Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC

Facility

$112,796.21

Service Code	MSDRG 717
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$112,796.21
Rate for Payer: Aetna of CA HMO/PPO	$57,312.40
Rate for Payer: EPIC Health Plan Commercial	$112,796.21
Rate for Payer: EPIC Health Plan Senior	$75,197.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$68,361.34
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$95,705.88
Rate for Payer: Molina Healthcare of CA Medicare	$91,604.20
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 MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC

Facility

$103,082.69

Service Code	MSDRG 718
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$103,082.69
Rate for Payer: Aetna of CA HMO/PPO	$40,717.42
Rate for Payer: EPIC Health Plan Commercial	$103,082.69
Rate for Payer: EPIC Health Plan Senior	$68,721.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$62,474.36
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$87,464.10
Rate for Payer: Molina Healthcare of CA Medicare	$83,715.64
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 MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC

Facility

$118,950.12

Service Code	MSDRG 715
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$118,950.12
Rate for Payer: Aetna of CA HMO/PPO	$67,825.99
Rate for Payer: EPIC Health Plan Commercial	$118,950.12
Rate for Payer: EPIC Health Plan Senior	$79,300.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$72,090.98
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$100,927.37
Rate for Payer: Molina Healthcare of CA Medicare	$96,601.91
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 MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC

Facility

$105,352.25

Service Code	MSDRG 716
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$105,352.25
Rate for Payer: Aetna of CA HMO/PPO	$44,594.84
Rate for Payer: EPIC Health Plan Commercial	$105,352.25
Rate for Payer: EPIC Health Plan Senior	$70,234.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$63,849.85
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$89,389.79
Rate for Payer: Molina Healthcare of CA Medicare	$85,558.80
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 MENTAL DISORDER DIAGNOSES

Facility

$98,252.53

Service Code	MSDRG 887
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$98,252.53
Rate for Payer: Aetna of CA HMO/PPO	$32,465.40
Rate for Payer: EPIC Health Plan Commercial	$98,252.53
Rate for Payer: EPIC Health Plan Senior	$65,501.69
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$59,546.99
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$83,365.79
Rate for Payer: Molina Healthcare of CA Medicare	$79,792.97
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 MENTAL HEALTH CONDITIONS AND DISORDERS

Facility

$11,265.37

Service Code	APR-DRG 7603
Min. Negotiated Rate	$8,997.47
Max. Negotiated Rate	$11,265.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,997.47
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$11,265.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,079.54

OTHER MENTAL HEALTH CONDITIONS AND DISORDERS

Facility

$6,090.91

Service Code	APR-DRG 7601
Min. Negotiated Rate	$4,864.71
Max. Negotiated Rate	$6,090.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$4,864.71
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$6,090.91
Rate for Payer: Molina Healthcare of CA Medi-Cal	$5,449.76

OTHER MENTAL HEALTH CONDITIONS AND DISORDERS

Facility

$8,284.36

Service Code	APR-DRG 7602
Min. Negotiated Rate	$6,616.59
Max. Negotiated Rate	$8,284.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,616.59
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$8,284.36
Rate for Payer: Molina Healthcare of CA Medi-Cal	$7,412.32

OTHER MENTAL HEALTH CONDITIONS AND DISORDERS

Facility

$22,677.77

Service Code	APR-DRG 7604
Min. Negotiated Rate	$18,112.38
Max. Negotiated Rate	$22,677.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$18,112.38
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$22,677.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,290.64

OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$106,445.33

Service Code	MSDRG 964
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$106,445.33
Rate for Payer: Aetna of CA HMO/PPO	$46,462.30
Rate for Payer: EPIC Health Plan Commercial	$106,445.33
Rate for Payer: EPIC Health Plan Senior	$70,963.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$64,512.32
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$90,317.25
Rate for Payer: Molina Healthcare of CA Medicare	$86,446.51
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 MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$127,760.42

Service Code	MSDRG 963
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$127,760.42
Rate for Payer: Aetna of CA HMO/PPO	$82,877.88
Rate for Payer: EPIC Health Plan Commercial	$127,760.42
Rate for Payer: EPIC Health Plan Senior	$85,173.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$77,430.56
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$108,402.78
Rate for Payer: Molina Healthcare of CA Medicare	$103,756.95
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 MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$95,938.62

Service Code	MSDRG 965
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$95,938.62
Rate for Payer: Aetna of CA HMO/PPO	$28,512.20
Rate for Payer: EPIC Health Plan Commercial	$95,938.62
Rate for Payer: EPIC Health Plan Senior	$63,959.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$58,144.62
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$81,402.47
Rate for Payer: Molina Healthcare of CA Medicare	$77,913.79
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 MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES

Facility

$20,719.97

Service Code	APR-DRG 3513
Min. Negotiated Rate	$16,548.72
Max. Negotiated Rate	$20,719.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16,548.72
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$20,719.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,538.92

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES

Facility

$10,683.57

Service Code	APR-DRG 3511
Min. Negotiated Rate	$8,532.80
Max. Negotiated Rate	$10,683.57
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,532.80
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$10,683.57
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,558.98

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES

Facility

$47,511.21

Service Code	APR-DRG 3514
Min. Negotiated Rate	$37,946.45
Max. Negotiated Rate	$47,511.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$37,946.45
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$47,511.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,510.03

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES

Facility

$14,134.18

Service Code	APR-DRG 3512
Min. Negotiated Rate	$11,288.74
Max. Negotiated Rate	$14,134.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,288.74
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$14,134.18
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,646.37

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC

Facility

$96,540.15

Service Code	MSDRG 565
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$96,540.15
Rate for Payer: Aetna of CA HMO/PPO	$29,539.91
Rate for Payer: EPIC Health Plan Commercial	$96,540.15
Rate for Payer: EPIC Health Plan Senior	$64,360.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$58,509.18
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$81,912.85
Rate for Payer: Molina Healthcare of CA Medicare	$78,402.30
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 MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC

Facility

$106,640.52

Service Code	MSDRG 564
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$106,640.52
Rate for Payer: Aetna of CA HMO/PPO	$46,795.78
Rate for Payer: EPIC Health Plan Commercial	$106,640.52
Rate for Payer: EPIC Health Plan Senior	$71,093.68
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$64,630.62
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$90,482.87
Rate for Payer: Molina Healthcare of CA Medicare	$86,605.03
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 MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC

Facility

$92,545.81

Service Code	MSDRG 566
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$92,545.81
Rate for Payer: Aetna of CA HMO/PPO	$22,715.78
Rate for Payer: EPIC Health Plan Commercial	$92,545.81
Rate for Payer: EPIC Health Plan Senior	$61,697.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$56,088.37
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$78,523.72
Rate for Payer: Molina Healthcare of CA Medicare	$75,158.42
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 MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC

Facility

$116,125.14

Service Code	MSDRG 516
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$116,125.14
Rate for Payer: Aetna of CA HMO/PPO	$62,999.68
Rate for Payer: EPIC Health Plan Commercial	$116,125.14
Rate for Payer: EPIC Health Plan Senior	$77,416.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$70,378.87
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$98,530.42
Rate for Payer: Molina Healthcare of CA Medicare	$94,307.69
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 MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC

Facility

$135,800.61

Service Code	MSDRG 515
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$135,800.61
Rate for Payer: Aetna of CA HMO/PPO	$96,614.06
Rate for Payer: EPIC Health Plan Commercial	$135,800.61
Rate for Payer: EPIC Health Plan Senior	$90,533.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$82,303.40
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$115,224.76
Rate for Payer: Molina Healthcare of CA Medicare	$110,286.56
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 MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC

Facility

$106,518.08

Service Code	MSDRG 517
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$106,518.08
Rate for Payer: Aetna of CA HMO/PPO	$46,586.60
Rate for Payer: EPIC Health Plan Commercial	$106,518.08
Rate for Payer: EPIC Health Plan Senior	$71,012.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$64,556.41
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$90,378.97
Rate for Payer: Molina Healthcare of CA Medicare	$86,505.59
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 MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE PROCEDURES

Facility

$23,387.46

Service Code	APR-DRG 3201
Min. Negotiated Rate	$18,679.20
Max. Negotiated Rate	$23,387.46
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$18,679.20
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$23,387.46
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,925.62

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE PROCEDURES

Facility

$32,657.07

Service Code	APR-DRG 3202
Min. Negotiated Rate	$26,082.68
Max. Negotiated Rate	$32,657.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$26,082.68
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$32,657.07
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,219.48

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE PROCEDURES

Facility

$47,310.61

Service Code	APR-DRG 3203
Min. Negotiated Rate	$37,786.24
Max. Negotiated Rate	$47,310.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$37,786.24
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$47,310.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,330.54

Know your out-of-pocket cost for care.

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