Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

MAGNESIUM SULFATE ORAL SOLUTION (IV FORM) 0.5 G/ML [4080434]

Facility

$1.55

Service Code	NDC 9994080434
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$1.40
Rate for Payer: Adventist Health Commercial	$0.31
Rate for Payer: Blue Shield of California Commercial	$1.24
Rate for Payer: Blue Shield of California EPN	$0.78
Rate for Payer: Cash Price	$0.70
Rate for Payer: Central Health Plan Commercial	$1.24
Rate for Payer: Cigna of CA HMO	$1.08
Rate for Payer: Cigna of CA PPO	$1.08
Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant	$1.08
Rate for Payer: EPIC Health Plan Commercial	$0.62
Rate for Payer: EPIC Health Plan Senior	$0.62
Rate for Payer: Galaxy Health WC	$1.32
Rate for Payer: Global Benefits Group Commercial	$0.93
Rate for Payer: Health Management Network EPO/PPO	$1.40
Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded	$0.98
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$0.91
Rate for Payer: LLUH Dept of Risk Management WC	$0.31
Rate for Payer: Multiplan Commercial	$1.16
Rate for Payer: Networks By Design Commercial	$1.01
Rate for Payer: Prime Health Services Commercial	$1.32

MAJOR ABDOMINAL VASCULAR PROCEDURES

Facility

$52,242.04

Service Code	APR-DRG 1692
Min. Negotiated Rate	$32,994.97
Max. Negotiated Rate	$52,242.04
Rate for Payer: Adventist Health Medi-Cal	$32,994.97
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$39,319.01
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$52,242.04

MAJOR ABDOMINAL VASCULAR PROCEDURES

Facility

$64,182.17

Service Code	APR-DRG 1693
Min. Negotiated Rate	$40,536.11
Max. Negotiated Rate	$64,182.17
Rate for Payer: Adventist Health Medi-Cal	$40,536.11
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$48,305.53
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$64,182.17

MAJOR ABDOMINAL VASCULAR PROCEDURES

Facility

$44,817.75

Service Code	APR-DRG 1691
Min. Negotiated Rate	$28,305.95
Max. Negotiated Rate	$44,817.75
Rate for Payer: Adventist Health Medi-Cal	$28,305.95
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$33,731.25
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$44,817.75

MAJOR ABDOMINAL VASCULAR PROCEDURES

Facility

$94,433.29

Service Code	APR-DRG 1694
Min. Negotiated Rate	$59,642.08
Max. Negotiated Rate	$94,433.29
Rate for Payer: Adventist Health Medi-Cal	$59,642.08
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$71,073.47
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$94,433.29

MAJOR BILIARY TRACT PROCEDURES

Facility

$41,520.51

Service Code	APR-DRG 2613
Min. Negotiated Rate	$26,223.48
Max. Negotiated Rate	$41,520.51
Rate for Payer: Adventist Health Medi-Cal	$26,223.48
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$31,249.65
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$41,520.51

MAJOR BILIARY TRACT PROCEDURES

Facility

$79,034.79

Service Code	APR-DRG 2614
Min. Negotiated Rate	$49,916.71
Max. Negotiated Rate	$79,034.79
Rate for Payer: Adventist Health Medi-Cal	$49,916.71
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$59,484.08
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$79,034.79

MAJOR BILIARY TRACT PROCEDURES

Facility

$33,540.30

Service Code	APR-DRG 2612
Min. Negotiated Rate	$21,183.35
Max. Negotiated Rate	$33,540.30
Rate for Payer: Adventist Health Medi-Cal	$21,183.35
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$25,243.49
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$33,540.30

MAJOR BILIARY TRACT PROCEDURES

Facility

$23,884.27

Service Code	APR-DRG 2611
Min. Negotiated Rate	$15,084.80
Max. Negotiated Rate	$23,884.27
Rate for Payer: Adventist Health Medi-Cal	$15,084.80
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$17,976.06
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$23,884.27

MAJOR BLADDER PROCEDURES

Facility

$52,882.57

Service Code	APR-DRG 4413
Min. Negotiated Rate	$33,399.52
Max. Negotiated Rate	$52,882.57
Rate for Payer: Adventist Health Medi-Cal	$33,399.52
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$39,801.09
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$52,882.57

MAJOR BLADDER PROCEDURES

Facility

$42,424.89

Service Code	APR-DRG 4412
Min. Negotiated Rate	$26,794.67
Max. Negotiated Rate	$42,424.89
Rate for Payer: Adventist Health Medi-Cal	$26,794.67
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$31,930.31
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$42,424.89

MAJOR BLADDER PROCEDURES

Facility

$33,403.33

Service Code	APR-DRG 4411
Min. Negotiated Rate	$21,096.84
Max. Negotiated Rate	$33,403.33
Rate for Payer: Adventist Health Medi-Cal	$21,096.84
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$25,140.40
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$33,403.33

MAJOR BLADDER PROCEDURES

Facility

$82,563.66

Service Code	APR-DRG 4414
Min. Negotiated Rate	$52,145.47
Max. Negotiated Rate	$82,563.66
Rate for Payer: Adventist Health Medi-Cal	$52,145.47
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$62,140.02
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$82,563.66

MAJOR BLADDER PROCEDURES WITH CC

Facility

$73,674.78

Service Code	MSDRG 654
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$73,674.78
Rate for Payer: Aetna of CA HMO/PPO	$73,674.78
Rate for Payer: Anthem Blue Cross of CA Exchange	$47,590.90
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$66,628.94
Rate for Payer: EPIC Health Plan Commercial	$65,190.97
Rate for Payer: EPIC Health Plan Senior	$43,460.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$39,509.68
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$55,313.55
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$52,942.97
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$39,509.68
Rate for Payer: Prime Health Services Medicare	$41,880.26
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

MAJOR BLADDER PROCEDURES WITH MCC

Facility

$136,764.05

Service Code	MSDRG 653
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$136,764.05
Rate for Payer: Aetna of CA HMO/PPO	$136,764.05
Rate for Payer: Anthem Blue Cross of CA Exchange	$88,344.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$123,684.71
Rate for Payer: EPIC Health Plan Commercial	$119,741.47
Rate for Payer: EPIC Health Plan Senior	$79,827.65
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$72,570.59
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$101,598.83
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$97,244.59
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$72,570.59
Rate for Payer: Prime Health Services Medicare	$76,924.83
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

MAJOR BLADDER PROCEDURES WITHOUT CC/MCC

Facility

$55,706.80

Service Code	MSDRG 655
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$55,706.80
Rate for Payer: Aetna of CA HMO/PPO	$55,706.80
Rate for Payer: Anthem Blue Cross of CA Exchange	$35,984.32
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$50,379.31
Rate for Payer: EPIC Health Plan Commercial	$49,654.84
Rate for Payer: EPIC Health Plan Senior	$33,103.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,093.84
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$42,131.38
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$40,325.75
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$30,093.84
Rate for Payer: Prime Health Services Medicare	$31,899.47
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

MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$50,308.43

Service Code	APR-DRG 1601
Min. Negotiated Rate	$31,773.74
Max. Negotiated Rate	$50,308.43
Rate for Payer: Adventist Health Medi-Cal	$31,773.74
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$37,863.71
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$50,308.43

MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$203,159.27

Service Code	APR-DRG 1604
Min. Negotiated Rate	$128,311.12
Max. Negotiated Rate	$203,159.27
Rate for Payer: Adventist Health Medi-Cal	$128,311.12
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$152,904.08
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$203,159.27

MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$89,297.09

Service Code	APR-DRG 1603
Min. Negotiated Rate	$56,398.16
Max. Negotiated Rate	$89,297.09
Rate for Payer: Adventist Health Medi-Cal	$56,398.16
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$67,207.81
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$89,297.09

MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$69,711.11

Service Code	APR-DRG 1602
Min. Negotiated Rate	$44,028.07
Max. Negotiated Rate	$69,711.11
Rate for Payer: Adventist Health Medi-Cal	$44,028.07
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$52,466.79
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$69,711.11

MAJOR CHEST AND RESPIRATORY TRAUMA

Facility

$9,776.89

Service Code	APR-DRG 1351
Min. Negotiated Rate	$6,174.88
Max. Negotiated Rate	$9,776.89
Rate for Payer: Adventist Health Medi-Cal	$6,174.88
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$7,358.39
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$9,776.89

MAJOR CHEST AND RESPIRATORY TRAUMA

Facility

$32,686.27

Service Code	APR-DRG 1354
Min. Negotiated Rate	$20,643.96
Max. Negotiated Rate	$32,686.27
Rate for Payer: Adventist Health Medi-Cal	$20,643.96
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$24,600.72
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$32,686.27

MAJOR CHEST AND RESPIRATORY TRAUMA

Facility

$18,216.33

Service Code	APR-DRG 1353
Min. Negotiated Rate	$11,505.05
Max. Negotiated Rate	$18,216.33
Rate for Payer: Adventist Health Medi-Cal	$11,505.05
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$13,710.18
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$18,216.33

MAJOR CHEST AND RESPIRATORY TRAUMA

Facility

$12,355.03

Service Code	APR-DRG 1352
Min. Negotiated Rate	$7,803.18
Max. Negotiated Rate	$12,355.03
Rate for Payer: Adventist Health Medi-Cal	$7,803.18
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$9,298.79
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$12,355.03

MAJOR CHEST PROCEDURES WITH CC

Facility

$66,429.16

Service Code	MSDRG 164
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$66,429.16
Rate for Payer: Aetna of CA HMO/PPO	$66,429.16
Rate for Payer: Anthem Blue Cross of CA Exchange	$42,910.52
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$60,076.25
Rate for Payer: EPIC Health Plan Commercial	$58,926.00
Rate for Payer: EPIC Health Plan Senior	$39,284.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,712.73
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$49,997.82
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$47,855.06
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$35,712.73
Rate for Payer: Prime Health Services Medicare	$37,855.49
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