Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility

$31,058.60

Service Code	APR-DRG 8434
Min. Negotiated Rate	$19,615.96
Max. Negotiated Rate	$31,058.60
Rate for Payer: Adventist Health Medi-Cal	$19,615.96
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$23,375.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$31,058.60

EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility

$15,083.28

Service Code	APR-DRG 8433
Min. Negotiated Rate	$9,526.28
Max. Negotiated Rate	$15,083.28
Rate for Payer: Adventist Health Medi-Cal	$9,526.28
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$11,352.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,083.28

EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT

Facility

$24,950.80

Service Code	APR-DRG 8411
Min. Negotiated Rate	$15,758.40
Max. Negotiated Rate	$24,950.80
Rate for Payer: Adventist Health Medi-Cal	$15,758.40
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$18,778.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$24,950.80

EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT

Facility

$264,344.85

Service Code	APR-DRG 8414
Min. Negotiated Rate	$166,954.64
Max. Negotiated Rate	$264,344.85
Rate for Payer: Adventist Health Medi-Cal	$166,954.64
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$198,954.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$264,344.85

EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT

Facility

$28,400.19

Service Code	APR-DRG 8412
Min. Negotiated Rate	$17,936.96
Max. Negotiated Rate	$28,400.19
Rate for Payer: Adventist Health Medi-Cal	$17,936.96
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$21,374.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$28,400.19

EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT

Facility

$97,011.82

Service Code	APR-DRG 8413
Min. Negotiated Rate	$61,270.62
Max. Negotiated Rate	$97,011.82
Rate for Payer: Adventist Health Medi-Cal	$61,270.62
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$73,014.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$97,011.82

EXTERNAL HEART ASSIST SYSTEMS

Facility

$87,094.61

Service Code	APR-DRG 1782
Min. Negotiated Rate	$55,007.12
Max. Negotiated Rate	$87,094.61
Rate for Payer: Adventist Health Medi-Cal	$55,007.12
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$65,550.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$87,094.61

EXTERNAL HEART ASSIST SYSTEMS

Facility

$77,681.10

Service Code	APR-DRG 1781
Min. Negotiated Rate	$49,061.75
Max. Negotiated Rate	$77,681.10
Rate for Payer: Adventist Health Medi-Cal	$49,061.75
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$58,465.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$77,681.10

EXTERNAL HEART ASSIST SYSTEMS

Facility

$93,480.86

Service Code	APR-DRG 1783
Min. Negotiated Rate	$59,040.54
Max. Negotiated Rate	$93,480.86
Rate for Payer: Adventist Health Medi-Cal	$59,040.54
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$70,356.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$93,480.86

EXTERNAL HEART ASSIST SYSTEMS

Facility

$126,360.79

Service Code	APR-DRG 1784
Min. Negotiated Rate	$79,806.82
Max. Negotiated Rate	$126,360.79
Rate for Payer: Adventist Health Medi-Cal	$79,806.82
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$95,103.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$126,360.79

Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; without endoscopic cyclophotocoagulation

Facility

$15,354.00

Service Code	CPT 66982
Hospital Revenue Code	360
Min. Negotiated Rate	$381.98
Max. Negotiated Rate	$15,354.00
Rate for Payer: Adventist Health Medi-Cal	$2,911.63
Rate for Payer: Aetna of CA HMO/PPO	$11,071.00
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$4,367.44
Rate for Payer: Alpha Care Medical Group Medi-Cal	$3,202.79
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$2,911.63
Rate for Payer: Anthem Blue Cross of CA Exchange	$8,405.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,254.00
Rate for Payer: Blue Shield of California Commercial	$8,958.72
Rate for Payer: Blue Shield of California EPN	$6,434.55
Rate for Payer: Caremore Medicare Advantage	$2,911.63
Rate for Payer: Dignity Health Commercial/Exchange	$4,367.44
Rate for Payer: Dignity Health Media	$2,911.63
Rate for Payer: Dignity Health Medi-Cal	$3,202.79
Rate for Payer: EPIC Health Plan Commercial	$3,930.70
Rate for Payer: EPIC Health Plan Medicare/Senior	$2,911.63
Rate for Payer: EPIC Health Plan Transplant	$2,911.63
Rate for Payer: Heritage Provider Network Commercial/Senior	$4,775.07
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$4,804.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$2,911.63
Rate for Payer: InnovAge PACE Commercial	$4,367.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$381.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$2,911.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$3,901.58
Rate for Payer: Molina Healthcare of CA Medicare	$3,901.58
Rate for Payer: Prime Health Services Medicare	$3,086.33
Rate for Payer: Riverside University Health System MISP	$3,202.79
Rate for Payer: United Healthcare All Other Commercial	$11,375.00
Rate for Payer: United Healthcare All Other HMO	$15,354.00
Rate for Payer: United Healthcare HMO Rider	$9,681.00
Rate for Payer: United Healthcare Select/Navigate/Core	$8,852.00
Rate for Payer: Vantage Medical Group Commercial/Exchange	$4,367.44
Rate for Payer: Vantage Medical Group Medi-Cal	$3,202.79
Rate for Payer: Vantage Medical Group Senior	$2,911.63

Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more

Facility

$25,512.00

Service Code	CPT 66991
Hospital Revenue Code	360
Min. Negotiated Rate	$1,128.96
Max. Negotiated Rate	$25,512.00
Rate for Payer: Adventist Health Medi-Cal	$6,530.21
Rate for Payer: Aetna of CA HMO/PPO	$11,417.00
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$9,795.32
Rate for Payer: Alpha Care Medical Group Medi-Cal	$7,183.23
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$6,530.21
Rate for Payer: Anthem Blue Cross of CA Exchange	$8,405.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,254.00
Rate for Payer: Blue Shield of California Commercial	$7,609.02
Rate for Payer: Blue Shield of California EPN	$5,465.14
Rate for Payer: Caremore Medicare Advantage	$6,530.21
Rate for Payer: Dignity Health Commercial/Exchange	$9,795.32
Rate for Payer: Dignity Health Media	$6,530.21
Rate for Payer: Dignity Health Medi-Cal	$7,183.23
Rate for Payer: EPIC Health Plan Commercial	$8,815.78
Rate for Payer: EPIC Health Plan Medicare/Senior	$6,530.21
Rate for Payer: EPIC Health Plan Transplant	$6,530.21
Rate for Payer: Heritage Provider Network Commercial/Senior	$10,709.54
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$10,774.85
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$6,530.21
Rate for Payer: InnovAge PACE Commercial	$9,795.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$1,128.96
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$6,530.21
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8,750.48
Rate for Payer: Molina Healthcare of CA Medicare	$8,750.48
Rate for Payer: Prime Health Services Medicare	$6,922.02
Rate for Payer: Riverside University Health System MISP	$7,183.23
Rate for Payer: United Healthcare All Other Commercial	$14,836.00
Rate for Payer: United Healthcare All Other HMO	$25,512.00
Rate for Payer: United Healthcare HMO Rider	$16,069.00
Rate for Payer: United Healthcare Select/Navigate/Core	$14,692.00
Rate for Payer: Vantage Medical Group Commercial/Exchange	$9,795.32
Rate for Payer: Vantage Medical Group Medi-Cal	$7,183.23
Rate for Payer: Vantage Medical Group Senior	$6,530.21

Facility

$15,354.00

Service Code	CPT 66984
Hospital Revenue Code	360
Min. Negotiated Rate	$381.98
Max. Negotiated Rate	$15,354.00
Rate for Payer: Adventist Health Medi-Cal	$2,911.63
Rate for Payer: Aetna of CA HMO/PPO	$11,071.00
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$4,367.44
Rate for Payer: Alpha Care Medical Group Medi-Cal	$3,202.79
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$2,911.63
Rate for Payer: Anthem Blue Cross of CA Exchange	$8,405.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,254.00
Rate for Payer: Blue Shield of California Commercial	$8,958.72
Rate for Payer: Blue Shield of California EPN	$6,434.55
Rate for Payer: Caremore Medicare Advantage	$2,911.63
Rate for Payer: Dignity Health Commercial/Exchange	$4,367.44
Rate for Payer: Dignity Health Media	$2,911.63
Rate for Payer: Dignity Health Medi-Cal	$3,202.79
Rate for Payer: EPIC Health Plan Commercial	$3,930.70
Rate for Payer: EPIC Health Plan Medicare/Senior	$2,911.63
Rate for Payer: EPIC Health Plan Transplant	$2,911.63
Rate for Payer: Heritage Provider Network Commercial/Senior	$4,775.07
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$4,804.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$2,911.63
Rate for Payer: InnovAge PACE Commercial	$4,367.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$381.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$2,911.63
Rate for Payer: Molina Healthcare of CA Medi-Cal	$3,901.58
Rate for Payer: Molina Healthcare of CA Medicare	$3,901.58
Rate for Payer: Prime Health Services Medicare	$3,086.33
Rate for Payer: Riverside University Health System MISP	$3,202.79
Rate for Payer: United Healthcare All Other Commercial	$11,375.00
Rate for Payer: United Healthcare All Other HMO	$15,354.00
Rate for Payer: United Healthcare HMO Rider	$9,681.00
Rate for Payer: United Healthcare Select/Navigate/Core	$8,852.00
Rate for Payer: Vantage Medical Group Commercial/Exchange	$4,367.44
Rate for Payer: Vantage Medical Group Medi-Cal	$3,202.79
Rate for Payer: Vantage Medical Group Senior	$2,911.63

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$63,445.54

Service Code	APR-DRG 0091
Min. Negotiated Rate	$40,070.87
Max. Negotiated Rate	$63,445.54
Rate for Payer: Adventist Health Medi-Cal	$40,070.87
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$47,751.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$63,445.54

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$229,973.44

Service Code	APR-DRG 0094
Min. Negotiated Rate	$145,246.38
Max. Negotiated Rate	$229,973.44
Rate for Payer: Adventist Health Medi-Cal	$145,246.38
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$173,085.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$229,973.44

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$77,306.90

Service Code	APR-DRG 0092
Min. Negotiated Rate	$48,825.41
Max. Negotiated Rate	$77,306.90
Rate for Payer: Adventist Health Medi-Cal	$48,825.41
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$58,183.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$77,306.90

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$105,992.60

Service Code	APR-DRG 0093
Min. Negotiated Rate	$66,942.70
Max. Negotiated Rate	$105,992.60
Rate for Payer: Adventist Health Medi-Cal	$66,942.70
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$79,773.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$105,992.60

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), percutaneous, 6 years and older (includes fluoroscopic guidance, when performed)

Facility

$7,084.00

Service Code	CPT 33952
Hospital Revenue Code	360
Min. Negotiated Rate	$558.11
Max. Negotiated Rate	$7,084.00
Rate for Payer: Aetna of CA HMO/PPO	$2,324.57
Rate for Payer: Anthem Blue Cross of CA Exchange	$5,806.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$7,084.00
Rate for Payer: Blue Shield of California Commercial	$951.13
Rate for Payer: Blue Shield of California EPN	$683.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$558.11
Rate for Payer: United Healthcare All Other Commercial	$4,121.00
Rate for Payer: United Healthcare All Other HMO	$4,248.00
Rate for Payer: United Healthcare HMO Rider	$2,468.00
Rate for Payer: United Healthcare Select/Navigate/Core	$2,257.00

EYE INFECTIONS AND OTHER EYE DISORDERS

Facility

$30,021.14

Service Code	APR-DRG 0824
Min. Negotiated Rate	$18,960.72
Max. Negotiated Rate	$30,021.14
Rate for Payer: Adventist Health Medi-Cal	$18,960.72
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$22,594.86
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$30,021.14

EYE INFECTIONS AND OTHER EYE DISORDERS

Facility

$8,496.65

Service Code	APR-DRG 0821
Min. Negotiated Rate	$5,366.30
Max. Negotiated Rate	$8,496.65
Rate for Payer: Adventist Health Medi-Cal	$5,366.30
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$6,394.85
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$8,496.65

EYE INFECTIONS AND OTHER EYE DISORDERS

Facility

$10,440.37

Service Code	APR-DRG 0822
Min. Negotiated Rate	$6,593.92
Max. Negotiated Rate	$10,440.37
Rate for Payer: Adventist Health Medi-Cal	$6,593.92
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$7,857.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10,440.37

EYE INFECTIONS AND OTHER EYE DISORDERS

Facility

$15,195.00

Service Code	APR-DRG 0823
Min. Negotiated Rate	$9,596.84
Max. Negotiated Rate	$15,195.00
Rate for Payer: Adventist Health Medi-Cal	$9,596.84
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$11,436.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15,195.00

EZETIMIBE 10 MG-SIMVASTATIN 20 MG TABLET [39221]

Facility

$13.67

Service Code	NDC 66582-312-31
Hospital Charge Code	1710951
Hospital Revenue Code	259
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$12.30
Rate for Payer: Blue Shield of California Commercial	$10.25
Rate for Payer: Blue Shield of California EPN	$7.30
Rate for Payer: Cash Price	$6.15
Rate for Payer: Central Health Plan Commercial	$10.94
Rate for Payer: Cigna of CA HMO	$9.57
Rate for Payer: Cigna of CA PPO	$9.57
Rate for Payer: EPIC Health Plan Commercial	$5.47
Rate for Payer: Galaxy Health WC	$11.62
Rate for Payer: Global Benefits Group Commercial	$8.20
Rate for Payer: Health Management Network EPO/PPO	$12.30
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$9.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$5.21
Rate for Payer: LLUH Dept of Risk Management WC	$2.73
Rate for Payer: Multiplan Commercial	$10.25
Rate for Payer: Networks By Design Commercial	$8.89
Rate for Payer: Prime Health Services Commercial	$11.62

EZETIMIBE 10 MG-SIMVASTATIN 20 MG TABLET [39221]

Facility

$13.67

Service Code	NDC 66582-312-31
Hospital Charge Code	1710951
Hospital Revenue Code	259
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$12.30
Rate for Payer: Aetna of CA HMO/PPO	$8.30
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$11.62
Rate for Payer: Alpha Care Medical Group Medi-Cal	$7.52
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$7.52
Rate for Payer: Anthem Blue Cross of CA Exchange	$6.62
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$8.08
Rate for Payer: Blue Distinction Transplant	$8.20
Rate for Payer: Blue Shield of California Commercial	$8.60
Rate for Payer: Blue Shield of California EPN	$6.68
Rate for Payer: Cash Price	$6.15
Rate for Payer: Central Health Plan Commercial	$10.94
Rate for Payer: Cigna of CA HMO	$9.57
Rate for Payer: Cigna of CA PPO	$9.57
Rate for Payer: Dignity Health Commercial/Exchange	$11.62
Rate for Payer: Dignity Health Media	$11.62
Rate for Payer: Dignity Health Medi-Cal	$11.62
Rate for Payer: EPIC Health Plan Commercial	$5.47
Rate for Payer: EPIC Health Plan Transplant	$5.47
Rate for Payer: Galaxy Health WC	$11.62
Rate for Payer: Global Benefits Group Commercial	$8.20
Rate for Payer: Health Management Network EPO/PPO	$12.30
Rate for Payer: Health Plan of Nevada (Sierra) Other	$10.25
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$4.78
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$9.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$5.21
Rate for Payer: LLUH Dept of Risk Management WC	$2.73
Rate for Payer: Multiplan Commercial	$10.25
Rate for Payer: Networks By Design Commercial	$8.89
Rate for Payer: Prime Health Services Commercial	$11.62
Rate for Payer: Riverside University Health System MISP	$5.47
Rate for Payer: Temecula Valley Physicians Medical Group Commercial	$8.20
Rate for Payer: TriValley Medical Group Commercial/Senior	$8.20
Rate for Payer: United Healthcare All Other Commercial	$6.84
Rate for Payer: United Healthcare All Other HMO	$6.84
Rate for Payer: United Healthcare HMO Rider	$6.84
Rate for Payer: United Healthcare Select/Navigate/Core	$6.84
Rate for Payer: Vantage Medical Group Medi-Cal	$11.62
Rate for Payer: Vantage Medical Group Senior	$11.62

EZETIMIBE 10 MG TABLET [34153]

Facility

$0.37

Service Code	NDC 67877-490-30
Hospital Charge Code	1712290
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.33
Rate for Payer: Blue Shield of California Commercial	$0.28
Rate for Payer: Blue Shield of California EPN	$0.20
Rate for Payer: Cash Price	$0.17
Rate for Payer: Central Health Plan Commercial	$0.30
Rate for Payer: Cigna of CA HMO	$0.26
Rate for Payer: Cigna of CA PPO	$0.26
Rate for Payer: EPIC Health Plan Commercial	$0.15
Rate for Payer: Galaxy Health WC	$0.31
Rate for Payer: Global Benefits Group Commercial	$0.22
Rate for Payer: Health Management Network EPO/PPO	$0.33
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$0.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Commercial	$0.28
Rate for Payer: Networks By Design Commercial	$0.24
Rate for Payer: Prime Health Services Commercial	$0.31

Know your out-of-pocket cost for care.

All Charges