Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$63,725.73

Service Code	APR-DRG 2224
Min. Negotiated Rate	$48,884.35
Max. Negotiated Rate	$63,725.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$48,884.35
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$63,725.73

OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$29,889.89

Service Code	APR-DRG 2223
Min. Negotiated Rate	$22,928.69
Max. Negotiated Rate	$29,889.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$22,928.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$29,889.89

OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES

Facility

$11,860.90

Service Code	APR-DRG 2221
Min. Negotiated Rate	$9,098.56
Max. Negotiated Rate	$11,860.90
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$9,098.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,860.90

Otoplasty, protruding ear, with or without size reduction

Facility

$9,590.00

Service Code	CPT 69300
Min. Negotiated Rate	$707.37
Max. Negotiated Rate	$9,590.00
Rate for Payer: Aetna of CA HMO/PPO	$9,590.00
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$6,034.04
Rate for Payer: Alpha Care Medical Group Medi-Cal	$4,424.96
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$4,022.69
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$5,938.00
Rate for Payer: Dignity Health Commercial/Exchange	$6,034.04
Rate for Payer: Dignity Health Media	$4,022.69
Rate for Payer: Dignity Health Medi-Cal	$4,424.96
Rate for Payer: EPIC Health Plan Commercial	$5,430.63
Rate for Payer: EPIC Health Plan Medicare/Senior	$4,022.69
Rate for Payer: EPIC Health Plan Transplant	$4,022.69
Rate for Payer: Heritage Provider Network Commercial	$6,597.21
Rate for Payer: Heritage Provider Network Transplant	$6,597.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,516.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant	$6,516.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$4,022.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$707.37
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$4,022.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$5,068.59
Rate for Payer: Molina Healthcare of CA Medicare	$5,390.40
Rate for Payer: Vantage Medical Group Commercial/Exchange	$6,034.04
Rate for Payer: Vantage Medical Group Medi-Cal	$4,424.96
Rate for Payer: Vantage Medical Group Senior	$4,022.69

Outdated MS-DRG 222

Facility

$157,239.59

Service Code	MSDRG 222
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$157,239.59
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: Heritage Provider Network Commercial	$12,764.00
Rate for Payer: Multiplan WC	$157,239.59
Rate for Payer: Prime Health Services WC	$155,635.10
Rate for Payer: United Healthcare All Other Commercial	$127,379.00
Rate for Payer: United Healthcare All Other HMO	$127,379.00
Rate for Payer: United Healthcare HMO Rider	$127,379.00
Rate for Payer: United Healthcare Select/Navigate/Core	$127,379.00

Outdated MS-DRG 223

Facility

$109,242.00

Service Code	MSDRG 223
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$109,242.00
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: Heritage Provider Network Commercial	$12,764.00
Rate for Payer: Multiplan WC	$107,173.71
Rate for Payer: Prime Health Services WC	$106,080.10
Rate for Payer: United Healthcare All Other Commercial	$109,242.00
Rate for Payer: United Healthcare All Other HMO	$109,242.00
Rate for Payer: United Healthcare HMO Rider	$109,242.00
Rate for Payer: United Healthcare Select/Navigate/Core	$109,242.00

Outdated MS-DRG 224

Facility

$145,587.18

Service Code	MSDRG 224
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$145,587.18
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: Heritage Provider Network Commercial	$12,764.00
Rate for Payer: Multiplan WC	$145,587.18
Rate for Payer: Prime Health Services WC	$144,101.60
Rate for Payer: United Healthcare All Other Commercial	$114,283.00
Rate for Payer: United Healthcare All Other HMO	$114,283.00
Rate for Payer: United Healthcare HMO Rider	$114,283.00
Rate for Payer: United Healthcare Select/Navigate/Core	$114,283.00

Outdated MS-DRG 225

Facility

$103,867.34

Service Code	MSDRG 225
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$103,867.34
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: Heritage Provider Network Commercial	$12,764.00
Rate for Payer: Multiplan WC	$103,867.34
Rate for Payer: Prime Health Services WC	$102,807.47
Rate for Payer: United Healthcare All Other Commercial	$99,952.00
Rate for Payer: United Healthcare All Other HMO	$99,952.00
Rate for Payer: United Healthcare HMO Rider	$99,952.00
Rate for Payer: United Healthcare Select/Navigate/Core	$99,952.00

Outdated MS-DRG 226

Facility

$131,451.93

Service Code	MSDRG 226
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$131,451.93
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: Heritage Provider Network Commercial	$12,764.00
Rate for Payer: Multiplan WC	$131,451.93
Rate for Payer: Prime Health Services WC	$130,110.58
Rate for Payer: United Healthcare All Other Commercial	$94,610.00
Rate for Payer: United Healthcare All Other HMO	$94,610.00
Rate for Payer: United Healthcare HMO Rider	$94,610.00
Rate for Payer: United Healthcare Select/Navigate/Core	$94,610.00

Outdated MS-DRG 227

Facility

$107,228.00

Service Code	MSDRG 227
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$107,228.00
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: Heritage Provider Network Commercial	$12,764.00
Rate for Payer: Multiplan WC	$103,107.49
Rate for Payer: Prime Health Services WC	$102,055.37
Rate for Payer: United Healthcare All Other Commercial	$107,228.00
Rate for Payer: United Healthcare All Other HMO	$107,228.00
Rate for Payer: United Healthcare HMO Rider	$107,228.00
Rate for Payer: United Healthcare Select/Navigate/Core	$107,228.00

Outdated MS-DRG 228

Facility

$25,651.00

Service Code	MSDRG 228
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$25,651.00
Rate for Payer: Heritage Provider Network Commercial	$25,651.00

Outdated MS-DRG 229

Facility

$25,651.00

Service Code	MSDRG 229
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$25,651.00
Rate for Payer: Heritage Provider Network Commercial	$25,651.00

Outdated MS-DRG 230

Facility

$148,568.00

Service Code	MSDRG 230
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$148,568.00
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: Heritage Provider Network Commercial	$25,651.00
Rate for Payer: United Healthcare All Other Commercial	$148,568.00
Rate for Payer: United Healthcare All Other HMO	$148,568.00
Rate for Payer: United Healthcare HMO Rider	$148,568.00
Rate for Payer: United Healthcare Select/Navigate/Core	$148,568.00

Outdated MS-DRG 237

Facility

$86,600.00

Service Code	MSDRG 237
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$86,600.00
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: United Healthcare All Other Commercial	$86,600.00
Rate for Payer: United Healthcare All Other HMO	$86,600.00
Rate for Payer: United Healthcare HMO Rider	$86,600.00
Rate for Payer: United Healthcare Select/Navigate/Core	$86,600.00

Outdated MS-DRG 238

Facility

$73,293.00

Service Code	MSDRG 238
Min. Negotiated Rate	$11,745.00
Max. Negotiated Rate	$73,293.00
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: United Healthcare All Other Commercial	$73,293.00
Rate for Payer: United Healthcare All Other HMO	$73,293.00
Rate for Payer: United Healthcare HMO Rider	$73,293.00
Rate for Payer: United Healthcare Select/Navigate/Core	$73,293.00

Outdated MS-DRG 246

Facility

$61,514.96

Service Code	MSDRG 246
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$61,514.96
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: Heritage Provider Network Commercial	$7,978.00
Rate for Payer: Multiplan WC	$61,514.96
Rate for Payer: Prime Health Services WC	$60,887.26
Rate for Payer: United Healthcare All Other Commercial	$48,629.00
Rate for Payer: United Healthcare All Other HMO	$48,629.00
Rate for Payer: United Healthcare HMO Rider	$48,629.00
Rate for Payer: United Healthcare Select/Navigate/Core	$48,629.00

Outdated MS-DRG 247

Facility

$49,935.00

Service Code	MSDRG 247
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$49,935.00
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: Heritage Provider Network Commercial	$7,978.00
Rate for Payer: Multiplan WC	$39,214.41
Rate for Payer: Prime Health Services WC	$38,814.26
Rate for Payer: United Healthcare All Other Commercial	$49,935.00
Rate for Payer: United Healthcare All Other HMO	$49,935.00
Rate for Payer: United Healthcare HMO Rider	$49,935.00
Rate for Payer: United Healthcare Select/Navigate/Core	$49,935.00

Outdated MS-DRG 248

Facility

$61,810.69

Service Code	MSDRG 248
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$61,810.69
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: Heritage Provider Network Commercial	$7,978.00
Rate for Payer: Multiplan WC	$61,810.69
Rate for Payer: Prime Health Services WC	$61,179.97
Rate for Payer: United Healthcare All Other Commercial	$27,797.00
Rate for Payer: United Healthcare All Other HMO	$27,797.00
Rate for Payer: United Healthcare HMO Rider	$27,797.00
Rate for Payer: United Healthcare Select/Navigate/Core	$27,797.00

Outdated MS-DRG 249

Facility

$40,735.00

Service Code	MSDRG 249
Min. Negotiated Rate	$7,978.00
Max. Negotiated Rate	$40,735.00
Rate for Payer: Cigna of CA HMO	$11,745.00
Rate for Payer: Cigna of CA PPO	$14,790.00
Rate for Payer: Heritage Provider Network Commercial	$7,978.00
Rate for Payer: Multiplan WC	$37,308.62
Rate for Payer: Prime Health Services WC	$36,927.92
Rate for Payer: United Healthcare All Other Commercial	$40,735.00
Rate for Payer: United Healthcare All Other HMO	$40,735.00
Rate for Payer: United Healthcare HMO Rider	$40,735.00
Rate for Payer: United Healthcare Select/Navigate/Core	$40,735.00

Outdated MS-DRG 338

Facility

$54,555.15

Service Code	MSDRG 338
Min. Negotiated Rate	$53,998.46
Max. Negotiated Rate	$54,555.15
Rate for Payer: Multiplan WC	$54,555.15
Rate for Payer: Prime Health Services WC	$53,998.46

Outdated MS-DRG 339

Facility

$33,441.60

Service Code	MSDRG 339
Min. Negotiated Rate	$33,100.36
Max. Negotiated Rate	$33,441.60
Rate for Payer: Multiplan WC	$33,441.60
Rate for Payer: Prime Health Services WC	$33,100.36

Outdated MS-DRG 340

Facility

$24,641.72

Service Code	MSDRG 340
Min. Negotiated Rate	$24,390.27
Max. Negotiated Rate	$24,641.72
Rate for Payer: Multiplan WC	$24,641.72
Rate for Payer: Prime Health Services WC	$24,390.27

Outdated MS-DRG 341

Facility

$46,391.90

Service Code	MSDRG 341
Min. Negotiated Rate	$45,918.51
Max. Negotiated Rate	$46,391.90
Rate for Payer: Multiplan WC	$46,391.90
Rate for Payer: Prime Health Services WC	$45,918.51

Outdated MS-DRG 342

Facility

$29,843.61

Service Code	MSDRG 343
Min. Negotiated Rate	$29,539.08
Max. Negotiated Rate	$29,843.61
Rate for Payer: Multiplan WC	$29,843.61
Rate for Payer: Prime Health Services WC	$29,539.08

Outdated MS-DRG 343

Facility

$22,440.21

Service Code	MSDRG 343
Min. Negotiated Rate	$22,211.22
Max. Negotiated Rate	$22,440.21
Rate for Payer: Multiplan WC	$22,440.21
Rate for Payer: Prime Health Services WC	$22,211.22

Know your out-of-pocket cost for care.

All Charges