Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

OTHER KIDNEY AND URINARY TRACT DIAGNOSES, SIGNS AND SYMPTOMS

Facility

$10,048.80

Service Code	APR-DRG 4682
Min. Negotiated Rate	$6,346.61
Max. Negotiated Rate	$10,048.80
Rate for Payer: Adventist Health Medi-Cal	$6,346.61
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$7,563.04
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$10,048.80

OTHER KIDNEY AND URINARY TRACT DIAGNOSES, SIGNS AND SYMPTOMS

Facility

$7,502.85

Service Code	APR-DRG 4681
Min. Negotiated Rate	$4,738.64
Max. Negotiated Rate	$7,502.85
Rate for Payer: Adventist Health Medi-Cal	$4,738.64
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$5,646.88
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$7,502.85

OTHER KIDNEY AND URINARY TRACT DIAGNOSES, SIGNS AND SYMPTOMS

Facility

$26,716.22

Service Code	APR-DRG 4684
Min. Negotiated Rate	$16,873.40
Max. Negotiated Rate	$26,716.22
Rate for Payer: Adventist Health Medi-Cal	$16,873.40
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$20,107.47
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$26,716.22

OTHER KIDNEY AND URINARY TRACT DIAGNOSES, SIGNS AND SYMPTOMS

Facility

$15,249.44

Service Code	APR-DRG 4683
Min. Negotiated Rate	$9,631.22
Max. Negotiated Rate	$15,249.44
Rate for Payer: Adventist Health Medi-Cal	$9,631.22
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$11,477.21
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$15,249.44

OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC

Facility

$26,713.78

Service Code	MSDRG 699
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$26,713.78
Rate for Payer: Aetna of CA HMO/PPO	$26,713.78
Rate for Payer: Anthem Blue Cross of CA Exchange	$17,256.01
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$24,159.03
Rate for Payer: EPIC Health Plan Commercial	$24,585.87
Rate for Payer: EPIC Health Plan Senior	$16,390.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,900.53
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$20,860.74
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$19,966.71
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$14,900.53
Rate for Payer: Prime Health Services Medicare	$15,794.56
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 KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC

Facility

$43,542.15

Service Code	MSDRG 698
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$43,542.15
Rate for Payer: Aetna of CA HMO/PPO	$43,542.15
Rate for Payer: Anthem Blue Cross of CA Exchange	$28,126.45
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$39,378.03
Rate for Payer: EPIC Health Plan Commercial	$39,136.61
Rate for Payer: EPIC Health Plan Senior	$26,091.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,719.16
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$33,206.82
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$31,783.67
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$23,719.16
Rate for Payer: Prime Health Services Medicare	$25,142.31
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 KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC

Facility

$18,157.48

Service Code	MSDRG 700
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$18,157.48
Rate for Payer: Aetna of CA HMO/PPO	$18,157.48
Rate for Payer: Anthem Blue Cross of CA Exchange	$11,728.99
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$16,421.00
Rate for Payer: EPIC Health Plan Commercial	$17,187.60
Rate for Payer: EPIC Health Plan Senior	$11,458.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,416.73
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$14,583.42
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$13,958.42
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$10,416.73
Rate for Payer: Prime Health Services Medicare	$11,041.73
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

$61,549.61

Service Code	MSDRG 674
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$61,549.61
Rate for Payer: Aetna of CA HMO/PPO	$61,549.61
Rate for Payer: Anthem Blue Cross of CA Exchange	$39,758.54
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$55,663.36
Rate for Payer: EPIC Health Plan Commercial	$54,706.90
Rate for Payer: EPIC Health Plan Senior	$36,471.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$33,155.70
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$46,417.98
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$44,428.64
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$33,155.70
Rate for Payer: Prime Health Services Medicare	$35,145.04
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

$110,581.91

Service Code	MSDRG 673
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$110,581.91
Rate for Payer: Aetna of CA HMO/PPO	$110,581.91
Rate for Payer: Anthem Blue Cross of CA Exchange	$71,431.40
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$100,006.48
Rate for Payer: EPIC Health Plan Commercial	$97,102.95
Rate for Payer: EPIC Health Plan Senior	$64,735.30
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$58,850.27
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$82,390.38
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$78,859.36
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$58,850.27
Rate for Payer: Prime Health Services Medicare	$62,381.29
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

$43,200.01

Service Code	MSDRG 675
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$43,200.01
Rate for Payer: Aetna of CA HMO/PPO	$43,200.01
Rate for Payer: Anthem Blue Cross of CA Exchange	$27,905.44
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$39,068.60
Rate for Payer: EPIC Health Plan Commercial	$38,840.77
Rate for Payer: EPIC Health Plan Senior	$25,893.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,539.86
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$32,955.80
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$31,543.41
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$23,539.86
Rate for Payer: Prime Health Services Medicare	$24,952.25
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

$66,168.16

Service Code	APR-DRG 4474
Min. Negotiated Rate	$41,790.42
Max. Negotiated Rate	$66,168.16
Rate for Payer: Adventist Health Medi-Cal	$41,790.42
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$49,800.25
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$66,168.16

OTHER KIDNEY, URINARY TRACT AND RELATED NON-PERCUTANEOUS PROCEDURES

Facility

$34,909.93

Service Code	APR-DRG 4473
Min. Negotiated Rate	$22,048.38
Max. Negotiated Rate	$34,909.93
Rate for Payer: Adventist Health Medi-Cal	$22,048.38
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$26,274.32
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$34,909.93

OTHER KIDNEY, URINARY TRACT AND RELATED NON-PERCUTANEOUS PROCEDURES

Facility

$19,956.59

Service Code	APR-DRG 4471
Min. Negotiated Rate	$12,604.16
Max. Negotiated Rate	$19,956.59
Rate for Payer: Adventist Health Medi-Cal	$12,604.16
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$15,019.96
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$19,956.59

OTHER KIDNEY, URINARY TRACT AND RELATED NON-PERCUTANEOUS PROCEDURES

Facility

$24,794.68

Service Code	APR-DRG 4472
Min. Negotiated Rate	$15,659.80
Max. Negotiated Rate	$24,794.68
Rate for Payer: Adventist Health Medi-Cal	$15,659.80
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$18,661.26
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$24,794.68

OTHER KIDNEY, URINARY TRACT AND RELATED PERCUTANEOUS PROCEDURES

Facility

$20,858.96

Service Code	APR-DRG 4481
Min. Negotiated Rate	$13,174.08
Max. Negotiated Rate	$20,858.96
Rate for Payer: Adventist Health Medi-Cal	$13,174.08
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$15,699.11
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$20,858.96

OTHER KIDNEY, URINARY TRACT AND RELATED PERCUTANEOUS PROCEDURES

Facility

$29,614.63

Service Code	APR-DRG 4482
Min. Negotiated Rate	$18,703.98
Max. Negotiated Rate	$29,614.63
Rate for Payer: Adventist Health Medi-Cal	$18,703.98
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$22,288.91
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$29,614.63

OTHER KIDNEY, URINARY TRACT AND RELATED PERCUTANEOUS PROCEDURES

Facility

$39,629.19

Service Code	APR-DRG 4483
Min. Negotiated Rate	$25,028.96
Max. Negotiated Rate	$39,629.19
Rate for Payer: Adventist Health Medi-Cal	$25,028.96
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$29,826.18
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$39,629.19

OTHER KIDNEY, URINARY TRACT AND RELATED PERCUTANEOUS PROCEDURES

Facility

$64,248.63

Service Code	APR-DRG 4484
Min. Negotiated Rate	$40,578.08
Max. Negotiated Rate	$64,248.63
Rate for Payer: Adventist Health Medi-Cal	$40,578.08
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$48,355.55
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$64,248.63

OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC

Facility

$93,598.26

Service Code	MSDRG 271
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$93,598.26
Rate for Payer: Aetna of CA HMO/PPO	$93,598.26
Rate for Payer: Anthem Blue Cross of CA Exchange	$60,460.66
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$84,647.05
Rate for Payer: EPIC Health Plan Commercial	$82,417.93
Rate for Payer: EPIC Health Plan Senior	$54,945.29
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$49,950.26
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$69,930.36
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$66,933.35
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$49,950.26
Rate for Payer: Prime Health Services Medicare	$52,947.28
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

$138,866.94

Service Code	MSDRG 270
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$138,866.94
Rate for Payer: Aetna of CA HMO/PPO	$138,866.94
Rate for Payer: Anthem Blue Cross of CA Exchange	$89,702.38
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$125,586.49
Rate for Payer: EPIC Health Plan Commercial	$121,559.79
Rate for Payer: EPIC Health Plan Senior	$81,039.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$73,672.60
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$103,141.64
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$98,721.28
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$73,672.60
Rate for Payer: Prime Health Services Medicare	$78,092.96
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

$67,192.41

Service Code	MSDRG 272
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$67,192.41
Rate for Payer: Aetna of CA HMO/PPO	$67,192.41
Rate for Payer: Anthem Blue Cross of CA Exchange	$43,403.55
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$60,766.51
Rate for Payer: EPIC Health Plan Commercial	$59,585.94
Rate for Payer: EPIC Health Plan Senior	$39,723.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,112.69
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$50,557.77
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$48,391.00
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$36,112.69
Rate for Payer: Prime Health Services Medicare	$38,279.45
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

$25,479.51

Service Code	APR-DRG 0911
Min. Negotiated Rate	$16,092.32
Max. Negotiated Rate	$25,479.51
Rate for Payer: Adventist Health Medi-Cal	$16,092.32
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$19,176.69
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$25,479.51

OTHER MAJOR HEAD AND NECK PROCEDURES

Facility

$64,981.81

Service Code	APR-DRG 0913
Min. Negotiated Rate	$41,041.14
Max. Negotiated Rate	$64,981.81
Rate for Payer: Adventist Health Medi-Cal	$41,041.14
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$48,907.36
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$64,981.81

OTHER MAJOR HEAD AND NECK PROCEDURES

Facility

$41,351.32

Service Code	APR-DRG 0912
Min. Negotiated Rate	$26,116.62
Max. Negotiated Rate	$41,351.32
Rate for Payer: Adventist Health Medi-Cal	$26,116.62
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$31,122.31
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$41,351.32

OTHER MAJOR HEAD AND NECK PROCEDURES

Facility

$102,306.75

Service Code	APR-DRG 0914
Min. Negotiated Rate	$64,614.79
Max. Negotiated Rate	$102,306.75
Rate for Payer: Adventist Health Medi-Cal	$64,614.79
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$76,999.29
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$102,306.75

Know your out-of-pocket cost for care.

All Charges