Loma Linda University Medical Center

All Charges

Charge

Type

Price

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

Facility IP

$7,509.48

Service Code	APR-DRG 7941
Min. Negotiated Rate	$7,509.48
Max. Negotiated Rate	$7,509.48
Rate for Payer: IEHP Medi-Cal	$7,509.48

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

Facility IP

$14,042.96

Service Code	APR-DRG 7943
Min. Negotiated Rate	$14,042.96
Max. Negotiated Rate	$14,042.96
Rate for Payer: IEHP Medi-Cal	$14,042.96

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

Facility IP

$25,134.06

Service Code	APR-DRG 7944
Min. Negotiated Rate	$25,134.06
Max. Negotiated Rate	$25,134.06
Rate for Payer: IEHP Medi-Cal	$25,134.06

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

Facility IP

$9,652.48

Service Code	APR-DRG 7942
Min. Negotiated Rate	$9,652.48
Max. Negotiated Rate	$9,652.48
Rate for Payer: IEHP Medi-Cal	$9,652.48

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

Facility IP

$30,585.09

Service Code	APR-DRG 9524
Min. Negotiated Rate	$30,585.09
Max. Negotiated Rate	$30,585.09
Rate for Payer: IEHP Medi-Cal	$30,585.09

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

Facility IP

$7,925.34

Service Code	APR-DRG 9521
Min. Negotiated Rate	$7,925.34
Max. Negotiated Rate	$7,925.34
Rate for Payer: IEHP Medi-Cal	$7,925.34

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

Facility IP

$17,388.79

Service Code	APR-DRG 9523
Min. Negotiated Rate	$17,388.79
Max. Negotiated Rate	$17,388.79
Rate for Payer: IEHP Medi-Cal	$17,388.79

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

Facility IP

$10,915.01

Service Code	APR-DRG 9522
Min. Negotiated Rate	$10,915.01
Max. Negotiated Rate	$10,915.01
Rate for Payer: IEHP Medi-Cal	$10,915.01

NON-HYPOVOLEMIC SODIUM DISORDERS

Facility IP

$7,896.48

Service Code	APR-DRG 4263
Min. Negotiated Rate	$7,896.48
Max. Negotiated Rate	$7,896.48
Rate for Payer: IEHP Medi-Cal	$7,896.48

NON-HYPOVOLEMIC SODIUM DISORDERS

Facility IP

$4,079.07

Service Code	APR-DRG 4261
Min. Negotiated Rate	$4,079.07
Max. Negotiated Rate	$4,079.07
Rate for Payer: IEHP Medi-Cal	$4,079.07

NON-HYPOVOLEMIC SODIUM DISORDERS

Facility IP

$5,402.29

Service Code	APR-DRG 4262
Min. Negotiated Rate	$5,402.29
Max. Negotiated Rate	$5,402.29
Rate for Payer: IEHP Medi-Cal	$5,402.29

NON-HYPOVOLEMIC SODIUM DISORDERS

Facility IP

$14,001.17

Service Code	APR-DRG 4264
Min. Negotiated Rate	$14,001.17
Max. Negotiated Rate	$14,001.17
Rate for Payer: IEHP Medi-Cal	$14,001.17

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION

Facility IP

$8,795.88

Service Code	APR-DRG 0463
Min. Negotiated Rate	$8,795.88
Max. Negotiated Rate	$8,795.88
Rate for Payer: IEHP Medi-Cal	$8,795.88

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION

Facility IP

$5,647.03

Service Code	APR-DRG 0461
Min. Negotiated Rate	$5,647.03
Max. Negotiated Rate	$5,647.03
Rate for Payer: IEHP Medi-Cal	$5,647.03

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION

Facility IP

$7,119.48

Service Code	APR-DRG 0462
Min. Negotiated Rate	$7,119.48
Max. Negotiated Rate	$7,119.48
Rate for Payer: IEHP Medi-Cal	$7,119.48

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION

Facility IP

$15,436.81

Service Code	APR-DRG 0464
Min. Negotiated Rate	$15,436.81
Max. Negotiated Rate	$15,436.81
Rate for Payer: IEHP Medi-Cal	$15,436.81

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility IP

$2.62

Service Code	NDC 25021-316-04
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$1.96
Rate for Payer: Adventist Health Commercial	$0.52
Rate for Payer: Aetna of CA Non-Gatekeeper	$1.80
Rate for Payer: Cash Price	$1.18
Rate for Payer: EPIC Health Plan Commercial	$1.41
Rate for Payer: Heritage Provider Network Commercial	$1.77
Rate for Payer: Heritage Provider Network Senior	$1.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.47
Rate for Payer: LLUH Dept of Risk Management WC	$0.66
Rate for Payer: Multiplan Commercial	$1.96

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility IP

$1.50

Service Code	NDC 43066-997-01
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$1.12
Rate for Payer: Adventist Health Commercial	$0.30
Rate for Payer: Aetna of CA Non-Gatekeeper	$1.03
Rate for Payer: Cash Price	$0.68
Rate for Payer: EPIC Health Plan Commercial	$0.81
Rate for Payer: Heritage Provider Network Commercial	$1.02
Rate for Payer: Heritage Provider Network Senior	$1.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.27
Rate for Payer: LLUH Dept of Risk Management WC	$0.38
Rate for Payer: Multiplan Commercial	$1.12

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility IP

$3.15

Service Code	NDC 63323-940-04
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$2.36
Rate for Payer: Adventist Health Commercial	$0.63
Rate for Payer: Aetna of CA Non-Gatekeeper	$2.16
Rate for Payer: Cash Price	$1.42
Rate for Payer: EPIC Health Plan Commercial	$1.70
Rate for Payer: Heritage Provider Network Commercial	$2.13
Rate for Payer: Heritage Provider Network Senior	$2.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.57
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: Multiplan Commercial	$2.36

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility OP

$3.15

Service Code	NDC 63323-940-21
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$2.68
Rate for Payer: Adventist Health Commercial	$0.63
Rate for Payer: Aetna of CA Gatekeeper	$1.68
Rate for Payer: Aetna of CA Non-Gatekeeper	$2.16
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$2.68
Rate for Payer: AlphaCare Medical Group Medi-Cal	$1.73
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$2.36
Rate for Payer: Blue Shield of California Commercial	$1.96
Rate for Payer: Blue Shield of California EPN	$1.85
Rate for Payer: Cash Price	$1.42
Rate for Payer: Cigna of CA HMO/PPO	$2.05
Rate for Payer: Dignity Health Commercial/Exchange	$2.68
Rate for Payer: Dignity Health Medi-Cal	$2.68
Rate for Payer: Dignity Health Senior	$2.68
Rate for Payer: EPIC Health Plan Commercial	$2.02
Rate for Payer: Heritage Provider Network Commercial	$1.95
Rate for Payer: Heritage Provider Network Senior	$1.95
Rate for Payer: Kaiser Permanente of CA Commercial	$1.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.57
Rate for Payer: LLUH Dept of Risk Management WC	$0.79
Rate for Payer: Multiplan Commercial	$2.36
Rate for Payer: Vantage Medical Group Medi-Cal	$2.68
Rate for Payer: Vantage Medical Group Senior	$2.68

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility IP

$5.24

Service Code	NDC 67457-852-00
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$3.93
Rate for Payer: Adventist Health Commercial	$1.05
Rate for Payer: Aetna of CA Non-Gatekeeper	$3.60
Rate for Payer: Cash Price	$2.36
Rate for Payer: EPIC Health Plan Commercial	$2.83
Rate for Payer: Heritage Provider Network Commercial	$3.55
Rate for Payer: Heritage Provider Network Senior	$3.55
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.95
Rate for Payer: LLUH Dept of Risk Management WC	$1.31
Rate for Payer: Multiplan Commercial	$3.93

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility OP

$6.74

Service Code	NDC 0409-3375-14
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$5.73
Rate for Payer: Adventist Health Commercial	$1.35
Rate for Payer: Aetna of CA Gatekeeper	$3.60
Rate for Payer: Aetna of CA Non-Gatekeeper	$4.63
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$5.73
Rate for Payer: AlphaCare Medical Group Medi-Cal	$3.71
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$5.06
Rate for Payer: Blue Shield of California Commercial	$4.19
Rate for Payer: Blue Shield of California EPN	$3.96
Rate for Payer: Cash Price	$3.03
Rate for Payer: Cigna of CA HMO/PPO	$4.38
Rate for Payer: Dignity Health Commercial/Exchange	$5.73
Rate for Payer: Dignity Health Medi-Cal	$5.73
Rate for Payer: Dignity Health Senior	$5.73
Rate for Payer: EPIC Health Plan Commercial	$4.31
Rate for Payer: Heritage Provider Network Commercial	$4.17
Rate for Payer: Heritage Provider Network Senior	$4.17
Rate for Payer: Kaiser Permanente of CA Commercial	$3.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$1.22
Rate for Payer: LLUH Dept of Risk Management WC	$1.68
Rate for Payer: Multiplan Commercial	$5.06
Rate for Payer: Vantage Medical Group Medi-Cal	$5.73
Rate for Payer: Vantage Medical Group Senior	$5.73

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility IP

$5.41

Service Code	NDC 70121-1576-1
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$4.06
Rate for Payer: Adventist Health Commercial	$1.08
Rate for Payer: Aetna of CA Non-Gatekeeper	$3.72
Rate for Payer: Cash Price	$2.43
Rate for Payer: EPIC Health Plan Commercial	$2.92
Rate for Payer: Heritage Provider Network Commercial	$3.66
Rate for Payer: Heritage Provider Network Senior	$3.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.98
Rate for Payer: LLUH Dept of Risk Management WC	$1.35
Rate for Payer: Multiplan Commercial	$4.06

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility IP

$5.41

Service Code	NDC 70121-1576-7
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$4.06
Rate for Payer: Adventist Health Commercial	$1.08
Rate for Payer: Aetna of CA Non-Gatekeeper	$3.72
Rate for Payer: Cash Price	$2.43
Rate for Payer: EPIC Health Plan Commercial	$2.92
Rate for Payer: Heritage Provider Network Commercial	$3.66
Rate for Payer: Heritage Provider Network Senior	$3.66
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.98
Rate for Payer: LLUH Dept of Risk Management WC	$1.35
Rate for Payer: Multiplan Commercial	$4.06

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility OP

$6.74

Service Code	NDC 0409-3375-04
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$5.73
Rate for Payer: Adventist Health Commercial	$1.35
Rate for Payer: Aetna of CA Gatekeeper	$3.60
Rate for Payer: Aetna of CA Non-Gatekeeper	$4.63
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$5.73
Rate for Payer: AlphaCare Medical Group Medi-Cal	$3.71
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$5.06
Rate for Payer: Blue Shield of California Commercial	$4.19
Rate for Payer: Blue Shield of California EPN	$3.96
Rate for Payer: Cash Price	$3.03
Rate for Payer: Cigna of CA HMO/PPO	$4.38
Rate for Payer: Dignity Health Commercial/Exchange	$5.73
Rate for Payer: Dignity Health Medi-Cal	$5.73
Rate for Payer: Dignity Health Senior	$5.73
Rate for Payer: EPIC Health Plan Commercial	$4.31
Rate for Payer: Heritage Provider Network Commercial	$4.17
Rate for Payer: Heritage Provider Network Senior	$4.17
Rate for Payer: Kaiser Permanente of CA Commercial	$3.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$1.22
Rate for Payer: LLUH Dept of Risk Management WC	$1.68
Rate for Payer: Multiplan Commercial	$5.06
Rate for Payer: Vantage Medical Group Medi-Cal	$5.73
Rate for Payer: Vantage Medical Group Senior	$5.73

Price Transparency.

All Charges