Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC

Facility

$54,693.51

Service Code	MSDRG 516
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$54,693.51
Rate for Payer: Aetna of CA HMO/PPO	$54,693.51
Rate for Payer: Anthem Blue Cross of CA Exchange	$35,329.78
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$49,462.94
Rate for Payer: EPIC Health Plan Commercial	$48,778.70
Rate for Payer: EPIC Health Plan Senior	$32,519.13
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,562.85
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$41,387.99
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$39,614.22
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$29,562.85
Rate for Payer: Prime Health Services Medicare	$31,336.62
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 MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC

Facility

$83,876.02

Service Code	MSDRG 515
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$83,876.02
Rate for Payer: Aetna of CA HMO/PPO	$83,876.02
Rate for Payer: Anthem Blue Cross of CA Exchange	$54,180.49
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$75,854.59
Rate for Payer: EPIC Health Plan Commercial	$74,011.56
Rate for Payer: EPIC Health Plan Senior	$49,341.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$44,855.49
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$62,797.69
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$60,106.36
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$44,855.49
Rate for Payer: Prime Health Services Medicare	$47,546.82
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 MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC

Facility

$40,444.41

Service Code	MSDRG 517
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$40,444.41
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: Aetna of CA HMO/PPO	$40,444.41
Rate for Payer: Anthem Blue Cross of CA Exchange	$26,125.44
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$36,576.53
Rate for Payer: EPIC Health Plan Commercial	$36,458.10
Rate for Payer: EPIC Health Plan Senior	$24,305.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,095.82
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$30,934.15
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$29,608.40
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$22,095.82
Rate for Payer: Prime Health Services Medicare	$23,421.57
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 Select/Navigate/Core	$7,611.00

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE PROCEDURES

Facility

$55,770.91

Service Code	APR-DRG 3204
Min. Negotiated Rate	$35,223.73
Max. Negotiated Rate	$55,770.91
Rate for Payer: Adventist Health Medi-Cal	$35,223.73
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$41,974.95
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$55,770.91

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE PROCEDURES

Facility

$24,190.42

Service Code	APR-DRG 3202
Min. Negotiated Rate	$15,278.16
Max. Negotiated Rate	$24,190.42
Rate for Payer: Adventist Health Medi-Cal	$15,278.16
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$18,206.47
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$24,190.42

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE PROCEDURES

Facility

$35,044.89

Service Code	APR-DRG 3203
Min. Negotiated Rate	$22,133.62
Max. Negotiated Rate	$35,044.89
Rate for Payer: Adventist Health Medi-Cal	$22,133.62
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$26,375.89
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$35,044.89

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE PROCEDURES

Facility

$17,324.05

Service Code	APR-DRG 3201
Min. Negotiated Rate	$10,941.50
Max. Negotiated Rate	$17,324.05
Rate for Payer: Adventist Health Medi-Cal	$10,941.50
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$13,038.63
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$17,324.05

OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC

Facility

$32,040.75

Service Code	MSDRG 844
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$32,040.75
Rate for Payer: Aetna of CA HMO/PPO	$32,040.75
Rate for Payer: Anthem Blue Cross of CA Exchange	$20,697.02
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$28,976.55
Rate for Payer: EPIC Health Plan Commercial	$29,191.87
Rate for Payer: EPIC Health Plan Senior	$19,461.24
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$17,692.04
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$24,768.86
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$23,707.33
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$17,692.04
Rate for Payer: Prime Health Services Medicare	$18,753.56
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 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC

Facility

$52,501.14

Service Code	MSDRG 843
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$52,501.14
Rate for Payer: Aetna of CA HMO/PPO	$52,501.14
Rate for Payer: Anthem Blue Cross of CA Exchange	$33,913.59
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$47,480.23
Rate for Payer: EPIC Health Plan Commercial	$46,883.08
Rate for Payer: EPIC Health Plan Senior	$31,255.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,413.99
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$39,779.59
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$38,074.75
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$28,413.99
Rate for Payer: Prime Health Services Medicare	$30,118.83
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 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC

Facility

$22,413.26

Service Code	MSDRG 845
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$22,413.26
Rate for Payer: Aetna of CA HMO/PPO	$22,413.26
Rate for Payer: Anthem Blue Cross of CA Exchange	$14,478.05
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$20,269.78
Rate for Payer: EPIC Health Plan Commercial	$20,867.37
Rate for Payer: EPIC Health Plan Senior	$13,911.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$12,646.89
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$17,705.65
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$16,946.83
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$12,646.89
Rate for Payer: Prime Health Services Medicare	$13,405.70
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 NERVOUS SYSTEM AND RELATED PROCEDURES

Facility

$19,817.61

Service Code	APR-DRG 0261
Min. Negotiated Rate	$12,516.38
Max. Negotiated Rate	$19,817.61
Rate for Payer: Adventist Health Medi-Cal	$12,516.38
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$14,915.36
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$19,817.61

OTHER NERVOUS SYSTEM AND RELATED PROCEDURES

Facility

$38,686.55

Service Code	APR-DRG 0263
Min. Negotiated Rate	$24,433.61
Max. Negotiated Rate	$38,686.55
Rate for Payer: Adventist Health Medi-Cal	$24,433.61
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$29,116.72
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$38,686.55

OTHER NERVOUS SYSTEM AND RELATED PROCEDURES

Facility

$28,923.78

Service Code	APR-DRG 0262
Min. Negotiated Rate	$18,267.65
Max. Negotiated Rate	$28,923.78
Rate for Payer: Adventist Health Medi-Cal	$18,267.65
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$21,768.95
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$28,923.78

OTHER NERVOUS SYSTEM AND RELATED PROCEDURES

Facility

$62,298.89

Service Code	APR-DRG 0264
Min. Negotiated Rate	$39,346.67
Max. Negotiated Rate	$62,298.89
Rate for Payer: Adventist Health Medi-Cal	$39,346.67
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$46,888.11
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$62,298.89

OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS

Facility

$25,157.24

Service Code	APR-DRG 4254
Min. Negotiated Rate	$15,888.78
Max. Negotiated Rate	$25,157.24
Rate for Payer: Adventist Health Medi-Cal	$15,888.78
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$18,934.13
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$25,157.24

OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS

Facility

$7,353.82

Service Code	APR-DRG 4251
Min. Negotiated Rate	$4,644.52
Max. Negotiated Rate	$7,353.82
Rate for Payer: Adventist Health Medi-Cal	$4,644.52
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$5,534.71
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$7,353.82

OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS

Facility

$13,045.91

Service Code	APR-DRG 4253
Min. Negotiated Rate	$8,239.52
Max. Negotiated Rate	$13,045.91
Rate for Payer: Adventist Health Medi-Cal	$8,239.52
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$9,818.77
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$13,045.91

OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS

Facility

$9,168.60

Service Code	APR-DRG 4252
Min. Negotiated Rate	$5,790.70
Max. Negotiated Rate	$9,168.60
Rate for Payer: Adventist Health Medi-Cal	$5,790.70
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$6,900.58
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$9,168.60

OTHER OPEN CRANIOTOMY

Facility

$52,340.74

Service Code	APR-DRG 0273
Min. Negotiated Rate	$33,057.31
Max. Negotiated Rate	$52,340.74
Rate for Payer: Adventist Health Medi-Cal	$33,057.31
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$39,393.30
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$52,340.74

OTHER OPEN CRANIOTOMY

Facility

$34,396.33

Service Code	APR-DRG 0272
Min. Negotiated Rate	$21,724.00
Max. Negotiated Rate	$34,396.33
Rate for Payer: Adventist Health Medi-Cal	$21,724.00
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$25,887.76
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$34,396.33

OTHER OPEN CRANIOTOMY

Facility

$74,094.00

Service Code	APR-DRG 0274
Min. Negotiated Rate	$46,796.21
Max. Negotiated Rate	$74,094.00
Rate for Payer: Adventist Health Medi-Cal	$46,796.21
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$55,765.48
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$74,094.00

OTHER OPEN CRANIOTOMY

Facility

$26,329.50

Service Code	APR-DRG 0271
Min. Negotiated Rate	$16,629.16
Max. Negotiated Rate	$26,329.50
Rate for Payer: Adventist Health Medi-Cal	$16,629.16
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$19,816.41
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$26,329.50

OTHER O.R. PROCEDURES FOR INJURIES WITH CC

Facility

$52,511.67

Service Code	MSDRG 908
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$52,511.67
Rate for Payer: Aetna of CA HMO/PPO	$52,511.67
Rate for Payer: Anthem Blue Cross of CA Exchange	$33,920.40
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$47,489.75
Rate for Payer: EPIC Health Plan Commercial	$46,892.16
Rate for Payer: EPIC Health Plan Senior	$31,261.44
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$28,419.49
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$39,787.29
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$38,082.12
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$28,419.49
Rate for Payer: Prime Health Services Medicare	$30,124.66
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 O.R. PROCEDURES FOR INJURIES WITH MCC

Facility

$101,046.54

Service Code	MSDRG 907
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$101,046.54
Rate for Payer: Aetna of CA HMO/PPO	$101,046.54
Rate for Payer: Anthem Blue Cross of CA Exchange	$65,271.94
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$91,383.02
Rate for Payer: EPIC Health Plan Commercial	$88,858.14
Rate for Payer: EPIC Health Plan Senior	$59,238.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$53,853.42
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$75,394.79
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$72,163.58
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$53,853.42
Rate for Payer: Prime Health Services Medicare	$57,084.63
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 O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC

Facility

$34,548.95

Service Code	MSDRG 909
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$34,548.95
Rate for Payer: Aetna of CA HMO/PPO	$34,548.95
Rate for Payer: Anthem Blue Cross of CA Exchange	$22,317.21
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$31,244.89
Rate for Payer: EPIC Health Plan Commercial	$31,360.59
Rate for Payer: EPIC Health Plan Senior	$20,907.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,006.42
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$26,608.99
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$25,468.60
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$19,006.42
Rate for Payer: Prime Health Services Medicare	$20,146.81
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

Know your out-of-pocket cost for care.

All Charges