Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

OTHER DIGESTIVE SYSTEM AND ABDOMINAL PROCEDURES

Facility

$24,154.26

Service Code	APR-DRG 2291
Min. Negotiated Rate	$19,291.63
Max. Negotiated Rate	$24,154.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$19,291.63
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$24,154.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,611.71

OTHER DIGESTIVE SYSTEM AND ABDOMINAL PROCEDURES

Facility

$33,815.42

Service Code	APR-DRG 2292
Min. Negotiated Rate	$27,007.84
Max. Negotiated Rate	$33,815.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$27,007.84
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$33,815.42
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,255.90

OTHER DIGESTIVE SYSTEM AND ABDOMINAL PROCEDURES

Facility

$107,584.93

Service Code	APR-DRG 2294
Min. Negotiated Rate	$85,926.39
Max. Negotiated Rate	$107,584.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$85,926.39
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$107,584.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$96,260.21

OTHER DIGESTIVE SYSTEM AND ABDOMINAL PROCEDURES

Facility

$51,568.81

Service Code	APR-DRG 2293
Min. Negotiated Rate	$41,187.20
Max. Negotiated Rate	$51,568.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$41,187.20
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$51,568.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,140.52

OTHER DIGESTIVE SYSTEM DIAGNOSES

Facility

$47,891.89

Service Code	APR-DRG 2544
Min. Negotiated Rate	$38,250.50
Max. Negotiated Rate	$47,891.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$38,250.50
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$47,891.89
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,850.64

OTHER DIGESTIVE SYSTEM DIAGNOSES

Facility

$22,166.56

Service Code	APR-DRG 2543
Min. Negotiated Rate	$17,704.08
Max. Negotiated Rate	$22,166.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,704.08
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$22,166.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,833.24

OTHER DIGESTIVE SYSTEM DIAGNOSES

Facility

$15,390.42

Service Code	APR-DRG 2542
Min. Negotiated Rate	$12,292.08
Max. Negotiated Rate	$15,390.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,292.08
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$15,390.42
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,770.37

OTHER DIGESTIVE SYSTEM DIAGNOSES

Facility

$11,173.01

Service Code	APR-DRG 2541
Min. Negotiated Rate	$8,923.70
Max. Negotiated Rate	$11,173.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,923.70
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$11,173.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,996.90

OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC

Facility

$95,853.43

Service Code	MSDRG 394
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$95,853.43
Rate for Payer: Aetna of CA HMO/PPO	$28,366.68
Rate for Payer: EPIC Health Plan Commercial	$95,853.43
Rate for Payer: EPIC Health Plan Senior	$63,902.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$58,092.99
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$81,330.19
Rate for Payer: Molina Healthcare of CA Medicare	$77,844.61
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

OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC

Facility

$107,628.91

Service Code	MSDRG 393
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$107,628.91
Rate for Payer: Aetna of CA HMO/PPO	$48,484.38
Rate for Payer: EPIC Health Plan Commercial	$107,628.91
Rate for Payer: EPIC Health Plan Senior	$71,752.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$65,229.64
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$91,321.50
Rate for Payer: Molina Healthcare of CA Medicare	$87,407.72
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 DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$90,766.01

Service Code	MSDRG 395
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$90,766.01
Rate for Payer: Aetna of CA HMO/PPO	$19,675.08
Rate for Payer: EPIC Health Plan Commercial	$90,766.01
Rate for Payer: EPIC Health Plan Senior	$60,510.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$55,009.70
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$77,013.58
Rate for Payer: Molina Healthcare of CA Medicare	$73,713.00
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 DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC

Facility

$120,515.21

Service Code	MSDRG 357
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$120,515.21
Rate for Payer: Aetna of CA HMO/PPO	$70,499.86
Rate for Payer: EPIC Health Plan Commercial	$120,515.21
Rate for Payer: EPIC Health Plan Senior	$80,343.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$73,039.52
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$102,255.33
Rate for Payer: Molina Healthcare of CA Medicare	$97,872.96
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 DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC

Facility

$157,199.08

Service Code	MSDRG 356
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$157,199.08
Rate for Payer: Aetna of CA HMO/PPO	$133,172.12
Rate for Payer: EPIC Health Plan Commercial	$157,199.08
Rate for Payer: EPIC Health Plan Senior	$104,799.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$95,272.17
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$133,381.04
Rate for Payer: Molina Healthcare of CA Medicare	$127,664.71
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 DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$104,055.10

Service Code	MSDRG 358
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$104,055.10
Rate for Payer: Aetna of CA HMO/PPO	$42,378.74
Rate for Payer: EPIC Health Plan Commercial	$104,055.10
Rate for Payer: EPIC Health Plan Senior	$69,370.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$63,063.70
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$88,289.18
Rate for Payer: Molina Healthcare of CA Medicare	$84,505.36
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 DISORDERS OF NERVOUS SYSTEM

Facility

$22,065.95

Service Code	APR-DRG 0582
Min. Negotiated Rate	$17,623.73
Max. Negotiated Rate	$22,065.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,623.73
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$22,065.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,743.22

OTHER DISORDERS OF NERVOUS SYSTEM

Facility

$30,979.35

Service Code	APR-DRG 0583
Min. Negotiated Rate	$24,742.72
Max. Negotiated Rate	$30,979.35
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$24,742.72
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$30,979.35
Rate for Payer: Molina Healthcare of CA Medi-Cal	$27,718.36

OTHER DISORDERS OF NERVOUS SYSTEM

Facility

$14,732.39

Service Code	APR-DRG 0581
Min. Negotiated Rate	$11,766.53
Max. Negotiated Rate	$14,732.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,766.53
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$14,732.39
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,181.61

OTHER DISORDERS OF NERVOUS SYSTEM

Facility

$53,411.79

Service Code	APR-DRG 0584
Min. Negotiated Rate	$42,659.16
Max. Negotiated Rate	$53,411.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$42,659.16
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$53,411.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$47,789.50

OTHER DISORDERS OF NERVOUS SYSTEM WITH CC

Facility

$97,402.57

Service Code	MSDRG 092
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$97,402.57
Rate for Payer: Aetna of CA HMO/PPO	$31,013.27
Rate for Payer: EPIC Health Plan Commercial	$97,402.57
Rate for Payer: EPIC Health Plan Senior	$64,935.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$59,031.86
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$82,644.60
Rate for Payer: Molina Healthcare of CA Medicare	$79,102.69
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 DISORDERS OF NERVOUS SYSTEM WITH MCC

Facility

$110,413.07

Service Code	MSDRG 091
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$110,413.07
Rate for Payer: Aetna of CA HMO/PPO	$53,240.96
Rate for Payer: EPIC Health Plan Commercial	$110,413.07
Rate for Payer: EPIC Health Plan Senior	$73,608.71
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$66,917.01
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$93,683.81
Rate for Payer: Molina Healthcare of CA Medicare	$89,668.79
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 DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility

$93,379.82

Service Code	MSDRG 093
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$93,379.82
Rate for Payer: Aetna of CA HMO/PPO	$24,140.63
Rate for Payer: EPIC Health Plan Commercial	$93,379.82
Rate for Payer: EPIC Health Plan Senior	$62,253.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$56,593.83
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$79,231.36
Rate for Payer: Molina Healthcare of CA Medicare	$75,835.73
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 DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT

Facility

$102,727.80

Service Code	MSDRG 124
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$102,727.80
Rate for Payer: Aetna of CA HMO/PPO	$40,111.10
Rate for Payer: EPIC Health Plan Commercial	$102,727.80
Rate for Payer: EPIC Health Plan Senior	$68,485.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$62,259.27
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$87,162.98
Rate for Payer: Molina Healthcare of CA Medicare	$83,427.42
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 DISORDERS OF THE EYE WITHOUT MCC

Facility

$92,874.11

Service Code	MSDRG 125
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$92,874.11
Rate for Payer: Aetna of CA HMO/PPO	$23,276.62
Rate for Payer: EPIC Health Plan Commercial	$92,874.11
Rate for Payer: EPIC Health Plan Senior	$61,916.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$56,287.34
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$78,802.28
Rate for Payer: Molina Healthcare of CA Medicare	$75,425.04
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 DISORDERS OF THE LIVER

Facility

$11,412.29

Service Code	APR-DRG 2831
Min. Negotiated Rate	$9,114.82
Max. Negotiated Rate	$11,412.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,114.82
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$11,412.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,211.00

OTHER DISORDERS OF THE LIVER

Facility

$23,169.93

Service Code	APR-DRG 2833
Min. Negotiated Rate	$18,505.46
Max. Negotiated Rate	$23,169.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$18,505.46
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$23,169.93
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,730.99

Know your out-of-pocket cost for care.

All Charges