Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

ACUTE AND SUBACUTE ENDOCARDITIS

Facility

$36,049.12

Service Code	APR-DRG 1934
Min. Negotiated Rate	$22,767.86
Max. Negotiated Rate	$36,049.12
Rate for Payer: Adventist Health Medi-Cal	$22,767.86
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$27,131.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$36,049.12

ACUTE AND SUBACUTE ENDOCARDITIS

Facility

$17,512.93

Service Code	APR-DRG 1932
Min. Negotiated Rate	$11,060.80
Max. Negotiated Rate	$17,512.93
Rate for Payer: Adventist Health Medi-Cal	$11,060.80
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$13,180.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$17,512.93

ACUTE AND SUBACUTE ENDOCARDITIS

Facility

$23,196.85

Service Code	APR-DRG 1933
Min. Negotiated Rate	$14,650.64
Max. Negotiated Rate	$23,196.85
Rate for Payer: Adventist Health Medi-Cal	$14,650.64
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$17,458.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$23,196.85

ACUTE AND SUBACUTE ENDOCARDITIS

Facility

$11,889.27

Service Code	APR-DRG 1931
Min. Negotiated Rate	$7,509.01
Max. Negotiated Rate	$11,889.27
Rate for Payer: Adventist Health Medi-Cal	$7,509.01
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$8,948.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$11,889.27

ACUTE ANXIETY AND DELIRIUM STATES

Facility

$8,987.89

Service Code	APR-DRG 7562
Min. Negotiated Rate	$5,676.56
Max. Negotiated Rate	$8,987.89
Rate for Payer: Adventist Health Medi-Cal	$5,676.56
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$6,764.57
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$8,987.89

ACUTE ANXIETY AND DELIRIUM STATES

Facility

$9,317.75

Service Code	APR-DRG 7563
Min. Negotiated Rate	$5,884.90
Max. Negotiated Rate	$9,317.75
Rate for Payer: Adventist Health Medi-Cal	$5,884.90
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$7,012.83
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$9,317.75

ACUTE ANXIETY AND DELIRIUM STATES

Facility

$6,873.93

Service Code	APR-DRG 7561
Min. Negotiated Rate	$4,341.43
Max. Negotiated Rate	$6,873.93
Rate for Payer: Adventist Health Medi-Cal	$4,341.43
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$5,173.54
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$6,873.93

ACUTE ANXIETY AND DELIRIUM STATES

Facility

$19,252.68

Service Code	APR-DRG 7564
Min. Negotiated Rate	$12,159.59
Max. Negotiated Rate	$19,252.68
Rate for Payer: Adventist Health Medi-Cal	$12,159.59
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$14,490.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$19,252.68

ACUTE BRONCHITIS AND RELATED SYMPTOMS

Facility

$9,376.29

Service Code	APR-DRG 1452
Min. Negotiated Rate	$5,921.87
Max. Negotiated Rate	$9,376.29
Rate for Payer: Adventist Health Medi-Cal	$5,921.87
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$7,056.89
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$9,376.29

ACUTE BRONCHITIS AND RELATED SYMPTOMS

Facility

$12,096.77

Service Code	APR-DRG 1453
Min. Negotiated Rate	$7,640.06
Max. Negotiated Rate	$12,096.77
Rate for Payer: Adventist Health Medi-Cal	$7,640.06
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$9,104.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$12,096.77

ACUTE BRONCHITIS AND RELATED SYMPTOMS

Facility

$7,335.03

Service Code	APR-DRG 1451
Min. Negotiated Rate	$4,632.65
Max. Negotiated Rate	$7,335.03
Rate for Payer: Adventist Health Medi-Cal	$4,632.65
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$5,520.57
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$7,335.03

ACUTE BRONCHITIS AND RELATED SYMPTOMS

Facility

$18,428.02

Service Code	APR-DRG 1454
Min. Negotiated Rate	$11,638.75
Max. Negotiated Rate	$18,428.02
Rate for Payer: Adventist Health Medi-Cal	$11,638.75
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$13,869.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$18,428.02

ACUTE KIDNEY INJURY

Facility

$27,623.42

Service Code	APR-DRG 4694
Min. Negotiated Rate	$17,446.37
Max. Negotiated Rate	$27,623.42
Rate for Payer: Adventist Health Medi-Cal	$17,446.37
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$20,790.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$27,623.42

ACUTE KIDNEY INJURY

Facility

$9,459.64

Service Code	APR-DRG 4692
Min. Negotiated Rate	$5,974.51
Max. Negotiated Rate	$9,459.64
Rate for Payer: Adventist Health Medi-Cal	$5,974.51
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$7,119.63
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$9,459.64

ACUTE KIDNEY INJURY

Facility

$7,294.23

Service Code	APR-DRG 4691
Min. Negotiated Rate	$4,606.88
Max. Negotiated Rate	$7,294.23
Rate for Payer: Adventist Health Medi-Cal	$4,606.88
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$5,489.87
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$7,294.23

ACUTE KIDNEY INJURY

Facility

$14,764.06

Service Code	APR-DRG 4693
Min. Negotiated Rate	$9,324.67
Max. Negotiated Rate	$14,764.06
Rate for Payer: Adventist Health Medi-Cal	$9,324.67
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$11,111.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$14,764.06

ACUTE LEUKEMIA

Facility

$48,060.77

Service Code	APR-DRG 6903
Min. Negotiated Rate	$30,354.17
Max. Negotiated Rate	$48,060.77
Rate for Payer: Adventist Health Medi-Cal	$30,354.17
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$36,172.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$48,060.77

ACUTE LEUKEMIA

Facility

$13,325.78

Service Code	APR-DRG 6901
Min. Negotiated Rate	$8,416.28
Max. Negotiated Rate	$13,325.78
Rate for Payer: Adventist Health Medi-Cal	$8,416.28
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$10,029.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$13,325.78

ACUTE LEUKEMIA

Facility

$83,680.71

Service Code	APR-DRG 6904
Min. Negotiated Rate	$52,850.98
Max. Negotiated Rate	$83,680.71
Rate for Payer: Adventist Health Medi-Cal	$52,850.98
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$62,980.75
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$83,680.71

ACUTE LEUKEMIA

Facility

$25,802.08

Service Code	APR-DRG 6902
Min. Negotiated Rate	$16,296.05
Max. Negotiated Rate	$25,802.08
Rate for Payer: Adventist Health Medi-Cal	$16,296.05
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$19,419.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$25,802.08

ACUTE MYOCARDIAL INFARCTION

Facility

$12,233.32

Service Code	APR-DRG 1901
Min. Negotiated Rate	$7,726.31
Max. Negotiated Rate	$12,233.32
Rate for Payer: Adventist Health Medi-Cal	$7,726.31
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$9,207.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$12,233.32

ACUTE MYOCARDIAL INFARCTION

Facility

$24,782.33

Service Code	APR-DRG 1904
Min. Negotiated Rate	$15,652.00
Max. Negotiated Rate	$24,782.33
Rate for Payer: Adventist Health Medi-Cal	$15,652.00
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$18,651.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$24,782.33

ACUTE MYOCARDIAL INFARCTION

Facility

$13,336.42

Service Code	APR-DRG 1902
Min. Negotiated Rate	$8,423.00
Max. Negotiated Rate	$13,336.42
Rate for Payer: Adventist Health Medi-Cal	$8,423.00
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$10,037.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$13,336.42

ACUTE MYOCARDIAL INFARCTION

Facility

$17,078.42

Service Code	APR-DRG 1903
Min. Negotiated Rate	$10,786.37
Max. Negotiated Rate	$17,078.42
Rate for Payer: Adventist Health Medi-Cal	$10,786.37
Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal	$12,853.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$17,078.42

ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION [8970]

Facility

$0.90

Service Code	CPT J8499
Hospital Charge Code	1715057
Hospital Revenue Code	259
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.81
Rate for Payer: Blue Shield of California Commercial	$0.68
Rate for Payer: Blue Shield of California Commercial	$0.15
Rate for Payer: Blue Shield of California EPN	$0.48
Rate for Payer: Blue Shield of California EPN	$0.11
Rate for Payer: Cash Price	$0.41
Rate for Payer: Cash Price	$0.09
Rate for Payer: Central Health Plan Commercial	$0.16
Rate for Payer: Central Health Plan Commercial	$0.72
Rate for Payer: Cigna of CA HMO	$0.14
Rate for Payer: Cigna of CA HMO	$0.63
Rate for Payer: Cigna of CA PPO	$0.14
Rate for Payer: Cigna of CA PPO	$0.63
Rate for Payer: EPIC Health Plan Commercial	$0.36
Rate for Payer: EPIC Health Plan Commercial	$0.08
Rate for Payer: Galaxy Health WC	$0.77
Rate for Payer: Galaxy Health WC	$0.17
Rate for Payer: Global Benefits Group Commercial	$0.54
Rate for Payer: Global Benefits Group Commercial	$0.12
Rate for Payer: Health Management Network EPO/PPO	$0.18
Rate for Payer: Health Management Network EPO/PPO	$0.81
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$0.13
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded	$0.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.34
Rate for Payer: LLUH Dept of Risk Management WC	$0.18
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Commercial	$0.15
Rate for Payer: Multiplan Commercial	$0.68
Rate for Payer: Networks By Design Commercial	$0.13
Rate for Payer: Networks By Design Commercial	$0.59
Rate for Payer: Prime Health Services Commercial	$0.17
Rate for Payer: Prime Health Services Commercial	$0.77

Know your out-of-pocket cost for care.

All Charges