Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC

Facility

$112,796.21

Service Code	MSDRG 261
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$112,796.21
Rate for Payer: Aetna of CA HMO/PPO	$57,312.40
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: Cigna of CA PPO	$14,790.00
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	$51,377.00
Rate for Payer: United Healthcare All Other HMO	$51,377.00
Rate for Payer: United Healthcare HMO Rider	$31,691.00
Rate for Payer: United Healthcare Select/Navigate/Core	$29,035.00

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC

Facility

$136,970.00

Service Code	MSDRG 260
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$136,970.00
Rate for Payer: Aetna of CA HMO/PPO	$98,611.88
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$136,970.00
Rate for Payer: EPIC Health Plan Senior	$91,313.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$83,012.12
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$116,216.97
Rate for Payer: Molina Healthcare of CA Medicare	$111,236.24
Rate for Payer: United Healthcare All Other Commercial	$51,377.00
Rate for Payer: United Healthcare All Other HMO	$51,377.00
Rate for Payer: United Healthcare HMO Rider	$31,691.00
Rate for Payer: United Healthcare Select/Navigate/Core	$29,035.00

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC

Facility

$108,171.89

Service Code	MSDRG 262
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$108,171.89
Rate for Payer: Aetna of CA HMO/PPO	$49,412.05
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$108,171.89
Rate for Payer: EPIC Health Plan Senior	$72,114.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$65,558.72
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$91,782.21
Rate for Payer: Molina Healthcare of CA Medicare	$87,848.68
Rate for Payer: United Healthcare All Other Commercial	$51,377.00
Rate for Payer: United Healthcare All Other HMO	$51,377.00
Rate for Payer: United Healthcare HMO Rider	$31,691.00
Rate for Payer: United Healthcare Select/Navigate/Core	$29,035.00

CARDIAC STRUCTURAL AND VALVULAR DISORDERS

Facility

$14,520.29

Service Code	APR-DRG 2002
Min. Negotiated Rate	$11,597.13
Max. Negotiated Rate	$14,520.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,597.13
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$14,520.29
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,991.84

CARDIAC STRUCTURAL AND VALVULAR DISORDERS

Facility

$9,919.48

Service Code	APR-DRG 2001
Min. Negotiated Rate	$7,922.53
Max. Negotiated Rate	$9,919.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,922.53
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$9,919.48
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,875.33

CARDIAC STRUCTURAL AND VALVULAR DISORDERS

Facility

$50,718.81

Service Code	APR-DRG 2004
Min. Negotiated Rate	$40,508.31
Max. Negotiated Rate	$50,718.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$40,508.31
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$50,718.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$45,379.99

CARDIAC STRUCTURAL AND VALVULAR DISORDERS

Facility

$22,117.62

Service Code	APR-DRG 2003
Min. Negotiated Rate	$17,664.99
Max. Negotiated Rate	$22,117.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,664.99
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$22,117.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$19,789.44

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC

Facility

$199,336.79

Service Code	MSDRG 217
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$199,336.79
Rate for Payer: Aetna of CA HMO/PPO	$199,336.79
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$195,927.17
Rate for Payer: EPIC Health Plan Senior	$130,618.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$118,743.74
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$166,241.24
Rate for Payer: Molina Healthcare of CA Medicare	$159,116.61
Rate for Payer: United Healthcare All Other Commercial	$126,798.00
Rate for Payer: United Healthcare All Other HMO	$126,798.00
Rate for Payer: United Healthcare HMO Rider	$97,715.00
Rate for Payer: United Healthcare Select/Navigate/Core	$89,522.00

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC

Facility

$296,575.36

Service Code	MSDRG 216
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$296,575.36
Rate for Payer: Aetna of CA HMO/PPO	$296,575.36
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$252,843.71
Rate for Payer: EPIC Health Plan Senior	$168,562.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$153,238.61
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$214,534.05
Rate for Payer: Molina Healthcare of CA Medicare	$205,339.74
Rate for Payer: United Healthcare All Other Commercial	$155,615.00
Rate for Payer: United Healthcare All Other HMO	$155,615.00
Rate for Payer: United Healthcare HMO Rider	$119,917.00
Rate for Payer: United Healthcare Select/Navigate/Core	$109,864.00

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$199,336.79

Service Code	MSDRG 218
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$199,336.79
Rate for Payer: Aetna of CA HMO/PPO	$199,336.79
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$195,927.17
Rate for Payer: EPIC Health Plan Senior	$130,618.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$118,743.74
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$166,241.24
Rate for Payer: Molina Healthcare of CA Medicare	$159,116.61
Rate for Payer: United Healthcare All Other Commercial	$164,634.00
Rate for Payer: United Healthcare All Other HMO	$164,634.00
Rate for Payer: United Healthcare HMO Rider	$88,410.00
Rate for Payer: United Healthcare Select/Navigate/Core	$80,997.00

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC

Facility

$173,879.21

Service Code	MSDRG 220
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$173,879.21
Rate for Payer: Aetna of CA HMO/PPO	$161,669.16
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$173,879.21
Rate for Payer: EPIC Health Plan Senior	$115,919.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$105,381.34
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$147,533.88
Rate for Payer: Molina Healthcare of CA Medicare	$141,211.00
Rate for Payer: United Healthcare All Other Commercial	$117,371.00
Rate for Payer: United Healthcare All Other HMO	$117,371.00
Rate for Payer: United Healthcare HMO Rider	$111,169.00
Rate for Payer: United Healthcare Select/Navigate/Core	$101,848.00

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$232,775.34

Service Code	MSDRG 219
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$232,775.34
Rate for Payer: Aetna of CA HMO/PPO	$232,775.34
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$215,499.72
Rate for Payer: EPIC Health Plan Senior	$143,666.48
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$130,605.89
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$182,848.25
Rate for Payer: Molina Healthcare of CA Medicare	$175,011.89
Rate for Payer: United Healthcare All Other Commercial	$147,690.00
Rate for Payer: United Healthcare All Other HMO	$147,690.00
Rate for Payer: United Healthcare HMO Rider	$111,169.00
Rate for Payer: United Healthcare Select/Navigate/Core	$101,848.00

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$171,252.00

Service Code	MSDRG 221
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$171,252.00
Rate for Payer: Aetna of CA HMO/PPO	$152,798.70
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: EPIC Health Plan Commercial	$168,687.09
Rate for Payer: EPIC Health Plan Senior	$112,458.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$102,234.60
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$143,128.44
Rate for Payer: Molina Healthcare of CA Medicare	$136,994.36
Rate for Payer: United Healthcare All Other Commercial	$171,252.00
Rate for Payer: United Healthcare All Other HMO	$171,252.00
Rate for Payer: United Healthcare HMO Rider	$111,169.00
Rate for Payer: United Healthcare Select/Navigate/Core	$101,848.00

CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$97,579.65

Service Code	APR-DRG 1621
Min. Negotiated Rate	$77,935.32
Max. Negotiated Rate	$97,579.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$77,935.32
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$97,579.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$87,308.11

CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$268,564.03

Service Code	APR-DRG 1624
Min. Negotiated Rate	$214,497.85
Max. Negotiated Rate	$268,564.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$214,497.85
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$268,564.03
Rate for Payer: Molina Healthcare of CA Medi-Cal	$240,294.13

CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$148,395.24

Service Code	APR-DRG 1623
Min. Negotiated Rate	$118,520.94
Max. Negotiated Rate	$148,395.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$118,520.94
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$148,395.24
Rate for Payer: Molina Healthcare of CA Medi-Cal	$132,774.69

CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$113,568.28

Service Code	APR-DRG 1622
Min. Negotiated Rate	$90,705.19
Max. Negotiated Rate	$113,568.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$90,705.19
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$113,568.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$101,613.73

CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$94,626.65

Service Code	APR-DRG 1632
Min. Negotiated Rate	$75,576.81
Max. Negotiated Rate	$94,626.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$75,576.81
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$94,626.65
Rate for Payer: Molina Healthcare of CA Medi-Cal	$84,665.95

CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$236,093.28

Service Code	APR-DRG 1634
Min. Negotiated Rate	$188,563.97
Max. Negotiated Rate	$236,093.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$188,563.97
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$236,093.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$211,241.35

CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$124,499.30

Service Code	APR-DRG 1633
Min. Negotiated Rate	$99,435.63
Max. Negotiated Rate	$124,499.30
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$99,435.63
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$124,499.30
Rate for Payer: Molina Healthcare of CA Medi-Cal	$111,394.12

CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS

Facility

$81,920.02

Service Code	APR-DRG 1631
Min. Negotiated Rate	$65,428.23
Max. Negotiated Rate	$81,920.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$65,428.23
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$81,920.02
Rate for Payer: Molina Healthcare of CA Medi-Cal	$73,296.86

CARDIOMYOPATHY

Facility

$50,186.56

Service Code	APR-DRG 2054
Min. Negotiated Rate	$40,083.21
Max. Negotiated Rate	$50,186.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$40,083.21
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$50,186.56
Rate for Payer: Molina Healthcare of CA Medi-Cal	$44,903.77

CARDIOMYOPATHY

Facility

$10,351.83

Service Code	APR-DRG 2051
Min. Negotiated Rate	$8,267.84
Max. Negotiated Rate	$10,351.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,267.84
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$10,351.83
Rate for Payer: Molina Healthcare of CA Medi-Cal	$9,262.16

CARDIOMYOPATHY

Facility

$13,750.77

Service Code	APR-DRG 2052
Min. Negotiated Rate	$10,982.53
Max. Negotiated Rate	$13,750.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,982.53
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$13,750.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$12,303.33

CARDIOMYOPATHY

Facility

$20,956.54

Service Code	APR-DRG 2053
Min. Negotiated Rate	$16,737.66
Max. Negotiated Rate	$20,956.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16,737.66
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$20,956.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$18,750.59

Know your out-of-pocket cost for care.

All Charges