Loma Linda University Children's Hospital

All Charges

Charge

Type

Price

OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS

Facility IP

$19,032.78

Service Code	APR-DRG 3443
Min. Negotiated Rate	$14,600.14
Max. Negotiated Rate	$19,032.78
Rate for Payer: IEHP Medi-Cal	$14,600.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$19,032.78

Osteotomy; calcaneus (eg, Dwyer or Chambers type procedure), with or without internal fixation

Facility OP

$14,659.19

Service Code	CPT 28300
Min. Negotiated Rate	$761.12
Max. Negotiated Rate	$14,659.19
Rate for Payer: Aetna of CA HMO/PPO	$7,385.00
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$13,407.80
Rate for Payer: AlphaCare Medical Group Medi-Cal	$9,832.38
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$8,938.53
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$5,938.00
Rate for Payer: Dignity Health Commercial/Exchange	$13,407.80
Rate for Payer: Dignity Health Media	$8,938.53
Rate for Payer: Dignity Health Medi-Cal	$9,832.38
Rate for Payer: EPIC Health Plan Commercial	$12,067.02
Rate for Payer: EPIC Health Plan Medicare/Senior	$8,938.53
Rate for Payer: EPIC Health Plan Transplant	$8,938.53
Rate for Payer: Heritage Provider Network Commercial	$14,659.19
Rate for Payer: Heritage Provider Network Transplant	$14,659.19
Rate for Payer: IEHP Medi-Cal	$14,480.42
Rate for Payer: IEHP Medi-Cal Transplant	$14,480.42
Rate for Payer: IEHP Medicare Advantage	$8,938.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$761.12
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,938.53
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,262.55
Rate for Payer: Molina Healthcare of CA Medicare	$11,977.63
Rate for Payer: Vantage Medical Group Commercial/Exchange	$13,407.80
Rate for Payer: Vantage Medical Group Medi-Cal	$9,832.38
Rate for Payer: Vantage Medical Group Senior	$8,938.53

Osteotomy, tarsal bones, other than calcaneus or talus;

Facility OP

$14,659.19

Service Code	CPT 28304
Min. Negotiated Rate	$640.87
Max. Negotiated Rate	$14,659.19
Rate for Payer: Aetna of CA HMO/PPO	$7,385.00
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$13,407.80
Rate for Payer: AlphaCare Medical Group Medi-Cal	$9,832.38
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$8,938.53
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$5,938.00
Rate for Payer: Dignity Health Commercial/Exchange	$13,407.80
Rate for Payer: Dignity Health Media	$8,938.53
Rate for Payer: Dignity Health Medi-Cal	$9,832.38
Rate for Payer: EPIC Health Plan Commercial	$12,067.02
Rate for Payer: EPIC Health Plan Medicare/Senior	$8,938.53
Rate for Payer: EPIC Health Plan Transplant	$8,938.53
Rate for Payer: Heritage Provider Network Commercial	$14,659.19
Rate for Payer: Heritage Provider Network Transplant	$14,659.19
Rate for Payer: IEHP Medi-Cal	$14,480.42
Rate for Payer: IEHP Medi-Cal Transplant	$14,480.42
Rate for Payer: IEHP Medicare Advantage	$8,938.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$640.87
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$8,938.53
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,262.55
Rate for Payer: Molina Healthcare of CA Medicare	$11,977.63
Rate for Payer: Vantage Medical Group Commercial/Exchange	$13,407.80
Rate for Payer: Vantage Medical Group Medi-Cal	$9,832.38
Rate for Payer: Vantage Medical Group Senior	$8,938.53

OSTOMY ADHESIVE PASTE [115464]

Facility OP

$0.16

Service Code	NDC 6845510690
Hospital Charge Code	1743626
Hospital Revenue Code	271
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.14
Rate for Payer: Aetna of CA HMO/PPO	$0.10
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$0.14
Rate for Payer: AlphaCare Medical Group Medi-Cal	$0.09
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$0.09
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$0.10
Rate for Payer: BCBS Transplant Transplant	$0.10
Rate for Payer: Blue Shield of California Commercial	$0.12
Rate for Payer: Blue Shield of California EPN	$0.09
Rate for Payer: Cash Price	$0.07
Rate for Payer: Cigna of CA HMO	$0.10
Rate for Payer: Cigna of CA PPO	$0.12
Rate for Payer: Dignity Health Commercial/Exchange	$0.14
Rate for Payer: Dignity Health Media	$0.14
Rate for Payer: Dignity Health Medi-Cal	$0.14
Rate for Payer: EPIC Health Plan Commercial	$0.06
Rate for Payer: EPIC Health Plan Transplant	$0.06
Rate for Payer: Galaxy Health WC	$0.14
Rate for Payer: Global Benefits Group Commercial	$0.10
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other	$0.12
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$0.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Commercial	$0.13
Rate for Payer: Networks By Design Commercial	$0.10
Rate for Payer: Prime Health Services Commercial	$0.14
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior	$0.10
Rate for Payer: Temecula Valley Physicians Medical Group Commercial	$0.10
Rate for Payer: TriValley Medical Group Commercial/Senior	$0.10
Rate for Payer: United Healthcare All Other Commercial	$0.08
Rate for Payer: United Healthcare All Other HMO	$0.08
Rate for Payer: United Healthcare HMO Rider	$0.08
Rate for Payer: United Healthcare Select/Navigate/Core	$0.08
Rate for Payer: Vantage Medical Group Commercial/Exchange	$0.14
Rate for Payer: Vantage Medical Group Medi-Cal	$0.14
Rate for Payer: Vantage Medical Group Senior	$0.14

OSTOMY ADHESIVE PASTE [115464]

Facility IP

$0.16

Service Code	NDC 6845510690
Hospital Charge Code	1743626
Hospital Revenue Code	271
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.07
Rate for Payer: EPIC Health Plan Commercial	$0.06
Rate for Payer: Galaxy Health WC	$0.14
Rate for Payer: Global Benefits Group Commercial	$0.10
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$0.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Commercial	$0.13
Rate for Payer: Networks By Design Commercial	$0.10
Rate for Payer: Prime Health Services Commercial	$0.14

OSTOMY SUPPLIES POWDER [110541]

Facility IP

$0.26

Service Code	NDC 6845510826
Hospital Charge Code	1743566
Hospital Revenue Code	271
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.22
Rate for Payer: Cash Price	$0.12
Rate for Payer: EPIC Health Plan Commercial	$0.10
Rate for Payer: Galaxy Health WC	$0.22
Rate for Payer: Global Benefits Group Commercial	$0.16
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$0.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Commercial	$0.21
Rate for Payer: Networks By Design Commercial	$0.17
Rate for Payer: Prime Health Services Commercial	$0.22

OSTOMY SUPPLIES POWDER [110541]

Facility OP

$0.26

Service Code	NDC 6845510826
Hospital Charge Code	1743566
Hospital Revenue Code	271
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.22
Rate for Payer: Aetna of CA HMO/PPO	$0.17
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$0.22
Rate for Payer: AlphaCare Medical Group Medi-Cal	$0.14
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$0.14
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$0.15
Rate for Payer: BCBS Transplant Transplant	$0.16
Rate for Payer: Blue Shield of California Commercial	$0.19
Rate for Payer: Blue Shield of California EPN	$0.15
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cigna of CA HMO	$0.17
Rate for Payer: Cigna of CA PPO	$0.19
Rate for Payer: Dignity Health Commercial/Exchange	$0.22
Rate for Payer: Dignity Health Media	$0.22
Rate for Payer: Dignity Health Medi-Cal	$0.22
Rate for Payer: EPIC Health Plan Commercial	$0.10
Rate for Payer: EPIC Health Plan Transplant	$0.10
Rate for Payer: Galaxy Health WC	$0.22
Rate for Payer: Global Benefits Group Commercial	$0.16
Rate for Payer: Health Plan of Nevada - Sierra Transplant Other	$0.20
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$0.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Commercial	$0.21
Rate for Payer: Networks By Design Commercial	$0.17
Rate for Payer: Prime Health Services Commercial	$0.22
Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior	$0.16
Rate for Payer: Temecula Valley Physicians Medical Group Commercial	$0.16
Rate for Payer: TriValley Medical Group Commercial/Senior	$0.16
Rate for Payer: United Healthcare All Other Commercial	$0.13
Rate for Payer: United Healthcare All Other HMO	$0.13
Rate for Payer: United Healthcare HMO Rider	$0.13
Rate for Payer: United Healthcare Select/Navigate/Core	$0.13
Rate for Payer: Vantage Medical Group Commercial/Exchange	$0.22
Rate for Payer: Vantage Medical Group Medi-Cal	$0.22
Rate for Payer: Vantage Medical Group Senior	$0.22

OTHER AFTERCARE AND CONVALESCENCE

Facility IP

$7,395.33

Service Code	APR-DRG 8621
Min. Negotiated Rate	$5,673.00
Max. Negotiated Rate	$7,395.33
Rate for Payer: IEHP Medi-Cal	$5,673.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$7,395.33

OTHER AFTERCARE AND CONVALESCENCE

Facility IP

$12,041.80

Service Code	APR-DRG 8623
Min. Negotiated Rate	$9,237.33
Max. Negotiated Rate	$12,041.80
Rate for Payer: IEHP Medi-Cal	$9,237.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$12,041.80

OTHER AFTERCARE AND CONVALESCENCE

Facility IP

$12,644.77

Service Code	APR-DRG 8624
Min. Negotiated Rate	$9,699.87
Max. Negotiated Rate	$12,644.77
Rate for Payer: IEHP Medi-Cal	$9,699.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$12,644.77

OTHER AFTERCARE AND CONVALESCENCE

Facility IP

$10,777.31

Service Code	APR-DRG 8622
Min. Negotiated Rate	$8,267.33
Max. Negotiated Rate	$10,777.31
Rate for Payer: IEHP Medi-Cal	$8,267.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10,777.31

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility IP

$28,118.21

Service Code	APR-DRG 2534
Min. Negotiated Rate	$21,569.63
Max. Negotiated Rate	$28,118.21
Rate for Payer: IEHP Medi-Cal	$21,569.63
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$28,118.21

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility IP

$16,322.92

Service Code	APR-DRG 2533
Min. Negotiated Rate	$12,521.40
Max. Negotiated Rate	$16,322.92
Rate for Payer: IEHP Medi-Cal	$12,521.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$16,322.92

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility IP

$8,970.17

Service Code	APR-DRG 2531
Min. Negotiated Rate	$6,881.06
Max. Negotiated Rate	$8,970.17
Rate for Payer: IEHP Medi-Cal	$6,881.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$8,970.17

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility IP

$11,591.33

Service Code	APR-DRG 2532
Min. Negotiated Rate	$8,891.77
Max. Negotiated Rate	$11,591.33
Rate for Payer: IEHP Medi-Cal	$8,891.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,591.33

OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility IP

$10,617.71

Service Code	APR-DRG 6632
Min. Negotiated Rate	$8,144.90
Max. Negotiated Rate	$10,617.71
Rate for Payer: IEHP Medi-Cal	$8,144.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10,617.71

OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility IP

$7,507.05

Service Code	APR-DRG 6631
Min. Negotiated Rate	$5,758.70
Max. Negotiated Rate	$7,507.05
Rate for Payer: IEHP Medi-Cal	$5,758.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$7,507.05

OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility IP

$14,826.12

Service Code	APR-DRG 6633
Min. Negotiated Rate	$11,373.19
Max. Negotiated Rate	$14,826.12
Rate for Payer: IEHP Medi-Cal	$11,373.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,826.12

OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility IP

$24,509.22

Service Code	APR-DRG 6634
Min. Negotiated Rate	$18,801.15
Max. Negotiated Rate	$24,509.22
Rate for Payer: IEHP Medi-Cal	$18,801.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$24,509.22

OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES

Facility IP

$27,490.40

Service Code	APR-DRG 3474
Min. Negotiated Rate	$21,088.03
Max. Negotiated Rate	$27,490.40
Rate for Payer: IEHP Medi-Cal	$21,088.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$27,490.40

OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES

Facility IP

$9,344.35

Service Code	APR-DRG 3471
Min. Negotiated Rate	$7,168.10
Max. Negotiated Rate	$9,344.35
Rate for Payer: IEHP Medi-Cal	$7,168.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$9,344.35

OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES

Facility IP

$15,946.95

Service Code	APR-DRG 3473
Min. Negotiated Rate	$12,232.99
Max. Negotiated Rate	$15,946.95
Rate for Payer: IEHP Medi-Cal	$12,232.99
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,946.95

OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES

Facility IP

$11,782.87

Service Code	APR-DRG 3472
Min. Negotiated Rate	$9,038.70
Max. Negotiated Rate	$11,782.87
Rate for Payer: IEHP Medi-Cal	$9,038.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,782.87

OTHER BLADDER PROCEDURES

Facility IP

$15,047.81

Service Code	APR-DRG 4451
Min. Negotiated Rate	$11,543.25
Max. Negotiated Rate	$15,047.81
Rate for Payer: IEHP Medi-Cal	$11,543.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,047.81

OTHER BLADDER PROCEDURES

Facility IP

$50,213.75

Service Code	APR-DRG 4454
Min. Negotiated Rate	$38,519.23
Max. Negotiated Rate	$50,213.75
Rate for Payer: IEHP Medi-Cal	$38,519.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$50,213.75

Price Transparency.

All Charges