Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

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 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC

Facility

$100,852.17

Service Code	MSDRG 844
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$100,852.17
Rate for Payer: Aetna of CA HMO/PPO	$36,906.70
Rate for Payer: EPIC Health Plan Commercial	$100,852.17
Rate for Payer: EPIC Health Plan Senior	$67,234.78
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$61,122.53
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$85,571.54
Rate for Payer: Molina Healthcare of CA Medicare	$81,904.19
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 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC

Facility

$114,646.98

Service Code	MSDRG 843
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$114,646.98
Rate for Payer: Aetna of CA HMO/PPO	$60,474.36
Rate for Payer: EPIC Health Plan Commercial	$114,646.98
Rate for Payer: EPIC Health Plan Senior	$76,431.32
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$69,483.02
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$97,276.23
Rate for Payer: Molina Healthcare of CA Medicare	$93,107.25
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 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC

Facility

$94,361.11

Service Code	MSDRG 845
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$94,361.11
Rate for Payer: Aetna of CA HMO/PPO	$25,817.11
Rate for Payer: EPIC Health Plan Commercial	$94,361.11
Rate for Payer: EPIC Health Plan Senior	$62,907.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$57,188.55
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$80,063.97
Rate for Payer: Molina Healthcare of CA Medicare	$76,632.66
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 NERVOUS SYSTEM AND RELATED PROCEDURES

Facility

$39,047.09

Service Code	APR-DRG 0262
Min. Negotiated Rate	$31,186.29
Max. Negotiated Rate	$39,047.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$31,186.29
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$39,047.09
Rate for Payer: Molina Healthcare of CA Medi-Cal	$34,936.87

OTHER NERVOUS SYSTEM AND RELATED PROCEDURES

Facility

$52,226.84

Service Code	APR-DRG 0263
Min. Negotiated Rate	$41,712.75
Max. Negotiated Rate	$52,226.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$41,712.75
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$52,226.84
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,729.28

OTHER NERVOUS SYSTEM AND RELATED PROCEDURES

Facility

$109,023.06

Service Code	APR-DRG 0264
Min. Negotiated Rate	$87,075.00
Max. Negotiated Rate	$109,023.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$87,075.00
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$109,023.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$97,546.95

OTHER NERVOUS SYSTEM AND RELATED PROCEDURES

Facility

$26,753.79

Service Code	APR-DRG 0261
Min. Negotiated Rate	$21,367.83
Max. Negotiated Rate	$26,753.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$21,367.83
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$26,753.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,937.60

OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS

Facility

$9,927.63

Service Code	APR-DRG 4251
Min. Negotiated Rate	$7,929.04
Max. Negotiated Rate	$9,927.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,929.04
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$9,927.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,882.62

OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS

Facility

$44,025.17

Service Code	APR-DRG 4254
Min. Negotiated Rate	$35,162.20
Max. Negotiated Rate	$44,025.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$35,162.20
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$44,025.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$39,390.94

OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS

Facility

$12,377.61

Service Code	APR-DRG 4252
Min. Negotiated Rate	$9,885.80
Max. Negotiated Rate	$12,377.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,885.80
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$12,377.61
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,074.70

OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS

Facility

$17,611.97

Service Code	APR-DRG 4253
Min. Negotiated Rate	$14,066.41
Max. Negotiated Rate	$17,611.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$14,066.41
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$17,611.97
Rate for Payer: Molina Healthcare of CA Medi-Cal	$15,758.08

OTHER OPEN CRANIOTOMY

Facility

$35,544.82

Service Code	APR-DRG 0271
Min. Negotiated Rate	$28,389.09
Max. Negotiated Rate	$35,544.82
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$28,389.09
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$35,544.82
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,803.26

OTHER OPEN CRANIOTOMY

Facility

$70,659.99

Service Code	APR-DRG 0273
Min. Negotiated Rate	$56,435.02
Max. Negotiated Rate	$70,659.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$56,435.02
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$70,659.99
Rate for Payer: Molina Healthcare of CA Medi-Cal	$63,222.10

OTHER OPEN CRANIOTOMY

Facility

$129,664.49

Service Code	APR-DRG 0274
Min. Negotiated Rate	$103,560.98
Max. Negotiated Rate	$129,664.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$103,560.98
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$129,664.49
Rate for Payer: Molina Healthcare of CA Medi-Cal	$116,015.60

OTHER OPEN CRANIOTOMY

Facility

$46,435.03

Service Code	APR-DRG 0272
Min. Negotiated Rate	$37,086.93
Max. Negotiated Rate	$46,435.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$37,086.93
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$46,435.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$41,547.13

OTHER O.R. PROCEDURES FOR INJURIES WITH CC

Facility

$114,654.08

Service Code	MSDRG 908
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$114,654.08
Rate for Payer: Aetna of CA HMO/PPO	$60,486.48
Rate for Payer: EPIC Health Plan Commercial	$114,654.08
Rate for Payer: EPIC Health Plan Senior	$76,436.05
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$69,487.32
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$97,282.25
Rate for Payer: Molina Healthcare of CA Medicare	$93,113.01
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 O.R. PROCEDURES FOR INJURIES WITH MCC

Facility

$147,377.34

Service Code	MSDRG 907
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$147,377.34
Rate for Payer: Aetna of CA HMO/PPO	$116,392.22
Rate for Payer: EPIC Health Plan Commercial	$147,377.34
Rate for Payer: EPIC Health Plan Senior	$98,251.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$89,319.60
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$125,047.44
Rate for Payer: Molina Healthcare of CA Medicare	$119,688.26
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 O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC

Facility

$102,543.24

Service Code	MSDRG 909
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$102,543.24
Rate for Payer: Aetna of CA HMO/PPO	$39,795.81
Rate for Payer: EPIC Health Plan Commercial	$102,543.24
Rate for Payer: EPIC Health Plan Senior	$68,362.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$62,147.42
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$87,006.39
Rate for Payer: Molina Healthcare of CA Medicare	$83,277.54
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 O.R. PROCEDURES FOR LYMPHATIC, HEMATOPOIETIC OR OTHER NEOPLASMS

Facility

$25,821.11

Service Code	APR-DRG 6811
Min. Negotiated Rate	$20,622.92
Max. Negotiated Rate	$25,821.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$20,622.92
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$25,821.11
Rate for Payer: Molina Healthcare of CA Medi-Cal	$23,103.10

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

Facility

$33,943.23

Service Code	APR-DRG 6812
Min. Negotiated Rate	$27,109.93
Max. Negotiated Rate	$33,943.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$27,109.93
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$33,943.23
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,370.26

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

Facility

$52,909.34

Service Code	APR-DRG 6813
Min. Negotiated Rate	$42,257.85
Max. Negotiated Rate	$52,909.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$42,257.85
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$52,909.34
Rate for Payer: Molina Healthcare of CA Medi-Cal	$47,339.93

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

Facility

$142,427.91

Service Code	APR-DRG 6814
Min. Negotiated Rate	$113,754.93
Max. Negotiated Rate	$142,427.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$113,754.93
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$142,427.91
Rate for Payer: Molina Healthcare of CA Medi-Cal	$127,435.50

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$154,024.53

Service Code	MSDRG 958
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$154,024.53
Rate for Payer: Aetna of CA HMO/PPO	$127,748.59
Rate for Payer: EPIC Health Plan Commercial	$154,024.53
Rate for Payer: EPIC Health Plan Senior	$102,683.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$93,348.20
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$130,687.48
Rate for Payer: Molina Healthcare of CA Medicare	$125,086.59
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 O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$231,004.89

Service Code	MSDRG 957
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$231,004.89
Rate for Payer: Aetna of CA HMO/PPO	$231,004.89
Rate for Payer: EPIC Health Plan Commercial	$214,463.40
Rate for Payer: EPIC Health Plan Senior	$142,975.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$129,977.82
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$181,968.95
Rate for Payer: Molina Healthcare of CA Medicare	$174,170.28
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