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

$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

$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

$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

$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

$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

$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

$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

$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

$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

$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

$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

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

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility IP

$6.74

Service Code	NDC 0409-3375-14
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$5.06
Rate for Payer: Adventist Health Commercial	$1.35
Rate for Payer: Aetna of CA Non-Gatekeeper	$4.63
Rate for Payer: Cash Price	$3.03
Rate for Payer: EPIC Health Plan Commercial	$3.64
Rate for Payer: Heritage Provider Network Commercial	$4.56
Rate for Payer: Heritage Provider Network Senior	$4.56
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

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility OP

$5.41

Service Code	NDC 70121-1576-7
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$4.60
Rate for Payer: Adventist Health Commercial	$1.08
Rate for Payer: Aetna of CA Gatekeeper	$2.89
Rate for Payer: Aetna of CA Non-Gatekeeper	$3.72
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$4.60
Rate for Payer: AlphaCare Medical Group Medi-Cal	$2.98
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$4.06
Rate for Payer: Blue Shield of California Commercial	$3.36
Rate for Payer: Blue Shield of California EPN	$3.18
Rate for Payer: Cash Price	$2.43
Rate for Payer: Cigna of CA HMO/PPO	$3.52
Rate for Payer: Dignity Health Commercial/Exchange	$4.60
Rate for Payer: Dignity Health Medi-Cal	$4.60
Rate for Payer: Dignity Health Senior	$4.60
Rate for Payer: EPIC Health Plan Commercial	$3.46
Rate for Payer: Heritage Provider Network Commercial	$3.35
Rate for Payer: Heritage Provider Network Senior	$3.35
Rate for Payer: Kaiser Permanente of CA Commercial	$2.61
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
Rate for Payer: Vantage Medical Group Medi-Cal	$4.60
Rate for Payer: Vantage Medical Group Senior	$4.60

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

$1.50

Service Code	NDC 43066-997-10
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$1.28
Rate for Payer: Adventist Health Commercial	$0.30
Rate for Payer: Aetna of CA Gatekeeper	$0.80
Rate for Payer: Aetna of CA Non-Gatekeeper	$1.03
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$1.28
Rate for Payer: AlphaCare Medical Group Medi-Cal	$0.83
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$1.12
Rate for Payer: Blue Shield of California Commercial	$0.93
Rate for Payer: Blue Shield of California EPN	$0.88
Rate for Payer: Cash Price	$0.68
Rate for Payer: Cigna of CA HMO/PPO	$0.98
Rate for Payer: Dignity Health Commercial/Exchange	$1.28
Rate for Payer: Dignity Health Medi-Cal	$1.28
Rate for Payer: Dignity Health Senior	$1.28
Rate for Payer: EPIC Health Plan Commercial	$0.96
Rate for Payer: Heritage Provider Network Commercial	$0.93
Rate for Payer: Heritage Provider Network Senior	$0.93
Rate for Payer: Kaiser Permanente of CA Commercial	$0.72
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
Rate for Payer: Vantage Medical Group Medi-Cal	$1.28
Rate for Payer: Vantage Medical Group Senior	$1.28

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility OP

$5.24

Service Code	NDC 67457-852-00
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$4.45
Rate for Payer: Adventist Health Commercial	$1.05
Rate for Payer: Aetna of CA Gatekeeper	$2.80
Rate for Payer: Aetna of CA Non-Gatekeeper	$3.60
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$4.45
Rate for Payer: AlphaCare Medical Group Medi-Cal	$2.88
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$3.93
Rate for Payer: Blue Shield of California Commercial	$3.25
Rate for Payer: Blue Shield of California EPN	$3.08
Rate for Payer: Cash Price	$2.36
Rate for Payer: Cigna of CA HMO/PPO	$3.41
Rate for Payer: Dignity Health Commercial/Exchange	$4.45
Rate for Payer: Dignity Health Medi-Cal	$4.45
Rate for Payer: Dignity Health Senior	$4.45
Rate for Payer: EPIC Health Plan Commercial	$3.35
Rate for Payer: Heritage Provider Network Commercial	$3.24
Rate for Payer: Heritage Provider Network Senior	$3.24
Rate for Payer: Kaiser Permanente of CA Commercial	$2.53
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
Rate for Payer: Vantage Medical Group Medi-Cal	$4.45
Rate for Payer: Vantage Medical Group Senior	$4.45

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility IP

$4.33

Service Code	NDC 0143-9318-01
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.25
Rate for Payer: Adventist Health Commercial	$0.87
Rate for Payer: Aetna of CA Non-Gatekeeper	$2.97
Rate for Payer: Cash Price	$1.95
Rate for Payer: EPIC Health Plan Commercial	$2.34
Rate for Payer: Heritage Provider Network Commercial	$2.93
Rate for Payer: Heritage Provider Network Senior	$2.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.78
Rate for Payer: LLUH Dept of Risk Management WC	$1.08
Rate for Payer: Multiplan Commercial	$3.25

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility OP

$4.33

Service Code	NDC 0143-9318-01
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.68
Rate for Payer: Adventist Health Commercial	$0.87
Rate for Payer: Aetna of CA Gatekeeper	$2.31
Rate for Payer: Aetna of CA Non-Gatekeeper	$2.97
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$3.68
Rate for Payer: AlphaCare Medical Group Medi-Cal	$2.38
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$3.25
Rate for Payer: Blue Shield of California Commercial	$2.69
Rate for Payer: Blue Shield of California EPN	$2.54
Rate for Payer: Cash Price	$1.95
Rate for Payer: Cigna of CA HMO/PPO	$2.81
Rate for Payer: Dignity Health Commercial/Exchange	$3.68
Rate for Payer: Dignity Health Medi-Cal	$3.68
Rate for Payer: Dignity Health Senior	$3.68
Rate for Payer: EPIC Health Plan Commercial	$2.77
Rate for Payer: Heritage Provider Network Commercial	$2.68
Rate for Payer: Heritage Provider Network Senior	$2.68
Rate for Payer: Kaiser Permanente of CA Commercial	$2.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.78
Rate for Payer: LLUH Dept of Risk Management WC	$1.08
Rate for Payer: Multiplan Commercial	$3.25
Rate for Payer: Vantage Medical Group Medi-Cal	$3.68
Rate for Payer: Vantage Medical Group Senior	$3.68

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility OP

$5.41

Service Code	NDC 70121-1576-1
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$4.60
Rate for Payer: Adventist Health Commercial	$1.08
Rate for Payer: Aetna of CA Gatekeeper	$2.89
Rate for Payer: Aetna of CA Non-Gatekeeper	$3.72
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$4.60
Rate for Payer: AlphaCare Medical Group Medi-Cal	$2.98
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$4.06
Rate for Payer: Blue Shield of California Commercial	$3.36
Rate for Payer: Blue Shield of California EPN	$3.18
Rate for Payer: Cash Price	$2.43
Rate for Payer: Cigna of CA HMO/PPO	$3.52
Rate for Payer: Dignity Health Commercial/Exchange	$4.60
Rate for Payer: Dignity Health Medi-Cal	$4.60
Rate for Payer: Dignity Health Senior	$4.60
Rate for Payer: EPIC Health Plan Commercial	$3.46
Rate for Payer: Heritage Provider Network Commercial	$3.35
Rate for Payer: Heritage Provider Network Senior	$3.35
Rate for Payer: Kaiser Permanente of CA Commercial	$2.61
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
Rate for Payer: Vantage Medical Group Medi-Cal	$4.60
Rate for Payer: Vantage Medical Group Senior	$4.60

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [10734]

Facility IP

$6.74

Service Code	NDC 0409-3375-04
Hospital Charge Code	1720130
Hospital Revenue Code	250
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$5.06
Rate for Payer: Adventist Health Commercial	$1.35
Rate for Payer: Aetna of CA Non-Gatekeeper	$4.63
Rate for Payer: Cash Price	$3.03
Rate for Payer: EPIC Health Plan Commercial	$3.64
Rate for Payer: Heritage Provider Network Commercial	$4.56
Rate for Payer: Heritage Provider Network Senior	$4.56
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

Price Transparency.

All Charges