Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC

Facility

$46,221.43

Service Code	MSDRG 091
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$46,221.43
Rate for Payer: EPIC Health Plan Senior	$27,635.50
Rate for Payer: Aetna of CA HMO/PPO	$46,221.43
Rate for Payer: Anthem Blue Cross of CA Exchange	$29,857.16
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$41,801.07
Rate for Payer: EPIC Health Plan Commercial	$41,453.25
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,123.18
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$35,172.45
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$33,665.06
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$25,123.18
Rate for Payer: Prime Health Services Medicare	$26,630.57
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 DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility

$20,957.82

Service Code	MSDRG 093
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$20,957.82
Rate for Payer: Aetna of CA HMO/PPO	$20,957.82
Rate for Payer: Anthem Blue Cross of CA Exchange	$13,537.90
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$18,953.53
Rate for Payer: EPIC Health Plan Commercial	$19,608.95
Rate for Payer: EPIC Health Plan Senior	$13,072.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,884.21
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$16,637.89
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$15,924.84
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$11,884.21
Rate for Payer: Prime Health Services Medicare	$12,597.26
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 DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT

Facility

$34,822.67

Service Code	MSDRG 124
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$34,822.67
Rate for Payer: Aetna of CA HMO/PPO	$34,822.67
Rate for Payer: Anthem Blue Cross of CA Exchange	$22,494.02
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$31,492.43
Rate for Payer: EPIC Health Plan Commercial	$31,597.29
Rate for Payer: EPIC Health Plan Senior	$21,064.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,149.87
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$26,809.82
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$25,660.83
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$19,149.87
Rate for Payer: Prime Health Services Medicare	$20,298.86
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 DISORDERS OF THE EYE WITHOUT MCC

Facility

$20,207.73

Service Code	MSDRG 125
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$20,207.73
Rate for Payer: Aetna of CA HMO/PPO	$20,207.73
Rate for Payer: Anthem Blue Cross of CA Exchange	$13,053.37
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$18,275.18
Rate for Payer: EPIC Health Plan Commercial	$18,960.36
Rate for Payer: EPIC Health Plan Senior	$12,640.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$11,491.13
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$16,087.58
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$15,398.11
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$11,491.13
Rate for Payer: Prime Health Services Medicare	$12,180.60
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 DISORDERS OF THE LIVER

Facility

$17,162.91

Service Code	APR-DRG 2833
Min. Negotiated Rate	$10,839.73
Max. Negotiated Rate	$17,162.91
Rate for Payer: Adventist Health Medi-Cal	$10,839.73
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$12,917.35
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$17,162.91

OTHER DISORDERS OF THE LIVER

Facility

$32,102.15

Service Code	APR-DRG 2834
Min. Negotiated Rate	$20,275.04
Max. Negotiated Rate	$32,102.15
Rate for Payer: Adventist Health Medi-Cal	$20,275.04
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$24,161.09
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$32,102.15

OTHER DISORDERS OF THE LIVER

Facility

$8,453.56

Service Code	APR-DRG 2831
Min. Negotiated Rate	$5,339.09
Max. Negotiated Rate	$8,453.56
Rate for Payer: Adventist Health Medi-Cal	$5,339.09
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$6,362.41
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$8,453.56

OTHER DISORDERS OF THE LIVER

Facility

$11,680.29

Service Code	APR-DRG 2832
Min. Negotiated Rate	$7,377.02
Max. Negotiated Rate	$11,680.29
Rate for Payer: Adventist Health Medi-Cal	$7,377.02
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$8,790.95
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$11,680.29

OTHER DRUG ABUSE AND DEPENDENCE

Facility

$12,665.23

Service Code	APR-DRG 7763
Min. Negotiated Rate	$7,999.09
Max. Negotiated Rate	$12,665.23
Rate for Payer: Adventist Health Medi-Cal	$7,999.09
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$9,532.25
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$12,665.23

OTHER DRUG ABUSE AND DEPENDENCE

Facility

$23,777.51

Service Code	APR-DRG 7764
Min. Negotiated Rate	$15,017.38
Max. Negotiated Rate	$23,777.51
Rate for Payer: Adventist Health Medi-Cal	$15,017.38
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$17,895.71
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$23,777.51

OTHER DRUG ABUSE AND DEPENDENCE

Facility

$7,033.55

Service Code	APR-DRG 7762
Min. Negotiated Rate	$4,442.24
Max. Negotiated Rate	$7,033.55
Rate for Payer: Adventist Health Medi-Cal	$4,442.24
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$5,293.67
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$7,033.55

OTHER DRUG ABUSE AND DEPENDENCE

Facility

$5,383.94

Service Code	APR-DRG 7761
Min. Negotiated Rate	$3,400.38
Max. Negotiated Rate	$5,383.94
Rate for Payer: Adventist Health Medi-Cal	$3,400.38
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$4,052.12
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$5,383.94

OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC

Facility

$24,121.36

Service Code	MSDRG 155
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$24,121.36
Rate for Payer: Aetna of CA HMO/PPO	$24,121.36
Rate for Payer: Anthem Blue Cross of CA Exchange	$15,581.42
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$21,814.53
Rate for Payer: EPIC Health Plan Commercial	$22,344.32
Rate for Payer: EPIC Health Plan Senior	$14,896.21
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$13,542.01
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$18,958.81
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$18,146.29
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$13,542.01
Rate for Payer: Prime Health Services Medicare	$14,354.53
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 EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC

Facility

$41,149.76

Service Code	MSDRG 154
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$41,149.76
Rate for Payer: Aetna of CA HMO/PPO	$41,149.76
Rate for Payer: Anthem Blue Cross of CA Exchange	$26,581.06
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$37,214.43
Rate for Payer: EPIC Health Plan Commercial	$37,068.03
Rate for Payer: EPIC Health Plan Senior	$24,712.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,465.47
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$31,451.66
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$30,103.73
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$22,465.47
Rate for Payer: Prime Health Services Medicare	$23,813.40
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 EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC

Facility

$18,189.06

Service Code	MSDRG 156
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$18,189.06
Rate for Payer: Aetna of CA HMO/PPO	$18,189.06
Rate for Payer: Anthem Blue Cross of CA Exchange	$11,749.39
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$16,449.56
Rate for Payer: EPIC Health Plan Commercial	$17,214.96
Rate for Payer: EPIC Health Plan Senior	$11,476.64
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,433.31
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$14,606.63
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$13,980.64
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$10,433.31
Rate for Payer: Prime Health Services Medicare	$11,059.31
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 EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC

Facility

$45,608.20

Service Code	MSDRG 144
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$45,608.20
Rate for Payer: Aetna of CA HMO/PPO	$45,608.20
Rate for Payer: Anthem Blue Cross of CA Exchange	$29,461.03
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$41,246.49
Rate for Payer: EPIC Health Plan Commercial	$40,923.02
Rate for Payer: EPIC Health Plan Senior	$27,282.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$24,801.83
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$34,722.56
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$33,234.45
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$24,801.83
Rate for Payer: Prime Health Services Medicare	$26,289.94
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 EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC

Facility

$98,606.77

Service Code	MSDRG 143
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$98,606.77
Rate for Payer: Aetna of CA HMO/PPO	$98,606.77
Rate for Payer: Anthem Blue Cross of CA Exchange	$63,695.95
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$89,176.57
Rate for Payer: EPIC Health Plan Commercial	$86,748.55
Rate for Payer: EPIC Health Plan Senior	$57,832.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$52,574.88
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$73,604.83
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$70,450.34
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$52,574.88
Rate for Payer: Prime Health Services Medicare	$55,729.37
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 EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$31,643.33

Service Code	MSDRG 145
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$31,643.33
Rate for Payer: Aetna of CA HMO/PPO	$31,643.33
Rate for Payer: Anthem Blue Cross of CA Exchange	$20,440.30
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$28,617.14
Rate for Payer: EPIC Health Plan Commercial	$28,848.24
Rate for Payer: EPIC Health Plan Senior	$19,232.16
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,483.78
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$24,477.29
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$23,428.27
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$17,483.78
Rate for Payer: Prime Health Services Medicare	$18,532.81
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 EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL DIAGNOSES

Facility

$15,644.22

Service Code	APR-DRG 1153
Min. Negotiated Rate	$9,880.56
Max. Negotiated Rate	$15,644.22
Rate for Payer: Adventist Health Medi-Cal	$9,880.56
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$11,774.33
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$15,644.22

OTHER EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL DIAGNOSES

Facility

$7,210.80

Service Code	APR-DRG 1151
Min. Negotiated Rate	$4,554.19
Max. Negotiated Rate	$7,210.80
Rate for Payer: Adventist Health Medi-Cal	$4,554.19
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$5,427.08
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$7,210.80

OTHER EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL DIAGNOSES

Facility

$10,348.90

Service Code	APR-DRG 1152
Min. Negotiated Rate	$6,536.15
Max. Negotiated Rate	$10,348.90
Rate for Payer: Adventist Health Medi-Cal	$6,536.15
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$7,788.91
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$10,348.90

OTHER EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL DIAGNOSES

Facility

$28,819.03

Service Code	APR-DRG 1154
Min. Negotiated Rate	$18,201.49
Max. Negotiated Rate	$28,819.03
Rate for Payer: Adventist Health Medi-Cal	$18,201.49
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$21,690.11
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$28,819.03

OTHER EAR, NOSE, MOUTH, THROAT, CRANIOFACIAL, AND NECK PROCEDURES

Facility

$13,325.88

Service Code	APR-DRG 0981
Min. Negotiated Rate	$8,416.34
Max. Negotiated Rate	$13,325.88
Rate for Payer: Adventist Health Medi-Cal	$8,416.34
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$10,029.48
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$13,325.88

OTHER EAR, NOSE, MOUTH, THROAT, CRANIOFACIAL, AND NECK PROCEDURES

Facility

$34,027.73

Service Code	APR-DRG 0983
Min. Negotiated Rate	$21,491.20
Max. Negotiated Rate	$34,027.73
Rate for Payer: Adventist Health Medi-Cal	$21,491.20
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$25,610.34
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$34,027.73

OTHER EAR, NOSE, MOUTH, THROAT, CRANIOFACIAL, AND NECK PROCEDURES

Facility

$58,155.71

Service Code	APR-DRG 0984
Min. Negotiated Rate	$36,729.92
Max. Negotiated Rate	$58,155.71
Rate for Payer: Adventist Health Medi-Cal	$36,729.92
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$43,769.83
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$58,155.71

Know your out-of-pocket cost for care.

All Charges