Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC

Facility

$145,381.02

Service Code	MSDRG 628
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$145,381.02
Rate for Payer: Aetna of CA HMO/PPO	$112,981.67
Rate for Payer: EPIC Health Plan Commercial	$145,381.02
Rate for Payer: EPIC Health Plan Senior	$96,920.68
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$88,109.71
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$123,353.59
Rate for Payer: Molina Healthcare of CA Medicare	$118,067.01
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 ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC

Facility

$105,148.20

Service Code	MSDRG 630
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$105,148.20
Rate for Payer: Aetna of CA HMO/PPO	$44,246.20
Rate for Payer: EPIC Health Plan Commercial	$105,148.20
Rate for Payer: EPIC Health Plan Senior	$70,098.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$63,726.18
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$89,216.65
Rate for Payer: Molina Healthcare of CA Medicare	$85,393.08
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 ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC

Facility

$158,442.98

Service Code	MSDRG 319
Min. Negotiated Rate	$56,595.00
Max. Negotiated Rate	$158,442.98
Rate for Payer: Aetna of CA HMO/PPO	$135,297.28
Rate for Payer: EPIC Health Plan Commercial	$158,442.98
Rate for Payer: EPIC Health Plan Senior	$105,628.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$96,026.05
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$134,436.47
Rate for Payer: Molina Healthcare of CA Medicare	$128,674.91
Rate for Payer: United Healthcare All Other Commercial	$86,080.00
Rate for Payer: United Healthcare All Other HMO	$86,080.00
Rate for Payer: United Healthcare HMO Rider	$61,775.00
Rate for Payer: United Healthcare Select/Navigate/Core	$56,595.00

OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC

Facility

$121,931.22

Service Code	MSDRG 320
Min. Negotiated Rate	$32,402.00
Max. Negotiated Rate	$121,931.22
Rate for Payer: Aetna of CA HMO/PPO	$72,919.07
Rate for Payer: EPIC Health Plan Commercial	$121,931.22
Rate for Payer: EPIC Health Plan Senior	$81,287.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$73,897.71
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$103,456.79
Rate for Payer: Molina Healthcare of CA Medicare	$99,022.93
Rate for Payer: United Healthcare All Other Commercial	$49,280.00
Rate for Payer: United Healthcare All Other HMO	$49,280.00
Rate for Payer: United Healthcare HMO Rider	$35,366.00
Rate for Payer: United Healthcare Select/Navigate/Core	$32,402.00

OTHER ESOPHAGEAL DISORDERS

Facility

$52,837.23

Service Code	APR-DRG 2434
Min. Negotiated Rate	$42,200.26
Max. Negotiated Rate	$52,837.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$42,200.26
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$52,837.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$47,275.42

OTHER ESOPHAGEAL DISORDERS

Facility

$11,608.09

Service Code	APR-DRG 2431
Min. Negotiated Rate	$9,271.20
Max. Negotiated Rate	$11,608.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,271.20
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$11,608.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,386.18

OTHER ESOPHAGEAL DISORDERS

Facility

$22,346.03

Service Code	APR-DRG 2433
Min. Negotiated Rate	$17,847.42
Max. Negotiated Rate	$22,346.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,847.42
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$22,346.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,993.82

OTHER ESOPHAGEAL DISORDERS

Facility

$15,499.19

Service Code	APR-DRG 2432
Min. Negotiated Rate	$12,378.96
Max. Negotiated Rate	$15,499.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$12,378.96
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$15,499.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$13,867.70

OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$89,115.74

Service Code	MSDRG 951
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$89,115.74
Rate for Payer: Aetna of CA HMO/PPO	$16,855.70
Rate for Payer: EPIC Health Plan Commercial	$89,115.74
Rate for Payer: EPIC Health Plan Senior	$59,410.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$54,009.54
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$75,613.36
Rate for Payer: Molina Healthcare of CA Medicare	$72,372.78
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 FEMALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES

Facility

$17,954.58

Service Code	APR-DRG 5181
Min. Negotiated Rate	$14,340.04
Max. Negotiated Rate	$17,954.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$14,340.04
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$17,954.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,064.63

OTHER FEMALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES

Facility

$102,579.67

Service Code	APR-DRG 5184
Min. Negotiated Rate	$81,928.76
Max. Negotiated Rate	$102,579.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$81,928.76
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$102,579.67
Rate for Payer: Molina Healthcare of CA Medi-Cal	$91,781.81

OTHER FEMALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES

Facility

$46,201.18

Service Code	APR-DRG 5183
Min. Negotiated Rate	$36,900.15
Max. Negotiated Rate	$46,201.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$36,900.15
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$46,201.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$41,337.90

OTHER FEMALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES

Facility

$29,176.55

Service Code	APR-DRG 5182
Min. Negotiated Rate	$23,302.85
Max. Negotiated Rate	$29,176.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$23,302.85
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$29,176.55
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,105.34

OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC

Facility

$124,811.25

Service Code	MSDRG 749
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$124,811.25
Rate for Payer: Aetna of CA HMO/PPO	$77,839.36
Rate for Payer: EPIC Health Plan Commercial	$124,811.25
Rate for Payer: EPIC Health Plan Senior	$83,207.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$75,643.18
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$105,900.45
Rate for Payer: Molina Healthcare of CA Medicare	$101,361.86
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 FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$105,437.44

Service Code	MSDRG 750
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$105,437.44
Rate for Payer: Aetna of CA HMO/PPO	$44,740.35
Rate for Payer: EPIC Health Plan Commercial	$105,437.44
Rate for Payer: EPIC Health Plan Senior	$70,291.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$63,901.48
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$89,462.07
Rate for Payer: Molina Healthcare of CA Medicare	$85,627.98
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 GASTROENTERITIS, NAUSEA AND VOMITING

Facility

$18,278.17

Service Code	APR-DRG 2493
Min. Negotiated Rate	$14,598.49
Max. Negotiated Rate	$18,278.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$14,598.49
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$18,278.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$16,354.15

OTHER GASTROENTERITIS, NAUSEA AND VOMITING

Facility

$12,654.95

Service Code	APR-DRG 2492
Min. Negotiated Rate	$10,107.31
Max. Negotiated Rate	$12,654.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,107.31
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$12,654.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,322.85

OTHER GASTROENTERITIS, NAUSEA AND VOMITING

Facility

$10,036.41

Service Code	APR-DRG 2491
Min. Negotiated Rate	$8,015.92
Max. Negotiated Rate	$10,036.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,015.92
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$10,036.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,979.94

OTHER GASTROENTERITIS, NAUSEA AND VOMITING

Facility

$41,945.50

Service Code	APR-DRG 2494
Min. Negotiated Rate	$33,501.21
Max. Negotiated Rate	$41,945.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$33,501.21
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$41,945.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$37,530.19

OTHER GYN PROCEDURES FOR MALIGNANCY

Facility

$27,748.99

Service Code	APR-DRG 5201
Min. Negotiated Rate	$22,162.68
Max. Negotiated Rate	$27,748.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$22,162.68
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$27,748.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,828.04

OTHER GYN PROCEDURES FOR MALIGNANCY

Facility

$52,319.29

Service Code	APR-DRG 5203
Min. Negotiated Rate	$41,786.59
Max. Negotiated Rate	$52,319.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$41,786.59
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$52,319.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,812.00

OTHER GYN PROCEDURES FOR MALIGNANCY

Facility

$35,223.95

Service Code	APR-DRG 5202
Min. Negotiated Rate	$28,132.81
Max. Negotiated Rate	$35,223.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$28,132.81
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$35,223.95
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,516.16

OTHER GYN PROCEDURES FOR MALIGNANCY

Facility

$142,907.28

Service Code	APR-DRG 5204
Min. Negotiated Rate	$114,137.79
Max. Negotiated Rate	$142,907.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$114,137.79
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$142,907.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$127,864.41

OTHER HEART ASSIST SYSTEM IMPLANT

Facility

$301,856.41

Service Code	MSDRG 215
Min. Negotiated Rate	$144,650.00
Max. Negotiated Rate	$301,856.41
Rate for Payer: Aetna of CA HMO/PPO	$301,856.41
Rate for Payer: EPIC Health Plan Commercial	$255,934.83
Rate for Payer: EPIC Health Plan Senior	$170,623.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$155,112.02
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$217,156.83
Rate for Payer: Molina Healthcare of CA Medicare	$207,850.11
Rate for Payer: United Healthcare All Other Commercial	$200,732.00
Rate for Payer: United Healthcare All Other HMO	$200,732.00
Rate for Payer: United Healthcare HMO Rider	$157,887.00
Rate for Payer: United Healthcare Select/Navigate/Core	$144,650.00

OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC

Facility

$118,073.54

Service Code	MSDRG 424
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$118,073.54
Rate for Payer: Aetna of CA HMO/PPO	$66,328.38
Rate for Payer: EPIC Health Plan Commercial	$118,073.54
Rate for Payer: EPIC Health Plan Senior	$78,715.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$71,559.72
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$100,183.61
Rate for Payer: Molina Healthcare of CA Medicare	$95,890.02
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