Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT

Facility

$26,389.08

Service Code	APR-DRG 3231
Min. Negotiated Rate	$16,666.79
Max. Negotiated Rate	$26,389.08
Rate for Payer: Adventist Health Medi-Cal	$16,666.79
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$19,861.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$26,389.08

NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT

Facility

$29,632.74

Service Code	APR-DRG 3232
Min. Negotiated Rate	$18,715.42
Max. Negotiated Rate	$29,632.74
Rate for Payer: Adventist Health Medi-Cal	$18,715.42
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$22,302.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$29,632.74

NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT

Facility

$39,438.20

Service Code	APR-DRG 3233
Min. Negotiated Rate	$24,908.34
Max. Negotiated Rate	$39,438.20
Rate for Payer: Adventist Health Medi-Cal	$24,908.34
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$29,682.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$39,438.20

NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT

Facility

$70,135.02

Service Code	APR-DRG 3254
Min. Negotiated Rate	$44,295.80
Max. Negotiated Rate	$70,135.02
Rate for Payer: Adventist Health Medi-Cal	$44,295.80
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$52,785.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$70,135.02

NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT

Facility

$38,171.95

Service Code	APR-DRG 3252
Min. Negotiated Rate	$24,108.60
Max. Negotiated Rate	$38,171.95
Rate for Payer: Adventist Health Medi-Cal	$24,108.60
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$28,729.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$38,171.95

NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT

Facility

$32,791.28

Service Code	APR-DRG 3251
Min. Negotiated Rate	$20,710.28
Max. Negotiated Rate	$32,791.28
Rate for Payer: Adventist Health Medi-Cal	$20,710.28
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$24,679.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$32,791.28

NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT

Facility

$50,383.99

Service Code	APR-DRG 3253
Min. Negotiated Rate	$31,821.47
Max. Negotiated Rate	$50,383.99
Rate for Payer: Adventist Health Medi-Cal	$31,821.47
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$37,920.58
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$50,383.99

NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$25,032.39

Service Code	APR-DRG 7943
Min. Negotiated Rate	$15,809.93
Max. Negotiated Rate	$25,032.39
Rate for Payer: Adventist Health Medi-Cal	$15,809.93
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$18,840.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$25,032.39

NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$44,802.91

Service Code	APR-DRG 7944
Min. Negotiated Rate	$28,296.58
Max. Negotiated Rate	$44,802.91
Rate for Payer: Adventist Health Medi-Cal	$28,296.58
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$33,720.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$44,802.91

NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$13,386.07

Service Code	APR-DRG 7941
Min. Negotiated Rate	$8,454.36
Max. Negotiated Rate	$13,386.07
Rate for Payer: Adventist Health Medi-Cal	$8,454.36
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$10,074.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$13,386.07

NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$17,206.12

Service Code	APR-DRG 7942
Min. Negotiated Rate	$10,867.02
Max. Negotiated Rate	$17,206.12
Rate for Payer: Adventist Health Medi-Cal	$10,867.02
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$12,949.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$17,206.12

NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$30,996.54

Service Code	APR-DRG 9523
Min. Negotiated Rate	$19,576.76
Max. Negotiated Rate	$30,996.54
Rate for Payer: Adventist Health Medi-Cal	$19,576.76
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$23,328.98
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$30,996.54

NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$19,456.63

Service Code	APR-DRG 9522
Min. Negotiated Rate	$12,288.40
Max. Negotiated Rate	$19,456.63
Rate for Payer: Adventist Health Medi-Cal	$12,288.40
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$14,643.67
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$19,456.63

NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$14,127.37

Service Code	APR-DRG 9521
Min. Negotiated Rate	$8,922.55
Max. Negotiated Rate	$14,127.37
Rate for Payer: Adventist Health Medi-Cal	$8,922.55
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$10,632.71
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,127.37

NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$54,519.70

Service Code	APR-DRG 9524
Min. Negotiated Rate	$34,433.50
Max. Negotiated Rate	$54,519.70
Rate for Payer: Adventist Health Medi-Cal	$34,433.50
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$41,033.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$54,519.70

NON-HYPOVOLEMIC SODIUM DISORDERS

Facility

$14,075.96

Service Code	APR-DRG 4263
Min. Negotiated Rate	$8,890.08
Max. Negotiated Rate	$14,075.96
Rate for Payer: Adventist Health Medi-Cal	$8,890.08
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$10,594.01
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,075.96

NON-HYPOVOLEMIC SODIUM DISORDERS

Facility

$9,629.88

Service Code	APR-DRG 4262
Min. Negotiated Rate	$6,082.03
Max. Negotiated Rate	$9,629.88
Rate for Payer: Adventist Health Medi-Cal	$6,082.03
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$7,247.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$9,629.88

NON-HYPOVOLEMIC SODIUM DISORDERS

Facility

$7,271.19

Service Code	APR-DRG 4261
Min. Negotiated Rate	$4,592.33
Max. Negotiated Rate	$7,271.19
Rate for Payer: Adventist Health Medi-Cal	$4,592.33
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$5,472.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$7,271.19

NON-HYPOVOLEMIC SODIUM DISORDERS

Facility

$24,957.91

Service Code	APR-DRG 4264
Min. Negotiated Rate	$15,762.89
Max. Negotiated Rate	$24,957.91
Rate for Payer: Adventist Health Medi-Cal	$15,762.89
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$18,784.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$24,957.91

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION

Facility

$12,690.88

Service Code	APR-DRG 0462
Min. Negotiated Rate	$8,015.29
Max. Negotiated Rate	$12,690.88
Rate for Payer: Adventist Health Medi-Cal	$8,015.29
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$9,551.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$12,690.88

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION

Facility

$10,066.16

Service Code	APR-DRG 0461
Min. Negotiated Rate	$6,357.58
Max. Negotiated Rate	$10,066.16
Rate for Payer: Adventist Health Medi-Cal	$6,357.58
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$7,576.11
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10,066.16

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION

Facility

$27,517.00

Service Code	APR-DRG 0464
Min. Negotiated Rate	$17,379.16
Max. Negotiated Rate	$27,517.00
Rate for Payer: Adventist Health Medi-Cal	$17,379.16
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$20,710.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$27,517.00

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION

Facility

$15,679.16

Service Code	APR-DRG 0463
Min. Negotiated Rate	$9,902.63
Max. Negotiated Rate	$15,679.16
Rate for Payer: Adventist Health Medi-Cal	$9,902.63
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$11,800.63
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,679.16

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$4.33

Service Code	NDC 0143-9318-01
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$3.90
Rate for Payer: Blue Shield of California Commercial	$3.25
Rate for Payer: Blue Shield of California EPN	$2.31
Rate for Payer: Cash Price	$1.95
Rate for Payer: Central Health Plan Commercial	$3.46
Rate for Payer: EPIC Health Plan Commercial	$1.73
Rate for Payer: Galaxy Health WC	$3.68
Rate for Payer: Global Benefits Group Commercial	$2.60
Rate for Payer: Health Management Network EPO/PPO	$3.90
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$2.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$1.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.87
Rate for Payer: Multiplan Commercial	$3.25
Rate for Payer: Networks By Design Commercial	$2.81
Rate for Payer: Prime Health Services Commercial	$3.68

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility

$4.33

Service Code	NDC 0143-9318-01
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$3.90
Rate for Payer: Aetna of CA HMO/PPO	$2.63
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$3.68
Rate for Payer: Alpha Care Medical Group Medi-Cal	$2.38
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$2.38
Rate for Payer: Anthem Blue Cross of CA Exchange	$2.10
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$2.56
Rate for Payer: Blue Distinction Transplant	$2.60
Rate for Payer: Blue Shield of California Commercial	$2.72
Rate for Payer: Blue Shield of California EPN	$2.12
Rate for Payer: Cash Price	$1.95
Rate for Payer: Central Health Plan Commercial	$3.46
Rate for Payer: Cigna of CA HMO	$2.77
Rate for Payer: Cigna of CA PPO	$3.20
Rate for Payer: Dignity Health Commercial/Exchange	$3.68
Rate for Payer: Dignity Health Media	$3.68
Rate for Payer: Dignity Health Medi-Cal	$3.68
Rate for Payer: EPIC Health Plan Commercial	$1.73
Rate for Payer: EPIC Health Plan Transplant	$1.73
Rate for Payer: Galaxy Health WC	$3.68
Rate for Payer: Global Benefits Group Commercial	$2.60
Rate for Payer: Health Management Network EPO/PPO	$3.90
Rate for Payer: Health Plan of Nevada (Sierra) Other	$3.25
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$1.52
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$2.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$1.65
Rate for Payer: LLUH Dept of Risk Management WC	$0.87
Rate for Payer: Multiplan Commercial	$3.25
Rate for Payer: Networks By Design Commercial	$2.81
Rate for Payer: Prime Health Services Commercial	$3.68
Rate for Payer: Riverside University Health System MISP	$1.73
Rate for Payer: Temecula Valley Physicians Medical Group Commercial	$2.60
Rate for Payer: TriValley Medical Group Commercial/Senior	$2.60
Rate for Payer: United Healthcare All Other Commercial	$2.16
Rate for Payer: United Healthcare All Other HMO	$2.16
Rate for Payer: United Healthcare HMO Rider	$2.16
Rate for Payer: United Healthcare Select/Navigate/Core	$2.16
Rate for Payer: Vantage Medical Group Medi-Cal	$3.68
Rate for Payer: Vantage Medical Group Senior	$3.68

Know your out-of-pocket cost for care.

All Charges