Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

OTHER GYN PROCEDURES FOR MALIGNANCY

Facility

$81,661.30

Service Code	APR-DRG 5204
Min. Negotiated Rate	$51,575.56
Max. Negotiated Rate	$81,661.30
Rate for Payer: Adventist Health Medi-Cal	$51,575.56
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$61,460.87
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$81,661.30

OTHER GYN PROCEDURES FOR MALIGNANCY

Facility

$38,755.02

Service Code	APR-DRG 5203
Min. Negotiated Rate	$24,476.86
Max. Negotiated Rate	$38,755.02
Rate for Payer: Adventist Health Medi-Cal	$24,476.86
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$29,168.25
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$38,755.02

OTHER GYN PROCEDURES FOR MALIGNANCY

Facility

$20,554.81

Service Code	APR-DRG 5201
Min. Negotiated Rate	$12,981.98
Max. Negotiated Rate	$20,554.81
Rate for Payer: Adventist Health Medi-Cal	$12,981.98
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$15,470.20
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$20,554.81

OTHER GYN PROCEDURES FOR MALIGNANCY

Facility

$26,091.83

Service Code	APR-DRG 5202
Min. Negotiated Rate	$16,479.05
Max. Negotiated Rate	$26,091.83
Rate for Payer: Adventist Health Medi-Cal	$16,479.05
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$19,637.53
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$26,091.83

OTHER HEART ASSIST SYSTEM IMPLANT

Facility

$262,058.28

Service Code	MSDRG 215
Min. Negotiated Rate	$138,229.01
Max. Negotiated Rate	$262,058.28
Rate for Payer: Aetna of CA HMO/PPO	$262,058.28
Rate for Payer: Anthem Blue Cross of CA Exchange	$169,278.96
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$236,996.51
Rate for Payer: EPIC Health Plan Commercial	$228,077.87
Rate for Payer: EPIC Health Plan Senior	$152,051.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$138,229.01
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$193,520.61
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$185,226.87
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$138,229.01
Rate for Payer: Prime Health Services Medicare	$146,522.75
Rate for Payer: United Healthcare All Other Commercial	$200,732.00
Rate for Payer: United Healthcare All Other HMO	$200,732.00
Rate for Payer: United Healthcare HMO Rider	$157,887.00
Rate for Payer: United Healthcare Select/Navigate/Core	$144,650.00

OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC

Facility

$57,583.34

Service Code	MSDRG 424
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$57,583.34
Rate for Payer: Aetna of CA HMO/PPO	$57,583.34
Rate for Payer: Anthem Blue Cross of CA Exchange	$37,196.49
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$52,076.40
Rate for Payer: EPIC Health Plan Commercial	$51,277.43
Rate for Payer: EPIC Health Plan Senior	$34,184.95
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,077.23
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$43,508.12
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$41,643.49
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$31,077.23
Rate for Payer: Prime Health Services Medicare	$32,941.86
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 HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC

Facility

$109,302.81

Service Code	MSDRG 423
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$109,302.81
Rate for Payer: Aetna of CA HMO/PPO	$109,302.81
Rate for Payer: Anthem Blue Cross of CA Exchange	$70,605.15
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$98,849.71
Rate for Payer: EPIC Health Plan Commercial	$95,996.97
Rate for Payer: EPIC Health Plan Senior	$63,997.98
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$58,179.98
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$81,451.97
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$77,961.17
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$58,179.98
Rate for Payer: Prime Health Services Medicare	$61,670.78
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 HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC

Facility

$39,486.40

Service Code	MSDRG 425
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$39,486.40
Rate for Payer: Aetna of CA HMO/PPO	$39,486.40
Rate for Payer: Anthem Blue Cross of CA Exchange	$25,506.60
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$35,710.14
Rate for Payer: EPIC Health Plan Commercial	$35,629.80
Rate for Payer: EPIC Health Plan Senior	$23,753.20
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$21,593.82
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$30,231.35
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$28,935.72
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$21,593.82
Rate for Payer: Prime Health Services Medicare	$22,889.45
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 HEPATOBILIARY, PANCREAS AND ABDOMINAL PROCEDURES

Facility

$18,816.56

Service Code	APR-DRG 2641
Min. Negotiated Rate	$11,884.14
Max. Negotiated Rate	$18,816.56
Rate for Payer: Adventist Health Medi-Cal	$11,884.14
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$14,161.93
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$18,816.56

OTHER HEPATOBILIARY, PANCREAS AND ABDOMINAL PROCEDURES

Facility

$24,534.85

Service Code	APR-DRG 2642
Min. Negotiated Rate	$15,495.70
Max. Negotiated Rate	$24,534.85
Rate for Payer: Adventist Health Medi-Cal	$15,495.70
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$18,465.70
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$24,534.85

OTHER HEPATOBILIARY, PANCREAS AND ABDOMINAL PROCEDURES

Facility

$68,272.99

Service Code	APR-DRG 2644
Min. Negotiated Rate	$43,119.78
Max. Negotiated Rate	$68,272.99
Rate for Payer: Adventist Health Medi-Cal	$43,119.78
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$51,384.40
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$68,272.99

OTHER HEPATOBILIARY, PANCREAS AND ABDOMINAL PROCEDURES

Facility

$36,523.30

Service Code	APR-DRG 2643
Min. Negotiated Rate	$23,067.35
Max. Negotiated Rate	$36,523.30
Rate for Payer: Adventist Health Medi-Cal	$23,067.35
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$27,488.59
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$36,523.30

OTHER INFECTIOUS AND PARASITIC DISEASES

Facility

$18,371.42

Service Code	APR-DRG 7243
Min. Negotiated Rate	$11,603.00
Max. Negotiated Rate	$18,371.42
Rate for Payer: Adventist Health Medi-Cal	$11,603.00
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$13,826.91
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$18,371.42

OTHER INFECTIOUS AND PARASITIC DISEASES

Facility

$11,676.26

Service Code	APR-DRG 7242
Min. Negotiated Rate	$7,374.48
Max. Negotiated Rate	$11,676.26
Rate for Payer: Adventist Health Medi-Cal	$7,374.48
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$8,787.92
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$11,676.26

OTHER INFECTIOUS AND PARASITIC DISEASES

Facility

$34,535.29

Service Code	APR-DRG 7244
Min. Negotiated Rate	$21,811.76
Max. Negotiated Rate	$34,535.29
Rate for Payer: Adventist Health Medi-Cal	$21,811.76
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$25,992.35
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$34,535.29

OTHER INFECTIOUS AND PARASITIC DISEASES

Facility

$7,939.93

Service Code	APR-DRG 7241
Min. Negotiated Rate	$5,014.69
Max. Negotiated Rate	$7,939.93
Rate for Payer: Adventist Health Medi-Cal	$5,014.69
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$5,975.84
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$7,939.93

OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC

Facility

$27,137.52

Service Code	MSDRG 868
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$27,137.52
Rate for Payer: Aetna of CA HMO/PPO	$27,137.52
Rate for Payer: Anthem Blue Cross of CA Exchange	$17,529.73
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$24,542.24
Rate for Payer: EPIC Health Plan Commercial	$24,952.27
Rate for Payer: EPIC Health Plan Senior	$16,634.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$15,122.59
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$21,171.63
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$20,264.27
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$15,122.59
Rate for Payer: Prime Health Services Medicare	$16,029.95
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 INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC

Facility

$55,090.93

Service Code	MSDRG 867
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$55,090.93
Rate for Payer: Aetna of CA HMO/PPO	$55,090.93
Rate for Payer: Anthem Blue Cross of CA Exchange	$35,586.49
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$49,822.35
Rate for Payer: EPIC Health Plan Commercial	$49,122.35
Rate for Payer: EPIC Health Plan Senior	$32,748.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,771.12
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$41,679.57
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$39,893.30
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$29,771.12
Rate for Payer: Prime Health Services Medicare	$31,557.39
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 INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC

Facility

$19,204.97

Service Code	MSDRG 869
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$19,204.97
Rate for Payer: Aetna of CA HMO/PPO	$19,204.97
Rate for Payer: Anthem Blue Cross of CA Exchange	$12,405.63
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$17,368.32
Rate for Payer: EPIC Health Plan Commercial	$18,093.32
Rate for Payer: EPIC Health Plan Senior	$12,062.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,965.65
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$15,351.91
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$14,693.97
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$10,965.65
Rate for Payer: Prime Health Services Medicare	$11,623.59
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 INJURY, POISONING AND TOXIC EFFECT DIAGNOSES

Facility

$33,542.32

Service Code	APR-DRG 8154
Min. Negotiated Rate	$21,184.62
Max. Negotiated Rate	$33,542.32
Rate for Payer: Adventist Health Medi-Cal	$21,184.62
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$25,245.01
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$33,542.32

OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES

Facility

$6,050.63

Service Code	APR-DRG 8151
Min. Negotiated Rate	$3,821.45
Max. Negotiated Rate	$6,050.63
Rate for Payer: Adventist Health Medi-Cal	$3,821.45
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$4,553.89
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$6,050.63

OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES

Facility

$9,434.47

Service Code	APR-DRG 8152
Min. Negotiated Rate	$5,958.61
Max. Negotiated Rate	$9,434.47
Rate for Payer: Adventist Health Medi-Cal	$5,958.61
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$7,100.68
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$9,434.47

OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES

Facility

$15,718.74

Service Code	APR-DRG 8153
Min. Negotiated Rate	$9,927.62
Max. Negotiated Rate	$15,718.74
Rate for Payer: Adventist Health Medi-Cal	$9,927.62
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$11,830.42
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$15,718.74

OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC

Facility

$46,042.46

Service Code	MSDRG 922
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$46,042.46
Rate for Payer: Aetna of CA HMO/PPO	$46,042.46
Rate for Payer: Anthem Blue Cross of CA Exchange	$29,741.55
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$41,639.22
Rate for Payer: EPIC Health Plan Commercial	$41,298.51
Rate for Payer: EPIC Health Plan Senior	$27,532.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$25,029.40
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$35,041.16
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$33,539.40
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$25,029.40
Rate for Payer: Prime Health Services Medicare	$26,531.16
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 INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC

Facility

$26,784.85

Service Code	MSDRG 923
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$26,784.85
Rate for Payer: Aetna of CA HMO/PPO	$26,784.85
Rate for Payer: Anthem Blue Cross of CA Exchange	$17,301.92
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$24,223.30
Rate for Payer: EPIC Health Plan Commercial	$24,647.29
Rate for Payer: EPIC Health Plan Senior	$16,431.53
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,937.75
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$20,912.85
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$20,016.58
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$14,937.75
Rate for Payer: Prime Health Services Medicare	$15,834.01
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

Know your out-of-pocket cost for care.

All Charges