391.07

Service Code	APR-DRG 6602
Min. Negotiated Rate	$13,091.29
Max. Negotiated Rate	$16,391.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,091.29
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$16,391.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,665.70

MAJOR HEMATOLOGIC OR IMMUNOLOGIC DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION

Facility

$60,345.14

Service Code	APR-DRG 6604
Min. Negotiated Rate	$48,196.71
Max. Negotiated Rate	$60,345.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$48,196.71
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$60,345.14
Rate for Payer: Molina Healthcare of CA Medi-Cal	$53,993.02

MAJOR HEMATOLOGIC OR IMMUNOLOGIC DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION

Facility

$25,440.43

Service Code	APR-DRG 6603
Min. Negotiated Rate	$20,318.87
Max. Negotiated Rate	$25,440.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$20,318.87
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$25,440.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$22,762.49

MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT

Facility

$133,073.23

Service Code	MSDRG 469
Min. Negotiated Rate	$23,506.00
Max. Negotiated Rate	$133,073.23
Rate for Payer: Aetna of CA HMO/PPO	$91,954.49
Rate for Payer: EPIC Health Plan Commercial	$133,073.23
Rate for Payer: EPIC Health Plan Senior	$88,715.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$80,650.44
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$112,910.62
Rate for Payer: Molina Healthcare of CA Medicare	$108,071.59
Rate for Payer: United Healthcare All Other Commercial	$41,904.00
Rate for Payer: United Healthcare All Other HMO	$41,904.00
Rate for Payer: United Healthcare HMO Rider	$34,363.00
Rate for Payer: United Healthcare Select/Navigate/Core	$31,483.00

MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC

Facility

$113,477.61

Service Code	MSDRG 470
Min. Negotiated Rate	$23,467.00
Max. Negotiated Rate	$113,477.61
Rate for Payer: Aetna of CA HMO/PPO	$58,476.53
Rate for Payer: EPIC Health Plan Commercial	$113,477.61
Rate for Payer: EPIC Health Plan Senior	$75,651.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$68,774.31
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$96,284.03
Rate for Payer: Molina Healthcare of CA Medicare	$92,157.58
Rate for Payer: United Healthcare All Other Commercial	$53,685.00
Rate for Payer: United Healthcare All Other HMO	$53,685.00
Rate for Payer: United Healthcare HMO Rider	$25,615.00
Rate for Payer: United Healthcare Select/Navigate/Core	$23,467.00

MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES

Facility

$128,436.51

Service Code	MSDRG 483
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$128,436.51
Rate for Payer: Aetna of CA HMO/PPO	$84,032.92
Rate for Payer: EPIC Health Plan Commercial	$128,436.51
Rate for Payer: EPIC Health Plan Senior	$85,624.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$77,840.31
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$108,976.43
Rate for Payer: Molina Healthcare of CA Medicare	$104,306.02
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

MAJOR LARGE BOWEL PROCEDURES

Facility

$113,594.77

Service Code	APR-DRG 2314
Min. Negotiated Rate	$90,726.35
Max. Negotiated Rate	$113,594.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$90,726.35
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$113,594.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$101,637.42

MAJOR LARGE BOWEL PROCEDURES

Facility

$32,828.37

Service Code	APR-DRG 2311
Min. Negotiated Rate	$26,219.50
Max. Negotiated Rate	$32,828.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$26,219.50
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$32,828.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,372.75

MAJOR LARGE BOWEL PROCEDURES

Facility

$40,882.51

Service Code	APR-DRG 2312
Min. Negotiated Rate	$32,652.21
Max. Negotiated Rate	$40,882.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$32,652.21
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$40,882.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$36,579.09

MAJOR LARGE BOWEL PROCEDURES

Facility

$57,798.40

Service Code	APR-DRG 2313
Min. Negotiated Rate	$46,162.67
Max. Negotiated Rate	$57,798.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$46,162.67
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$57,798.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$51,714.36

MAJOR MALE PELVIC PROCEDURES WITH CC/MCC

Facility

$114,744.60

Service Code	MSDRG 707
Min. Negotiated Rate	$22,398.00
Max. Negotiated Rate	$114,744.60
Rate for Payer: Aetna of CA HMO/PPO	$60,641.09
Rate for Payer: EPIC Health Plan Commercial	$114,744.60
Rate for Payer: EPIC Health Plan Senior	$76,496.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$69,542.18
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$97,359.05
Rate for Payer: Molina Healthcare of CA Medicare	$93,186.52
Rate for Payer: United Healthcare All Other Commercial	$24,996.00
Rate for Payer: United Healthcare All Other HMO	$24,996.00
Rate for Payer: United Healthcare HMO Rider	$24,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,398.00

MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC

Facility

$106,473.74

Service Code	MSDRG 708
Min. Negotiated Rate	$22,398.00
Max. Negotiated Rate	$106,473.74
Rate for Payer: Aetna of CA HMO/PPO	$46,510.81
Rate for Payer: EPIC Health Plan Commercial	$106,473.74
Rate for Payer: EPIC Health Plan Senior	$70,982.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$64,529.54
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$90,341.36
Rate for Payer: Molina Healthcare of CA Medicare	$86,469.58
Rate for Payer: United Healthcare All Other Commercial	$24,996.00
Rate for Payer: United Healthcare All Other HMO	$24,996.00
Rate for Payer: United Healthcare HMO Rider	$24,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,398.00

MAJOR O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS

Facility

$176,199.33

Service Code	APR-DRG 6804
Min. Negotiated Rate	$140,727.62
Max. Negotiated Rate	$176,199.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$140,727.62
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$176,199.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$157,652.03

MAJOR O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS

Facility

$33,228.09

Service Code	APR-DRG 6801
Min. Negotiated Rate	$26,538.75
Max. Negotiated Rate	$33,228.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$26,538.75
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$33,228.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,730.40

MAJOR O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS

Facility

$45,515.96

Service Code	APR-DRG 6802
Min. Negotiated Rate	$36,352.88
Max. Negotiated Rate	$45,515.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$36,352.88
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$45,515.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$40,724.81

MAJOR O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS

Facility

$72,158.26

Service Code	APR-DRG 6803
Min. Negotiated Rate	$57,631.66
Max. Negotiated Rate	$72,158.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$57,631.66
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$72,158.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$64,562.65

MAJOR PANCREAS, LIVER AND SHUNT PROCEDURES

Facility

$37,002.29

Service Code	APR-DRG 2601
Min. Negotiated Rate	$29,553.15
Max. Negotiated Rate	$37,002.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$29,553.15
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$37,002.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$33,107.31

MAJOR PANCREAS, LIVER AND SHUNT PROCEDURES

Facility

$156,146.56

Service Code	APR-DRG 2604
Min. Negotiated Rate	$124,711.79
Max. Negotiated Rate	$156,146.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$124,711.79
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$156,146.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$139,710.08

MAJOR PANCREAS, LIVER AND SHUNT PROCEDURES

Facility

$52,588.49

Service Code	APR-DRG 2602
Min. Negotiated Rate	$42,001.59
Max. Negotiated Rate	$52,588.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$42,001.59
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$52,588.49
Rate for Payer: Molina Healthcare of CA Medi-Cal	$47,052.86

Know your out-of-pocket cost for care.

All Charges