Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC

Facility

$91,491.76

Service Code	MSDRG 700
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$91,491.76
Rate for Payer: Aetna of CA HMO/PPO	$20,915.01
Rate for Payer: EPIC Health Plan Commercial	$91,491.76
Rate for Payer: EPIC Health Plan Senior	$60,994.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$55,449.55
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$77,629.37
Rate for Payer: Molina Healthcare of CA Medicare	$74,302.40
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 KIDNEY AND URINARY TRACT PROCEDURES WITH CC

Facility

$120,747.68

Service Code	MSDRG 674
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$120,747.68
Rate for Payer: Aetna of CA HMO/PPO	$70,897.00
Rate for Payer: EPIC Health Plan Commercial	$120,747.68
Rate for Payer: EPIC Health Plan Senior	$80,498.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$73,180.41
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$102,452.57
Rate for Payer: Molina Healthcare of CA Medicare	$98,061.75
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 KIDNEY AND URINARY TRACT PROCEDURES WITH MCC

Facility

$153,806.27

Service Code	MSDRG 673
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$153,806.27
Rate for Payer: Aetna of CA HMO/PPO	$127,375.71
Rate for Payer: EPIC Health Plan Commercial	$153,806.27
Rate for Payer: EPIC Health Plan Senior	$102,537.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$93,215.92
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$130,502.29
Rate for Payer: Molina Healthcare of CA Medicare	$124,909.33
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 KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC

Facility

$108,375.98

Service Code	MSDRG 675
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$108,375.98
Rate for Payer: Aetna of CA HMO/PPO	$49,760.68
Rate for Payer: EPIC Health Plan Commercial	$108,375.98
Rate for Payer: EPIC Health Plan Senior	$72,250.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$65,682.41
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$91,955.37
Rate for Payer: Molina Healthcare of CA Medicare	$88,014.43
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 KIDNEY, URINARY TRACT AND RELATED NON-PERCUTANEOUS PROCEDURES

Facility

$47,128.42

Service Code	APR-DRG 4473
Min. Negotiated Rate	$37,640.72
Max. Negotiated Rate	$47,128.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$37,640.72
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$47,128.42
Rate for Payer: Molina Healthcare of CA Medi-Cal	$42,167.53

OTHER KIDNEY, URINARY TRACT AND RELATED NON-PERCUTANEOUS PROCEDURES

Facility

$115,794.26

Service Code	APR-DRG 4474
Min. Negotiated Rate	$92,483.05
Max. Negotiated Rate	$115,794.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$92,483.05
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$115,794.26
Rate for Payer: Molina Healthcare of CA Medi-Cal	$103,605.40

OTHER KIDNEY, URINARY TRACT AND RELATED NON-PERCUTANEOUS PROCEDURES

Facility

$26,941.41

Service Code	APR-DRG 4471
Min. Negotiated Rate	$21,517.68
Max. Negotiated Rate	$26,941.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$21,517.68
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$26,941.41
Rate for Payer: Molina Healthcare of CA Medi-Cal	$24,105.47

OTHER KIDNEY, URINARY TRACT AND RELATED NON-PERCUTANEOUS PROCEDURES

Facility

$33,472.81

Service Code	APR-DRG 4472
Min. Negotiated Rate	$26,734.21
Max. Negotiated Rate	$33,472.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$26,734.21
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$33,472.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$29,949.36

OTHER KIDNEY, URINARY TRACT AND RELATED PERCUTANEOUS PROCEDURES

Facility

$39,979.76

Service Code	APR-DRG 4482
Min. Negotiated Rate	$31,931.20
Max. Negotiated Rate	$39,979.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$31,931.20
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$39,979.76
Rate for Payer: Molina Healthcare of CA Medi-Cal	$35,771.37

OTHER KIDNEY, URINARY TRACT AND RELATED PERCUTANEOUS PROCEDURES

Facility

$28,159.58

Service Code	APR-DRG 4481
Min. Negotiated Rate	$22,490.61
Max. Negotiated Rate	$28,159.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$22,490.61
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$28,159.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25,195.41

OTHER KIDNEY, URINARY TRACT AND RELATED PERCUTANEOUS PROCEDURES

Facility

$53,499.40

Service Code	APR-DRG 4483
Min. Negotiated Rate	$42,729.13
Max. Negotiated Rate	$53,499.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$42,729.13
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$53,499.40
Rate for Payer: Molina Healthcare of CA Medi-Cal	$47,867.89

OTHER KIDNEY, URINARY TRACT AND RELATED PERCUTANEOUS PROCEDURES

Facility

$112,435.10

Service Code	APR-DRG 4484
Min. Negotiated Rate	$89,800.14
Max. Negotiated Rate	$112,435.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$89,800.14
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$112,435.10
Rate for Payer: Molina Healthcare of CA Medi-Cal	$100,599.83

OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC

Facility

$142,355.52

Service Code	MSDRG 271
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$142,355.52
Rate for Payer: Aetna of CA HMO/PPO	$107,812.79
Rate for Payer: EPIC Health Plan Commercial	$142,355.52
Rate for Payer: EPIC Health Plan Senior	$94,903.68
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$86,276.07
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$120,786.50
Rate for Payer: Molina Healthcare of CA Medicare	$115,609.93
Rate for Payer: United Healthcare All Other Commercial	$63,629.00
Rate for Payer: United Healthcare All Other HMO	$63,629.00
Rate for Payer: United Healthcare HMO Rider	$42,494.00
Rate for Payer: United Healthcare Select/Navigate/Core	$38,930.00

OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC

Facility

$172,876.64

Service Code	MSDRG 270
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$172,876.64
Rate for Payer: Aetna of CA HMO/PPO	$159,956.31
Rate for Payer: EPIC Health Plan Commercial	$172,876.64
Rate for Payer: EPIC Health Plan Senior	$115,251.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$104,773.72
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$146,683.21
Rate for Payer: Molina Healthcare of CA Medicare	$140,396.78
Rate for Payer: United Healthcare All Other Commercial	$95,869.00
Rate for Payer: United Healthcare All Other HMO	$95,869.00
Rate for Payer: United Healthcare HMO Rider	$64,025.00
Rate for Payer: United Healthcare Select/Navigate/Core	$58,657.00

OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC

Facility

$124,552.15

Service Code	MSDRG 272
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$124,552.15
Rate for Payer: Aetna of CA HMO/PPO	$77,396.75
Rate for Payer: EPIC Health Plan Commercial	$124,552.15
Rate for Payer: EPIC Health Plan Senior	$83,034.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$75,486.15
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$105,680.61
Rate for Payer: Molina Healthcare of CA Medicare	$101,151.44
Rate for Payer: United Healthcare All Other Commercial	$45,573.00
Rate for Payer: United Healthcare All Other HMO	$45,573.00
Rate for Payer: United Healthcare HMO Rider	$30,435.00
Rate for Payer: United Healthcare Select/Navigate/Core	$27,883.00

OTHER MAJOR HEAD AND NECK PROCEDURES

Facility

$179,036.81

Service Code	APR-DRG 0914
Min. Negotiated Rate	$142,993.87
Max. Negotiated Rate	$179,036.81
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$142,993.87
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$179,036.81
Rate for Payer: Molina Healthcare of CA Medi-Cal	$160,190.83

OTHER MAJOR HEAD AND NECK PROCEDURES

Facility

$55,824.28

Service Code	APR-DRG 0912
Min. Negotiated Rate	$44,585.97
Max. Negotiated Rate	$55,824.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$44,585.97
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$55,824.28
Rate for Payer: Molina Healthcare of CA Medi-Cal	$49,948.04

OTHER MAJOR HEAD AND NECK PROCEDURES

Facility

$34,397.33

Service Code	APR-DRG 0911
Min. Negotiated Rate	$27,472.61
Max. Negotiated Rate	$34,397.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$27,472.61
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$34,397.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$30,776.56

OTHER MAJOR HEAD AND NECK PROCEDURES

Facility

$87,725.43

Service Code	APR-DRG 0913
Min. Negotiated Rate	$70,064.92
Max. Negotiated Rate	$87,725.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$70,064.92
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$87,725.43
Rate for Payer: Molina Healthcare of CA Medi-Cal	$78,491.18

OTHER MALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES

Facility

$101,917.01

Service Code	APR-DRG 4844
Min. Negotiated Rate	$81,399.50
Max. Negotiated Rate	$101,917.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$81,399.50
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$101,917.01
Rate for Payer: Molina Healthcare of CA Medi-Cal	$91,188.90

OTHER MALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES

Facility

$29,391.37

Service Code	APR-DRG 4842
Min. Negotiated Rate	$23,474.42
Max. Negotiated Rate	$29,391.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$23,474.42
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$29,391.37
Rate for Payer: Molina Healthcare of CA Medi-Cal	$26,297.54

OTHER MALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES

Facility

$45,360.96

Service Code	APR-DRG 4843
Min. Negotiated Rate	$36,229.08
Max. Negotiated Rate	$45,360.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$36,229.08
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$45,360.96
Rate for Payer: Molina Healthcare of CA Medi-Cal	$40,586.12

OTHER MALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES

Facility

$24,042.79

Service Code	APR-DRG 4841
Min. Negotiated Rate	$19,202.60
Max. Negotiated Rate	$24,042.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$19,202.60
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$24,042.79
Rate for Payer: Molina Healthcare of CA Medi-Cal	$21,511.97

OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC

Facility

$98,036.05

Service Code	MSDRG 729
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$98,036.05
Rate for Payer: Aetna of CA HMO/PPO	$32,095.55
Rate for Payer: EPIC Health Plan Commercial	$98,036.05
Rate for Payer: EPIC Health Plan Senior	$65,357.37
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$59,415.79
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$83,182.11
Rate for Payer: Molina Healthcare of CA Medicare	$79,617.16
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 MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$91,174.15

Service Code	MSDRG 730
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$91,174.15
Rate for Payer: Aetna of CA HMO/PPO	$20,372.35
Rate for Payer: EPIC Health Plan Commercial	$91,174.15
Rate for Payer: EPIC Health Plan Senior	$60,782.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$55,257.06
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$77,359.88
Rate for Payer: Molina Healthcare of CA Medicare	$74,044.46
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