Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

OTHER CARDIOTHORACIC PROCEDURES WITH MCC

Facility

$167,040.37

Service Code	MSDRG 228
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$167,040.37
Rate for Payer: Aetna of CA HMO/PPO	$149,985.38
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$167,040.37
Rate for Payer: EPIC Health Plan Senior	$111,360.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$101,236.59
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$141,731.23
Rate for Payer: Molina Healthcare of CA Medicare	$135,657.03
Rate for Payer: United Healthcare All Other Commercial	$120,397.00
Rate for Payer: United Healthcare All Other HMO	$120,397.00
Rate for Payer: United Healthcare HMO Rider	$86,872.00
Rate for Payer: United Healthcare Select/Navigate/Core	$79,589.00

OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC

Facility

$135,136.93

Service Code	MSDRG 229
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$135,136.93
Rate for Payer: Aetna of CA HMO/PPO	$95,480.24
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$135,136.93
Rate for Payer: EPIC Health Plan Senior	$90,091.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$81,901.17
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$114,661.64
Rate for Payer: Molina Healthcare of CA Medicare	$109,747.57
Rate for Payer: United Healthcare All Other Commercial	$71,243.00
Rate for Payer: United Healthcare All Other HMO	$71,243.00
Rate for Payer: United Healthcare HMO Rider	$68,556.00
Rate for Payer: United Healthcare Select/Navigate/Core	$62,809.00

OTHER CEREBROVASCULAR DISORDERS WITH CC

Facility

$97,455.80

Service Code	MSDRG 071
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$97,455.80
Rate for Payer: Aetna of CA HMO/PPO	$31,104.22
Rate for Payer: EPIC Health Plan Commercial	$97,455.80
Rate for Payer: EPIC Health Plan Senior	$64,970.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$59,064.12
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$82,689.77
Rate for Payer: Molina Healthcare of CA Medicare	$79,145.92
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

OTHER CEREBROVASCULAR DISORDERS WITH MCC

Facility

$108,791.20

Service Code	MSDRG 070
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$108,791.20
Rate for Payer: Aetna of CA HMO/PPO	$50,470.08
Rate for Payer: EPIC Health Plan Commercial	$108,791.20
Rate for Payer: EPIC Health Plan Senior	$72,527.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$65,934.06
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$92,307.68
Rate for Payer: Molina Healthcare of CA Medicare	$88,351.64
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

OTHER CEREBROVASCULAR DISORDERS WITHOUT CC/MCC

Facility

$92,668.24

Service Code	MSDRG 072
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$92,668.24
Rate for Payer: Aetna of CA HMO/PPO	$22,924.96
Rate for Payer: EPIC Health Plan Commercial	$92,668.24
Rate for Payer: EPIC Health Plan Senior	$61,778.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$56,162.57
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$78,627.60
Rate for Payer: Molina Healthcare of CA Medicare	$75,257.84
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

OTHER CHEMOTHERAPY

Facility

$25,967.95

Service Code	APR-DRG 6963
Min. Negotiated Rate	$20,740.19
Max. Negotiated Rate	$25,967.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$20,740.19
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$25,967.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,234.48

OTHER CHEMOTHERAPY

Facility

$13,489.73

Service Code	APR-DRG 6961
Min. Negotiated Rate	$10,774.04
Max. Negotiated Rate	$13,489.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,774.04
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$13,489.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,069.76

OTHER CHEMOTHERAPY

Facility

$63,041.62

Service Code	APR-DRG 6964
Min. Negotiated Rate	$50,350.35
Max. Negotiated Rate	$63,041.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$50,350.35
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$63,041.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$56,405.66

OTHER CHEMOTHERAPY

Facility

$17,239.46

Service Code	APR-DRG 6962
Min. Negotiated Rate	$13,768.88
Max. Negotiated Rate	$17,239.46
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,768.88
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$17,239.46
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,424.78

OTHER CIRCULATORY SYSTEM DIAGNOSES

Facility

$11,001.70

Service Code	APR-DRG 2071
Min. Negotiated Rate	$8,786.89
Max. Negotiated Rate	$11,001.70
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,786.89
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$11,001.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,843.63

OTHER CIRCULATORY SYSTEM DIAGNOSES

Facility

$14,384.33

Service Code	APR-DRG 2072
Min. Negotiated Rate	$11,488.54
Max. Negotiated Rate	$14,384.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,488.54
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$14,384.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,870.19

OTHER CIRCULATORY SYSTEM DIAGNOSES

Facility

$20,477.97

Service Code	APR-DRG 2073
Min. Negotiated Rate	$16,355.43
Max. Negotiated Rate	$20,477.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16,355.43
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$20,477.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,322.40

OTHER CIRCULATORY SYSTEM DIAGNOSES

Facility

$48,900.00

Service Code	APR-DRG 2074
Min. Negotiated Rate	$39,055.65
Max. Negotiated Rate	$48,900.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$39,055.65
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$48,900.00
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,752.63

OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC

Facility

$96,343.22

Service Code	MSDRG 315
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$96,343.22
Rate for Payer: Aetna of CA HMO/PPO	$29,203.40
Rate for Payer: EPIC Health Plan Commercial	$96,343.22
Rate for Payer: EPIC Health Plan Senior	$64,228.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$58,389.83
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$81,745.76
Rate for Payer: Molina Healthcare of CA Medicare	$78,242.37
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

OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC

Facility

$116,251.13

Service Code	MSDRG 314
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$116,251.13
Rate for Payer: Aetna of CA HMO/PPO	$63,214.92
Rate for Payer: EPIC Health Plan Commercial	$116,251.13
Rate for Payer: EPIC Health Plan Senior	$77,500.75
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$70,455.23
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$98,637.32
Rate for Payer: Molina Healthcare of CA Medicare	$94,410.01
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

OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$91,353.36

Service Code	MSDRG 316
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$91,353.36
Rate for Payer: Aetna of CA HMO/PPO	$20,678.54
Rate for Payer: EPIC Health Plan Commercial	$91,353.36
Rate for Payer: EPIC Health Plan Senior	$60,902.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$55,365.67
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$77,511.94
Rate for Payer: Molina Healthcare of CA Medicare	$74,190.00
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

OTHER CIRCULATORY SYSTEM O.R. PROCEDURES

Facility

$138,527.99

Service Code	MSDRG 264
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$138,527.99
Rate for Payer: Aetna of CA HMO/PPO	$101,273.63
Rate for Payer: EPIC Health Plan Commercial	$138,527.99
Rate for Payer: EPIC Health Plan Senior	$92,352.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$83,956.36
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$117,538.90
Rate for Payer: Molina Healthcare of CA Medicare	$112,501.52
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

OTHER CIRCULATORY SYSTEM PROCEDURES

Facility

$104,373.82

Service Code	APR-DRG 1804
Min. Negotiated Rate	$83,361.72
Max. Negotiated Rate	$104,373.82
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$83,361.72
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$104,373.82
Rate for Payer: Molina Healthcare of CA Medi-Cal	$93,387.10

OTHER CIRCULATORY SYSTEM PROCEDURES

Facility

$31,357.31

Service Code	APR-DRG 1802
Min. Negotiated Rate	$25,044.59
Max. Negotiated Rate	$31,357.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$25,044.59
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$31,357.31
Rate for Payer: Molina Healthcare of CA Medi-Cal	$28,056.54

OTHER CIRCULATORY SYSTEM PROCEDURES

Facility

$46,114.18

Service Code	APR-DRG 1803
Min. Negotiated Rate	$36,830.67
Max. Negotiated Rate	$46,114.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$36,830.67
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$46,114.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$41,260.05

OTHER CIRCULATORY SYSTEM PROCEDURES

Facility

$26,778.26

Service Code	APR-DRG 1801
Min. Negotiated Rate	$21,387.37
Max. Negotiated Rate	$26,778.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$21,387.37
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$26,778.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,959.49

OTHER COMPLICATIONS OF TREATMENT

Facility

$48,466.45

Service Code	APR-DRG 8134
Min. Negotiated Rate	$38,709.39
Max. Negotiated Rate	$48,466.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$38,709.39
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$48,466.45
Rate for Payer: Molina Healthcare of CA Medi-Cal	$43,364.72

OTHER COMPLICATIONS OF TREATMENT

Facility

$15,278.94

Service Code	APR-DRG 8132
Min. Negotiated Rate	$12,203.05
Max. Negotiated Rate	$15,278.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,203.05
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$15,278.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,670.64

OTHER COMPLICATIONS OF TREATMENT

Facility

$21,889.22

Service Code	APR-DRG 8133
Min. Negotiated Rate	$17,482.57
Max. Negotiated Rate	$21,889.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,482.57
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$21,889.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,585.09

OTHER COMPLICATIONS OF TREATMENT

Facility

$11,531.94

Service Code	APR-DRG 8131
Min. Negotiated Rate	$9,210.38
Max. Negotiated Rate	$11,531.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,210.38
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$11,531.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,318.05

Know your out-of-pocket cost for care.

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