Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

APR-DRG 41.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C

Facility

$10,768.48

Service Code	APR-DRG 5411
Min. Negotiated Rate	$6,801.14
Max. Negotiated Rate	$10,768.48
Rate for Payer: Adventist Health Medi-Cal	$6,801.14
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$8,104.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10,768.48

APR-DRG 41.00: VENTRICULAR SHUNT PROCEDURES

Facility

$25,771.98

Service Code	APR-DRG 0222
Min. Negotiated Rate	$16,277.04
Max. Negotiated Rate	$25,771.98
Rate for Payer: Adventist Health Medi-Cal	$16,277.04
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$19,396.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$25,771.98

APR-DRG 41.00: VENTRICULAR SHUNT PROCEDURES

Facility

$35,837.72

Service Code	APR-DRG 0223
Min. Negotiated Rate	$22,634.35
Max. Negotiated Rate	$35,837.72
Rate for Payer: Adventist Health Medi-Cal	$22,634.35
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$26,972.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$35,837.72

APR-DRG 41.00: VENTRICULAR SHUNT PROCEDURES

Facility

$22,331.78

Service Code	APR-DRG 0221
Min. Negotiated Rate	$14,104.28
Max. Negotiated Rate	$22,331.78
Rate for Payer: Adventist Health Medi-Cal	$14,104.28
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$16,807.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$22,331.78

APR-DRG 41.00: VENTRICULAR SHUNT PROCEDURES

Facility

$67,234.96

Service Code	APR-DRG 0224
Min. Negotiated Rate	$42,464.18
Max. Negotiated Rate	$67,234.96
Rate for Payer: Adventist Health Medi-Cal	$42,464.18
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$50,603.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$67,234.96

APR-DRG 41.00: VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES

Facility

$34,164.22

Service Code	APR-DRG 3103
Min. Negotiated Rate	$21,577.40
Max. Negotiated Rate	$34,164.22
Rate for Payer: Adventist Health Medi-Cal	$21,577.40
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$25,713.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$34,164.22

APR-DRG 41.00: VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES

Facility

$24,952.34

Service Code	APR-DRG 3102
Min. Negotiated Rate	$15,759.37
Max. Negotiated Rate	$24,952.34
Rate for Payer: Adventist Health Medi-Cal	$15,759.37
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$18,779.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$24,952.34

APR-DRG 41.00: VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES

Facility

$63,596.99

Service Code	APR-DRG 3104
Min. Negotiated Rate	$40,166.52
Max. Negotiated Rate	$63,596.99
Rate for Payer: Adventist Health Medi-Cal	$40,166.52
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$47,865.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$63,596.99

APR-DRG 41.00: VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES

Facility

$18,688.10

Service Code	APR-DRG 3101
Min. Negotiated Rate	$11,803.01
Max. Negotiated Rate	$18,688.10
Rate for Payer: Adventist Health Medi-Cal	$11,803.01
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$14,065.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$18,688.10

APR-DRG 41.00: VERTIGO AND OTHER LABYRINTH DISORDERS

Facility

$12,716.74

Service Code	APR-DRG 1113
Min. Negotiated Rate	$8,031.62
Max. Negotiated Rate	$12,716.74
Rate for Payer: Adventist Health Medi-Cal	$8,031.62
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$9,571.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$12,716.74

APR-DRG 41.00: VERTIGO AND OTHER LABYRINTH DISORDERS

Facility

$26,390.03

Service Code	APR-DRG 1114
Min. Negotiated Rate	$16,667.39
Max. Negotiated Rate	$26,390.03
Rate for Payer: Adventist Health Medi-Cal	$16,667.39
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$19,861.97
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$26,390.03

APR-DRG 41.00: VERTIGO AND OTHER LABYRINTH DISORDERS

Facility

$10,476.52

Service Code	APR-DRG 1112
Min. Negotiated Rate	$6,616.75
Max. Negotiated Rate	$10,476.52
Rate for Payer: Adventist Health Medi-Cal	$6,616.75
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$7,884.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10,476.52

APR-DRG 41.00: VERTIGO AND OTHER LABYRINTH DISORDERS

Facility

$9,137.71

Service Code	APR-DRG 1111
Min. Negotiated Rate	$5,771.18
Max. Negotiated Rate	$9,137.71
Rate for Payer: Adventist Health Medi-Cal	$5,771.18
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$6,877.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$9,137.71

APR-DRG 41.00: VIRAL ILLNESS

Facility

$6,098.79

Service Code	APR-DRG 7231
Min. Negotiated Rate	$3,851.87
Max. Negotiated Rate	$6,098.79
Rate for Payer: Adventist Health Medi-Cal	$3,851.87
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$4,590.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$6,098.79

APR-DRG 41.00: VIRAL ILLNESS

Facility

$12,982.97

Service Code	APR-DRG 7233
Min. Negotiated Rate	$8,199.77
Max. Negotiated Rate	$12,982.97
Rate for Payer: Adventist Health Medi-Cal	$8,199.77
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$9,771.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$12,982.97

APR-DRG 41.00: VIRAL ILLNESS

Facility

$27,053.72

Service Code	APR-DRG 7234
Min. Negotiated Rate	$17,086.56
Max. Negotiated Rate	$27,053.72
Rate for Payer: Adventist Health Medi-Cal	$17,086.56
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$20,361.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$27,053.72

APR-DRG 41.00: VIRAL ILLNESS

Facility

$8,489.24

Service Code	APR-DRG 7232
Min. Negotiated Rate	$5,361.62
Max. Negotiated Rate	$8,489.24
Rate for Payer: Adventist Health Medi-Cal	$5,361.62
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$6,389.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$8,489.24

APR-DRG 41.00: VIRAL MENINGITIS

Facility

$36,891.27

Service Code	APR-DRG 0514
Min. Negotiated Rate	$23,299.75
Max. Negotiated Rate	$36,891.27
Rate for Payer: Adventist Health Medi-Cal	$23,299.75
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$27,765.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$36,891.27

APR-DRG 41.00: VIRAL MENINGITIS

Facility

$8,036.62

Service Code	APR-DRG 0511
Min. Negotiated Rate	$5,075.76
Max. Negotiated Rate	$8,036.62
Rate for Payer: Adventist Health Medi-Cal	$5,075.76
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$6,048.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$8,036.62

APR-DRG 41.00: VIRAL MENINGITIS

Facility

$20,177.15

Service Code	APR-DRG 0513
Min. Negotiated Rate	$12,743.46
Max. Negotiated Rate	$20,177.15
Rate for Payer: Adventist Health Medi-Cal	$12,743.46
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$15,185.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$20,177.15

APR-DRG 41.00: VIRAL MENINGITIS

Facility

$11,935.14

Service Code	APR-DRG 0512
Min. Negotiated Rate	$7,537.98
Max. Negotiated Rate	$11,935.14
Rate for Payer: Adventist Health Medi-Cal	$7,537.98
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$8,982.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,935.14

APREPITANT 130 MG/18 ML (7.2 MG/ML) INTRAVENOUS EMULSION [220348]

Facility

$30.30

Service Code	HCPCS J0185
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$6.06
Max. Negotiated Rate	$27.27
Rate for Payer: Adventist Health Commercial	$6.06
Rate for Payer: Blue Shield of California Commercial	$23.42
Rate for Payer: Blue Shield of California EPN	$15.27
Rate for Payer: Cash Price	$16.67
Rate for Payer: Central Health Plan Commercial	$24.24
Rate for Payer: Cigna of CA HMO	$21.21
Rate for Payer: Cigna of CA PPO	$21.21
Rate for Payer: EPIC Health Plan Commercial	$12.12
Rate for Payer: EPIC Health Plan Senior	$12.12
Rate for Payer: Galaxy Health WC	$25.75
Rate for Payer: Global Benefits Group Commercial	$18.18
Rate for Payer: Health Management Network EPO/PPO	$27.27
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$20.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11.54
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$18.76
Rate for Payer: LLUH Dept of Risk Management WC	$6.06
Rate for Payer: Multiplan Commercial	$22.73
Rate for Payer: Networks By Design Commercial	$15.15
Rate for Payer: Prime Health Services Commercial	$25.75
Rate for Payer: United Healthcare All Other Commercial	$11.37
Rate for Payer: United Healthcare All Other HMO	$11.07
Rate for Payer: United Healthcare HMO Rider	$10.83
Rate for Payer: United Healthcare Select/Navigate/Core	$9.92

APREPITANT 130 MG/18 ML (7.2 MG/ML) INTRAVENOUS EMULSION [220348]

Facility

$30.30

Service Code	HCPCS J0185
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$27.27
Rate for Payer: Adventist Health Commercial	$6.06
Rate for Payer: Adventist Health Medi-Cal	$1.77
Rate for Payer: Aetna of CA HMO/PPO	$18.40
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$2.21
Rate for Payer: Alpha Care Medical Group Medi-Cal	$1.95
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$1.95
Rate for Payer: Anthem Blue Cross of CA Exchange	$7.53
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$2.31
Rate for Payer: Blue Shield of California Commercial	$4.43
Rate for Payer: Blue Shield of California EPN	$4.03
Rate for Payer: Cash Price	$16.67
Rate for Payer: Cash Price	$16.67
Rate for Payer: Central Health Plan Commercial	$24.24
Rate for Payer: Cigna of CA HMO	$21.21
Rate for Payer: Cigna of CA PPO	$21.21
Rate for Payer: Dignity Health Commercial/Exchange	$2.21
Rate for Payer: Dignity Health Medi-Cal	$1.95
Rate for Payer: Dignity Health Medicare Advantage	$1.95
Rate for Payer: EPIC Health Plan Commercial	$2.39
Rate for Payer: EPIC Health Plan Senior	$1.77
Rate for Payer: Galaxy Health WC	$25.75
Rate for Payer: Global Benefits Group Commercial	$18.18
Rate for Payer: Health Management Network EPO/PPO	$27.27
Rate for Payer: Heritage Provider Network Commercial/Senior	$2.90
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$1.71
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$1.77
Rate for Payer: InnovAge PACE Commercial	$2.65
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$20.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11.70
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$1.77
Rate for Payer: LLUH Dept of Risk Management WC	$6.06
Rate for Payer: Molina Healthcare of CA Medi-Cal	$2.37
Rate for Payer: Molina Healthcare of CA Medicare	$2.37
Rate for Payer: Multiplan Commercial	$22.73
Rate for Payer: Networks By Design Commercial	$15.15
Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage	$1.77
Rate for Payer: Prime Health Services Commercial	$25.75
Rate for Payer: Prime Health Services Medicare	$1.88
Rate for Payer: Riverside University Health System MISP	$1.95
Rate for Payer: Temecula Valley Physicians Medical Group Commercial	$18.18
Rate for Payer: TriValley Medical Group Commercial/Senior	$18.18
Rate for Payer: United Healthcare All Other Commercial	$11.37
Rate for Payer: United Healthcare All Other HMO	$11.07
Rate for Payer: United Healthcare HMO Rider	$10.83
Rate for Payer: United Healthcare Select/Navigate/Core	$9.92
Rate for Payer: Upland Medical Group Pediatric	$1.77
Rate for Payer: Vantage Medical Group Commercial/Exchange	$2.21
Rate for Payer: Vantage Medical Group Medi-Cal	$1.95
Rate for Payer: Vantage Medical Group Senior	$1.95

ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]

Facility

$2.50

Service Code	NDC 62756-277-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$2.25
Rate for Payer: Adventist Health Commercial	$0.50
Rate for Payer: Aetna of CA HMO/PPO	$1.52
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$2.12
Rate for Payer: Alpha Care Medical Group Medi-Cal	$1.38
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$1.88
Rate for Payer: Anthem Blue Cross of CA Exchange	$1.21
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$1.47
Rate for Payer: Blue Shield of California Commercial	$1.53
Rate for Payer: Blue Shield of California EPN	$1.00
Rate for Payer: Cash Price	$1.38
Rate for Payer: Central Health Plan Commercial	$2.00
Rate for Payer: Cigna of CA HMO	$1.75
Rate for Payer: Cigna of CA PPO	$1.75
Rate for Payer: Dignity Health Commercial/Exchange	$2.12
Rate for Payer: Dignity Health Medi-Cal	$2.12
Rate for Payer: Dignity Health Medicare Advantage	$2.12
Rate for Payer: EPIC Health Plan Commercial	$1.00
Rate for Payer: EPIC Health Plan Senior	$1.00
Rate for Payer: Galaxy Health WC	$2.12
Rate for Payer: Global Benefits Group Commercial	$1.50
Rate for Payer: Health Management Network EPO/PPO	$2.25
Rate for Payer: InnovAge PACE Commercial	$1.25
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$1.67
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.95
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$1.55
Rate for Payer: LLUH Dept of Risk Management WC	$0.50
Rate for Payer: Molina Healthcare of CA Medi-Cal	$1.75
Rate for Payer: Molina Healthcare of CA Medicare	$1.75
Rate for Payer: Multiplan Commercial	$1.88
Rate for Payer: Networks By Design Commercial	$1.62
Rate for Payer: Prime Health Services Commercial	$2.12
Rate for Payer: Riverside University Health System MISP	$1.00
Rate for Payer: Temecula Valley Physicians Medical Group Commercial	$1.50
Rate for Payer: TriValley Medical Group Commercial/Senior	$1.50
Rate for Payer: United Healthcare All Other Commercial	$1.25
Rate for Payer: United Healthcare All Other HMO	$1.25
Rate for Payer: United Healthcare HMO Rider	$1.25
Rate for Payer: United Healthcare Select/Navigate/Core	$1.25
Rate for Payer: Vantage Medical Group Commercial/Exchange	$2.12
Rate for Payer: Vantage Medical Group Medi-Cal	$2.12
Rate for Payer: Vantage Medical Group Senior	$2.12

ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]

Facility

$1.50

Service Code	NDC 69097-168-64
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$1.35
Rate for Payer: Adventist Health Commercial	$0.30
Rate for Payer: Aetna of CA HMO/PPO	$0.91
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$1.27
Rate for Payer: Alpha Care Medical Group Medi-Cal	$0.83
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$1.12
Rate for Payer: Anthem Blue Cross of CA Exchange	$0.73
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$0.88
Rate for Payer: Blue Shield of California Commercial	$0.92
Rate for Payer: Blue Shield of California EPN	$0.60
Rate for Payer: Cash Price	$0.83
Rate for Payer: Central Health Plan Commercial	$1.20
Rate for Payer: Cigna of CA HMO	$1.05
Rate for Payer: Cigna of CA PPO	$1.05
Rate for Payer: Dignity Health Commercial/Exchange	$1.27
Rate for Payer: Dignity Health Medi-Cal	$1.27
Rate for Payer: Dignity Health Medicare Advantage	$1.27
Rate for Payer: EPIC Health Plan Commercial	$0.60
Rate for Payer: EPIC Health Plan Senior	$0.60
Rate for Payer: Galaxy Health WC	$1.27
Rate for Payer: Global Benefits Group Commercial	$0.90
Rate for Payer: Health Management Network EPO/PPO	$1.35
Rate for Payer: InnovAge PACE Commercial	$0.75
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$1.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.57
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$0.93
Rate for Payer: LLUH Dept of Risk Management WC	$0.30
Rate for Payer: Molina Healthcare of CA Medi-Cal	$1.05
Rate for Payer: Molina Healthcare of CA Medicare	$1.05
Rate for Payer: Multiplan Commercial	$1.12
Rate for Payer: Networks By Design Commercial	$0.98
Rate for Payer: Prime Health Services Commercial	$1.27
Rate for Payer: Riverside University Health System MISP	$0.60
Rate for Payer: Temecula Valley Physicians Medical Group Commercial	$0.90
Rate for Payer: TriValley Medical Group Commercial/Senior	$0.90
Rate for Payer: United Healthcare All Other Commercial	$0.75
Rate for Payer: United Healthcare All Other HMO	$0.75
Rate for Payer: United Healthcare HMO Rider	$0.75
Rate for Payer: United Healthcare Select/Navigate/Core	$0.75
Rate for Payer: Vantage Medical Group Commercial/Exchange	$1.27
Rate for Payer: Vantage Medical Group Medi-Cal	$1.27
Rate for Payer: Vantage Medical Group Senior	$1.27

Know your out-of-pocket cost for care.

All Charges