Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC

Facility

$111,807.81

Service Code	MSDRG 742
Min. Negotiated Rate	$22,398.00
Max. Negotiated Rate	$111,807.81
Rate for Payer: Aetna of CA HMO/PPO	$55,623.80
Rate for Payer: EPIC Health Plan Commercial	$111,807.81
Rate for Payer: EPIC Health Plan Senior	$74,538.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$67,762.31
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$94,867.23
Rate for Payer: Molina Healthcare of CA Medicare	$90,801.50
Rate for Payer: United Healthcare All Other Commercial	$24,996.00
Rate for Payer: United Healthcare All Other HMO	$24,996.00
Rate for Payer: United Healthcare HMO Rider	$24,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,398.00

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC

Facility

$101,265.63

Service Code	MSDRG 743
Min. Negotiated Rate	$22,398.00
Max. Negotiated Rate	$101,265.63
Rate for Payer: Aetna of CA HMO/PPO	$37,613.06
Rate for Payer: EPIC Health Plan Commercial	$101,265.63
Rate for Payer: EPIC Health Plan Senior	$67,510.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$61,373.11
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$85,922.35
Rate for Payer: Molina Healthcare of CA Medicare	$82,239.97
Rate for Payer: United Healthcare All Other Commercial	$24,996.00
Rate for Payer: United Healthcare All Other HMO	$24,996.00
Rate for Payer: United Healthcare HMO Rider	$24,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,398.00

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY

Facility

$126,844.63

Service Code	APR-DRG 5124
Min. Negotiated Rate	$101,308.80
Max. Negotiated Rate	$126,844.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$101,308.80
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$126,844.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$113,492.56

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY

Facility

$33,124.77

Service Code	APR-DRG 5122
Min. Negotiated Rate	$26,456.23
Max. Negotiated Rate	$33,124.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$26,456.23
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$33,124.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,637.95

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY

Facility

$52,525.94

Service Code	APR-DRG 5123
Min. Negotiated Rate	$41,951.64
Max. Negotiated Rate	$52,525.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$41,951.64
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$52,525.94
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,996.89

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY

Facility

$28,224.84

Service Code	APR-DRG 5121
Min. Negotiated Rate	$22,542.74
Max. Negotiated Rate	$28,224.84
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$22,542.74
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$28,224.84
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,253.81

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC

Facility

$111,360.65

Service Code	MSDRG 740
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$111,360.65
Rate for Payer: Aetna of CA HMO/PPO	$54,859.83
Rate for Payer: EPIC Health Plan Commercial	$111,360.65
Rate for Payer: EPIC Health Plan Senior	$74,240.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$67,491.30
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$94,487.82
Rate for Payer: Molina Healthcare of CA Medicare	$90,438.34
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

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC

Facility

$142,825.77

Service Code	MSDRG 739
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$142,825.77
Rate for Payer: Aetna of CA HMO/PPO	$106,903.31
Rate for Payer: EPIC Health Plan Commercial	$142,825.77
Rate for Payer: EPIC Health Plan Senior	$95,217.18
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$86,561.07
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$121,185.50
Rate for Payer: Molina Healthcare of CA Medicare	$115,991.83
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

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$104,555.50

Service Code	MSDRG 741
Min. Negotiated Rate	$22,398.00
Max. Negotiated Rate	$104,555.50
Rate for Payer: Aetna of CA HMO/PPO	$43,233.65
Rate for Payer: EPIC Health Plan Commercial	$104,555.50
Rate for Payer: EPIC Health Plan Senior	$69,703.67
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$63,366.97
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$88,713.76
Rate for Payer: Molina Healthcare of CA Medicare	$84,911.74
Rate for Payer: United Healthcare All Other Commercial	$24,996.00
Rate for Payer: United Healthcare All Other HMO	$24,996.00
Rate for Payer: United Healthcare HMO Rider	$24,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$22,398.00

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY

Facility

$127,468.51

Service Code	APR-DRG 5114
Min. Negotiated Rate	$101,807.09
Max. Negotiated Rate	$127,468.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$101,807.09
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$127,468.51
Rate for Payer: Molina Healthcare of CA Medi-Cal	$114,050.77

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY

Facility

$52,479.73

Service Code	APR-DRG 5113
Min. Negotiated Rate	$41,914.73
Max. Negotiated Rate	$52,479.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$41,914.73
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$52,479.73
Rate for Payer: Molina Healthcare of CA Medi-Cal	$46,955.55

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY

Facility

$35,531.22

Service Code	APR-DRG 5112
Min. Negotiated Rate	$28,378.22
Max. Negotiated Rate	$35,531.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$28,378.22
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$35,531.22
Rate for Payer: Molina Healthcare of CA Medi-Cal	$31,791.09

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY

Facility

$29,184.70

Service Code	APR-DRG 5111
Min. Negotiated Rate	$23,309.36
Max. Negotiated Rate	$29,184.70
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$23,309.36
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$29,184.70
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,112.63

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC

Facility

$115,814.59

Service Code	MSDRG 737
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$115,814.59
Rate for Payer: Aetna of CA HMO/PPO	$62,469.15
Rate for Payer: EPIC Health Plan Commercial	$115,814.59
Rate for Payer: EPIC Health Plan Senior	$77,209.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$70,190.66
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$98,266.92
Rate for Payer: Molina Healthcare of CA Medicare	$94,055.48
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

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC

Facility

$142,678.49

Service Code	MSDRG 736
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$142,678.49
Rate for Payer: Aetna of CA HMO/PPO	$108,364.54
Rate for Payer: EPIC Health Plan Commercial	$142,678.49
Rate for Payer: EPIC Health Plan Senior	$95,118.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$86,471.81
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$121,060.53
Rate for Payer: Molina Healthcare of CA Medicare	$115,872.23
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

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$105,307.88

Service Code	MSDRG 738
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$105,307.88
Rate for Payer: Aetna of CA HMO/PPO	$44,519.05
Rate for Payer: EPIC Health Plan Commercial	$105,307.88
Rate for Payer: EPIC Health Plan Senior	$70,205.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$63,822.96
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$89,352.14
Rate for Payer: Molina Healthcare of CA Medicare	$85,522.77
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

UTERINE EVACUATION AND CURETTAGE FOR HYDATIDIFORM MOLE

Facility

$32,312.00

Service Code	CPT 59870
Hospital Revenue Code	360
Min. Negotiated Rate	$510.75
Max. Negotiated Rate	$32,312.00
Rate for Payer: Dignity Health Medi-Cal	$4,579.83
Rate for Payer: Aetna of CA HMO/PPO	$32,312.00
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$6,245.22
Rate for Payer: Alpha Care Medical Group Medi-Cal	$4,579.83
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$4,163.48
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$8,240.00
Rate for Payer: Blue Shield of California Commercial	$6,262.29
Rate for Payer: Blue Shield of California Commercial	$4,136.63
Rate for Payer: Dignity Health Commercial/Exchange	$6,245.22
Rate for Payer: Dignity Health Medicare Advantage	$4,163.48
Rate for Payer: EPIC Health Plan Commercial	$6,869.74
Rate for Payer: EPIC Health Plan Senior	$4,579.83
Rate for Payer: Heritage Provider Network Commercial/Senior	$6,828.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$510.75
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$4,163.48
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$577.64
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$5,828.87
Rate for Payer: Molina Healthcare of CA Medi-Cal	$5,245.98
Rate for Payer: Molina Healthcare of CA Medicare	$5,579.06
Rate for Payer: Multiplan WC	$6,436.87
Rate for Payer: Prime Health Services WC	$6,371.18
Rate for Payer: United Healthcare All Other HMO	$16,122.00
Rate for Payer: United Healthcare HMO Rider	$10,165.00
Rate for Payer: United Healthcare Select/Navigate/Core	$9,312.00
Rate for Payer: Upland Medical Group Pediatric	$4,163.48
Rate for Payer: Vantage Medical Group Commercial/Exchange	$6,245.22
Rate for Payer: Vantage Medical Group Medi-Cal	$4,579.83
Rate for Payer: Vantage Medical Group Senior	$4,163.48

VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC

Facility

$110,074.14

Service Code	MSDRG 746
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$110,074.14
Rate for Payer: Aetna of CA HMO/PPO	$52,661.92
Rate for Payer: EPIC Health Plan Commercial	$110,074.14
Rate for Payer: EPIC Health Plan Senior	$73,382.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$66,711.60
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$93,396.24
Rate for Payer: Molina Healthcare of CA Medicare	$89,393.54
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

VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC

Facility

$94,504.84

Service Code	MSDRG 747
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$94,504.84
Rate for Payer: Aetna of CA HMO/PPO	$25,450.28
Rate for Payer: EPIC Health Plan Commercial	$94,504.84
Rate for Payer: EPIC Health Plan Senior	$63,003.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$57,275.66
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$80,185.92
Rate for Payer: Molina Healthcare of CA Medicare	$76,749.38
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

VAGINAL DELIVERY

Facility

$14,536.44

Service Code	APR-DRG 5603
Min. Negotiated Rate	$8,021.47
Max. Negotiated Rate	$14,536.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,021.47
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$10,043.36
Rate for Payer: Molina Healthcare of CA Medi-Cal	$14,536.44

VAGINAL DELIVERY

Facility

$10,303.45

Service Code	APR-DRG 5602
Min. Negotiated Rate	$5,685.63
Max. Negotiated Rate	$10,303.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$5,685.63
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$7,118.75
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,303.45

VAGINAL DELIVERY

Facility

$8,876.42

Service Code	APR-DRG 5601
Min. Negotiated Rate	$4,898.17
Max. Negotiated Rate	$8,876.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$4,898.17
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$6,132.80
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,876.42

VAGINAL DELIVERY

Facility

$26,890.93

Service Code	APR-DRG 5604
Min. Negotiated Rate	$14,838.90
Max. Negotiated Rate	$26,890.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$14,838.90
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$18,579.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,890.93

VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C

Facility

$10,268.17

Service Code	APR-DRG 5421
Min. Negotiated Rate	$5,666.16
Max. Negotiated Rate	$10,268.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$5,666.16
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$7,094.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$10,268.17

VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C

Facility

$20,327.92

Service Code	APR-DRG 5423
Min. Negotiated Rate	$11,217.31
Max. Negotiated Rate	$20,327.92
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,217.31
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$14,044.74
Rate for Payer: Molina Healthcare of CA Medi-Cal	$20,327.92

Know your out-of-pocket cost for care.

All Charges