Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

SPINAL DISORDERS AND INJURIES

Facility

$15,130.38

Service Code	APR-DRG 0403
Min. Negotiated Rate	$15,130.38
Max. Negotiated Rate	$15,130.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$15,130.38

SPINAL DISORDERS AND INJURIES

Facility

$7,746.26

Service Code	APR-DRG 0401
Min. Negotiated Rate	$7,746.26
Max. Negotiated Rate	$7,746.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,746.26

SPINAL DISORDERS AND INJURIES

Facility

$24,529.17

Service Code	APR-DRG 0404
Min. Negotiated Rate	$24,529.17
Max. Negotiated Rate	$24,529.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$24,529.17

SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES

Facility

$25,830.49

Service Code	APR-DRG 3213
Min. Negotiated Rate	$25,830.49
Max. Negotiated Rate	$25,830.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$25,830.49

SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES

Facility

$15,470.63

Service Code	APR-DRG 3211
Min. Negotiated Rate	$15,470.63
Max. Negotiated Rate	$15,470.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$15,470.63

SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES

Facility

$18,764.73

Service Code	APR-DRG 3212
Min. Negotiated Rate	$18,764.73
Max. Negotiated Rate	$18,764.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$18,764.73

SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES

Facility

$40,383.82

Service Code	APR-DRG 3214
Min. Negotiated Rate	$40,383.82
Max. Negotiated Rate	$40,383.82
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$40,383.82

SPINAL PROCEDURES

Facility

$13,860.89

Service Code	APR-DRG 0231
Min. Negotiated Rate	$13,860.89
Max. Negotiated Rate	$13,860.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$13,860.89

SPINAL PROCEDURES

Facility

$32,011.77

Service Code	APR-DRG 0233
Min. Negotiated Rate	$32,011.77
Max. Negotiated Rate	$32,011.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$32,011.77

SPINAL PROCEDURES

Facility

$52,094.74

Service Code	APR-DRG 0234
Min. Negotiated Rate	$52,094.74
Max. Negotiated Rate	$52,094.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$52,094.74

SPINAL PROCEDURES

Facility

$19,002.51

Service Code	APR-DRG 0232
Min. Negotiated Rate	$19,002.51
Max. Negotiated Rate	$19,002.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$19,002.51

SPIRONOLACTONE 100 MG TABLET [11425]

Facility

$0.47

Service Code	NDC 59746-218-01
Hospital Charge Code	1710137
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.35
Rate for Payer: Adventist Health Commercial	$0.09
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.32
Rate for Payer: Cash Price	$0.21
Rate for Payer: EPIC Health Plan Commercial	$0.25
Rate for Payer: Heritage Provider Network Commercial	$0.32
Rate for Payer: Heritage Provider Network Senior	$0.32
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Commercial	$0.35

SPIRONOLACTONE 100 MG TABLET [11425]

Facility

$0.64

Service Code	NDC 53746-515-01
Hospital Charge Code	1710137
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.48
Rate for Payer: Adventist Health Commercial	$0.13
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.44
Rate for Payer: Cash Price	$0.29
Rate for Payer: EPIC Health Plan Commercial	$0.35
Rate for Payer: Heritage Provider Network Commercial	$0.43
Rate for Payer: Heritage Provider Network Senior	$0.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.12
Rate for Payer: LLUH Dept of Risk Management WC	$0.16
Rate for Payer: Multiplan Commercial	$0.48

SPIRONOLACTONE 100 MG TABLET [11425]

Facility

$0.64

Service Code	NDC 53746-515-01
Hospital Charge Code	1710137
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.54
Rate for Payer: Adventist Health Commercial	$0.13
Rate for Payer: Aetna of CA Gatekeeper	$0.34
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.44
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$0.54
Rate for Payer: Alpha Care Medical Group Medi-Cal	$0.35
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$0.48
Rate for Payer: Blue Shield of California Commercial	$0.40
Rate for Payer: Blue Shield of California EPN	$0.38
Rate for Payer: Cash Price	$0.29
Rate for Payer: Cigna of CA HMO/PPO	$0.42
Rate for Payer: Dignity Health Commercial/Exchange	$0.54
Rate for Payer: Dignity Health Medi-Cal	$0.54
Rate for Payer: Dignity Health Senior	$0.54
Rate for Payer: EPIC Health Plan Commercial	$0.41
Rate for Payer: Heritage Provider Network Commercial	$0.40
Rate for Payer: Heritage Provider Network Senior	$0.40
Rate for Payer: Kaiser Permanente of CA Commercial	$0.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.12
Rate for Payer: LLUH Dept of Risk Management WC	$0.16
Rate for Payer: Multiplan Commercial	$0.48
Rate for Payer: TriValley Medical Group Commercial	$0.26
Rate for Payer: TriValley Medical Group Senior	$0.26
Rate for Payer: Vantage Medical Group Medi-Cal	$0.54
Rate for Payer: Vantage Medical Group Senior	$0.54

SPIRONOLACTONE 100 MG TABLET [11425]

Facility

$0.57

Service Code	NDC 53489-329-01
Hospital Charge Code	1710137
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.48
Rate for Payer: Adventist Health Commercial	$0.11
Rate for Payer: Aetna of CA Gatekeeper	$0.30
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.39
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$0.48
Rate for Payer: Alpha Care Medical Group Medi-Cal	$0.31
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$0.43
Rate for Payer: Blue Shield of California Commercial	$0.35
Rate for Payer: Blue Shield of California EPN	$0.33
Rate for Payer: Cash Price	$0.26
Rate for Payer: Cigna of CA HMO/PPO	$0.37
Rate for Payer: Dignity Health Commercial/Exchange	$0.48
Rate for Payer: Dignity Health Medi-Cal	$0.48
Rate for Payer: Dignity Health Senior	$0.48
Rate for Payer: EPIC Health Plan Commercial	$0.36
Rate for Payer: Heritage Provider Network Commercial	$0.35
Rate for Payer: Heritage Provider Network Senior	$0.35
Rate for Payer: Kaiser Permanente of CA Commercial	$0.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Commercial	$0.43
Rate for Payer: TriValley Medical Group Commercial	$0.23
Rate for Payer: TriValley Medical Group Senior	$0.23
Rate for Payer: Vantage Medical Group Medi-Cal	$0.48
Rate for Payer: Vantage Medical Group Senior	$0.48

SPIRONOLACTONE 100 MG TABLET [11425]

Facility

$0.57

Service Code	NDC 53489-329-01
Hospital Charge Code	1710137
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.43
Rate for Payer: Adventist Health Commercial	$0.11
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.39
Rate for Payer: Cash Price	$0.26
Rate for Payer: EPIC Health Plan Commercial	$0.31
Rate for Payer: Heritage Provider Network Commercial	$0.39
Rate for Payer: Heritage Provider Network Senior	$0.39
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Commercial	$0.43

SPIRONOLACTONE 100 MG TABLET [11425]

Facility

$0.64

Service Code	NDC 16729-227-01
Hospital Charge Code	1710137
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.54
Rate for Payer: Adventist Health Commercial	$0.13
Rate for Payer: Aetna of CA Gatekeeper	$0.34
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.44
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$0.54
Rate for Payer: Alpha Care Medical Group Medi-Cal	$0.35
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$0.48
Rate for Payer: Blue Shield of California Commercial	$0.40
Rate for Payer: Blue Shield of California EPN	$0.38
Rate for Payer: Cash Price	$0.29
Rate for Payer: Cigna of CA HMO/PPO	$0.42
Rate for Payer: Dignity Health Commercial/Exchange	$0.54
Rate for Payer: Dignity Health Medi-Cal	$0.54
Rate for Payer: Dignity Health Senior	$0.54
Rate for Payer: EPIC Health Plan Commercial	$0.41
Rate for Payer: Heritage Provider Network Commercial	$0.40
Rate for Payer: Heritage Provider Network Senior	$0.40
Rate for Payer: Kaiser Permanente of CA Commercial	$0.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.12
Rate for Payer: LLUH Dept of Risk Management WC	$0.16
Rate for Payer: Multiplan Commercial	$0.48
Rate for Payer: TriValley Medical Group Commercial	$0.26
Rate for Payer: TriValley Medical Group Senior	$0.26
Rate for Payer: Vantage Medical Group Medi-Cal	$0.54
Rate for Payer: Vantage Medical Group Senior	$0.54

SPIRONOLACTONE 100 MG TABLET [11425]

Facility

$0.64

Service Code	NDC 16729-227-01
Hospital Charge Code	1710137
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.48
Rate for Payer: Adventist Health Commercial	$0.13
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.44
Rate for Payer: Cash Price	$0.29
Rate for Payer: EPIC Health Plan Commercial	$0.35
Rate for Payer: Heritage Provider Network Commercial	$0.43
Rate for Payer: Heritage Provider Network Senior	$0.43
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.12
Rate for Payer: LLUH Dept of Risk Management WC	$0.16
Rate for Payer: Multiplan Commercial	$0.48

SPIRONOLACTONE 100 MG TABLET [11425]

Facility

$0.47

Service Code	NDC 59746-218-01
Hospital Charge Code	1710137
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.40
Rate for Payer: Adventist Health Commercial	$0.09
Rate for Payer: Aetna of CA Gatekeeper	$0.25
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.32
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$0.40
Rate for Payer: Alpha Care Medical Group Medi-Cal	$0.26
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$0.35
Rate for Payer: Blue Shield of California Commercial	$0.29
Rate for Payer: Blue Shield of California EPN	$0.28
Rate for Payer: Cash Price	$0.21
Rate for Payer: Cigna of CA HMO/PPO	$0.31
Rate for Payer: Dignity Health Commercial/Exchange	$0.40
Rate for Payer: Dignity Health Medi-Cal	$0.40
Rate for Payer: Dignity Health Senior	$0.40
Rate for Payer: EPIC Health Plan Commercial	$0.30
Rate for Payer: Heritage Provider Network Commercial	$0.29
Rate for Payer: Heritage Provider Network Senior	$0.29
Rate for Payer: Kaiser Permanente of CA Commercial	$0.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Commercial	$0.35
Rate for Payer: TriValley Medical Group Commercial	$0.19
Rate for Payer: TriValley Medical Group Senior	$0.19
Rate for Payer: Vantage Medical Group Medi-Cal	$0.40
Rate for Payer: Vantage Medical Group Senior	$0.40

SPIRONOLACTONE 12.5 MG 1/2 TABLET [4081582]

Facility

$0.07

Service Code	NDC 9994-0815-82
Hospital Charge Code	ERX4081582
Hospital Revenue Code	259
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.05
Rate for Payer: Adventist Health Commercial	$0.01
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.05
Rate for Payer: Cash Price	$0.03
Rate for Payer: EPIC Health Plan Commercial	$0.04
Rate for Payer: Heritage Provider Network Commercial	$0.05
Rate for Payer: Heritage Provider Network Senior	$0.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Commercial	$0.05

SPIRONOLACTONE 12.5 MG 1/2 TABLET [4081582]

Facility

$0.07

Service Code	NDC 9994-0815-82
Hospital Charge Code	ERX4081582
Hospital Revenue Code	259
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.06
Rate for Payer: Adventist Health Commercial	$0.01
Rate for Payer: Aetna of CA Gatekeeper	$0.04
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.05
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$0.06
Rate for Payer: Alpha Care Medical Group Medi-Cal	$0.04
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$0.05
Rate for Payer: Blue Shield of California Commercial	$0.04
Rate for Payer: Blue Shield of California EPN	$0.04
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cigna of CA HMO/PPO	$0.05
Rate for Payer: Dignity Health Commercial/Exchange	$0.06
Rate for Payer: Dignity Health Medi-Cal	$0.06
Rate for Payer: Dignity Health Senior	$0.06
Rate for Payer: EPIC Health Plan Commercial	$0.04
Rate for Payer: Heritage Provider Network Commercial	$0.04
Rate for Payer: Heritage Provider Network Senior	$0.04
Rate for Payer: Kaiser Permanente of CA Commercial	$0.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Commercial	$0.05
Rate for Payer: TriValley Medical Group Commercial	$0.03
Rate for Payer: TriValley Medical Group Senior	$0.03
Rate for Payer: Vantage Medical Group Medi-Cal	$0.06
Rate for Payer: Vantage Medical Group Senior	$0.06

SPIRONOLACTONE 25 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET [7439]

Facility

$1.46

Service Code	NDC 53489-144-01
Hospital Charge Code	1711768
Hospital Revenue Code	259
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$1.10
Rate for Payer: Adventist Health Commercial	$0.29
Rate for Payer: Aetna of CA Non-Gatekeeper	$1.00
Rate for Payer: Cash Price	$0.66
Rate for Payer: EPIC Health Plan Commercial	$0.79
Rate for Payer: Heritage Provider Network Commercial	$0.99
Rate for Payer: Heritage Provider Network Senior	$0.99
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.37
Rate for Payer: Multiplan Commercial	$1.10

SPIRONOLACTONE 25 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET [7439]

Facility

$1.46

Service Code	NDC 53489-144-01
Hospital Charge Code	1711768
Hospital Revenue Code	259
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$1.24
Rate for Payer: Adventist Health Commercial	$0.29
Rate for Payer: Aetna of CA Gatekeeper	$0.78
Rate for Payer: Aetna of CA Non-Gatekeeper	$1.00
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$1.24
Rate for Payer: Alpha Care Medical Group Medi-Cal	$0.80
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$1.10
Rate for Payer: Blue Shield of California Commercial	$0.91
Rate for Payer: Blue Shield of California EPN	$0.86
Rate for Payer: Cash Price	$0.66
Rate for Payer: Cigna of CA HMO/PPO	$0.95
Rate for Payer: Dignity Health Commercial/Exchange	$1.24
Rate for Payer: Dignity Health Medi-Cal	$1.24
Rate for Payer: Dignity Health Senior	$1.24
Rate for Payer: EPIC Health Plan Commercial	$0.93
Rate for Payer: Heritage Provider Network Commercial	$0.90
Rate for Payer: Heritage Provider Network Senior	$0.90
Rate for Payer: Kaiser Permanente of CA Commercial	$0.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.26
Rate for Payer: LLUH Dept of Risk Management WC	$0.37
Rate for Payer: Multiplan Commercial	$1.10
Rate for Payer: TriValley Medical Group Commercial	$0.58
Rate for Payer: TriValley Medical Group Senior	$0.58
Rate for Payer: Vantage Medical Group Medi-Cal	$1.24
Rate for Payer: Vantage Medical Group Senior	$1.24

SPIRONOLACTONE 25 MG TABLET [7437]

Facility

$0.15

Service Code	NDC 16729-225-01
Hospital Charge Code	1710088
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.11
Rate for Payer: Adventist Health Commercial	$0.03
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.10
Rate for Payer: Cash Price	$0.07
Rate for Payer: EPIC Health Plan Commercial	$0.08
Rate for Payer: Heritage Provider Network Commercial	$0.10
Rate for Payer: Heritage Provider Network Senior	$0.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Commercial	$0.11

SPIRONOLACTONE 25 MG TABLET [7437]

Facility

$0.12

Service Code	NDC 53489-143-01
Hospital Charge Code	1710088
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.09
Rate for Payer: Adventist Health Commercial	$0.02
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.08
Rate for Payer: Cash Price	$0.05
Rate for Payer: EPIC Health Plan Commercial	$0.06
Rate for Payer: Heritage Provider Network Commercial	$0.08
Rate for Payer: Heritage Provider Network Senior	$0.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Commercial	$0.09

Know your out-of-pocket cost for care.

All Charges