Loma Linda University Medical Center

All Charges

Charge

Type

Price

Repair or advancement, flexor tendon, not in zone 2 digital flexor tendon sheath (eg, no man's land); primary or secondary without free graft, each tendon

Facility OP

$9,616.00

Service Code	CPT 26350
Min. Negotiated Rate	$587.18
Max. Negotiated Rate	$9,616.00
Rate for Payer: Aetna of CA Gatekeeper	$1,335.00
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$6,066.32
Rate for Payer: AlphaCare Medical Group Medi-Cal	$4,448.63
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$4,044.21
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$4,547.00
Rate for Payer: Dignity Health Commercial/Exchange	$6,066.32
Rate for Payer: Dignity Health Medi-Cal	$4,448.63
Rate for Payer: Dignity Health Senior	$4,044.21
Rate for Payer: EPIC Health Plan Commercial	$9,616.00
Rate for Payer: EPIC Health Plan Medicare	$4,044.21
Rate for Payer: Humana Medicare	$4,044.21
Rate for Payer: IEHP Medi-Cal	$587.18
Rate for Payer: IEHP Medicare Advantage	$4,044.21
Rate for Payer: Kaiser Permanente of CA Commercial	$7,684.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$4,772.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$5,095.70
Rate for Payer: Molina Healthcare of CA Medicare	$5,095.70
Rate for Payer: TriValley Medical Group Commercial	$4,448.63
Rate for Payer: TriValley Medical Group Senior	$4,044.21
Rate for Payer: Vantage Medical Group Commercial/Exchange	$6,066.32
Rate for Payer: Vantage Medical Group Medi-Cal	$4,448.63
Rate for Payer: Vantage Medical Group Senior	$4,044.21

Repair oval window fistula

Facility OP

$7,643.11

Service Code	CPT 69666
Min. Negotiated Rate	$249.74
Max. Negotiated Rate	$7,643.11
Rate for Payer: Aetna of CA Gatekeeper	$4,857.00
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$6,034.04
Rate for Payer: AlphaCare Medical Group Medi-Cal	$4,424.96
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$4,022.69
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$7,436.00
Rate for Payer: Dignity Health Commercial/Exchange	$6,034.04
Rate for Payer: Dignity Health Medi-Cal	$4,424.96
Rate for Payer: Dignity Health Senior	$4,022.69
Rate for Payer: EPIC Health Plan Medicare	$4,022.69
Rate for Payer: Humana Medicare	$4,022.69
Rate for Payer: IEHP Medi-Cal	$249.74
Rate for Payer: IEHP Medicare Advantage	$4,022.69
Rate for Payer: Kaiser Permanente of CA Commercial	$7,643.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$4,746.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$5,068.59
Rate for Payer: Molina Healthcare of CA Medicare	$5,068.59
Rate for Payer: TriValley Medical Group Commercial	$4,424.96
Rate for Payer: TriValley Medical Group Senior	$4,022.69
Rate for Payer: Vantage Medical Group Commercial/Exchange	$6,034.04
Rate for Payer: Vantage Medical Group Medi-Cal	$4,424.96
Rate for Payer: Vantage Medical Group Senior	$4,022.69

Repair recurrent inguinal hernia, any age; reducible

Facility OP

$9,616.00

Service Code	CPT 49520
Min. Negotiated Rate	$658.04
Max. Negotiated Rate	$9,616.00
Rate for Payer: Aetna of CA Gatekeeper	$4,857.00
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$6,483.93
Rate for Payer: AlphaCare Medical Group Medi-Cal	$4,754.88
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$4,322.62
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$7,436.00
Rate for Payer: Dignity Health Commercial/Exchange	$6,483.93
Rate for Payer: Dignity Health Medi-Cal	$4,754.88
Rate for Payer: Dignity Health Senior	$4,322.62
Rate for Payer: EPIC Health Plan Commercial	$9,616.00
Rate for Payer: EPIC Health Plan Medicare	$4,322.62
Rate for Payer: Humana Medicare	$4,322.62
Rate for Payer: IEHP Medi-Cal	$658.04
Rate for Payer: IEHP Medicare Advantage	$4,322.62
Rate for Payer: Kaiser Permanente of CA Commercial	$8,212.98
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$5,100.69
Rate for Payer: Molina Healthcare of CA Medi-Cal	$5,446.50
Rate for Payer: Molina Healthcare of CA Medicare	$5,446.50
Rate for Payer: TriValley Medical Group Commercial	$4,754.88
Rate for Payer: TriValley Medical Group Senior	$4,322.62
Rate for Payer: Vantage Medical Group Commercial/Exchange	$6,483.93
Rate for Payer: Vantage Medical Group Medi-Cal	$4,754.88
Rate for Payer: Vantage Medical Group Senior	$4,322.62

Repair round window fistula

Facility OP

$7,643.11

Service Code	CPT 69667
Min. Negotiated Rate	$1,254.51
Max. Negotiated Rate	$7,643.11
Rate for Payer: Aetna of CA Gatekeeper	$4,857.00
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$6,034.04
Rate for Payer: AlphaCare Medical Group Medi-Cal	$4,424.96
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$4,022.69
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$7,436.00
Rate for Payer: Dignity Health Commercial/Exchange	$6,034.04
Rate for Payer: Dignity Health Medi-Cal	$4,424.96
Rate for Payer: Dignity Health Senior	$4,022.69
Rate for Payer: EPIC Health Plan Medicare	$4,022.69
Rate for Payer: Humana Medicare	$4,022.69
Rate for Payer: IEHP Medi-Cal	$1,254.51
Rate for Payer: IEHP Medicare Advantage	$4,022.69
Rate for Payer: Kaiser Permanente of CA Commercial	$7,643.11
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$4,746.77
Rate for Payer: Molina Healthcare of CA Medi-Cal	$5,068.59
Rate for Payer: Molina Healthcare of CA Medicare	$5,068.59
Rate for Payer: TriValley Medical Group Commercial	$4,424.96
Rate for Payer: TriValley Medical Group Senior	$4,022.69
Rate for Payer: Vantage Medical Group Commercial/Exchange	$6,034.04
Rate for Payer: Vantage Medical Group Medi-Cal	$4,424.96
Rate for Payer: Vantage Medical Group Senior	$4,022.69

Repair, secondary, Achilles tendon, with or without graft

Facility OP

$16,983.21

Service Code	CPT 27654
Min. Negotiated Rate	$921.13
Max. Negotiated Rate	$16,983.21
Rate for Payer: Aetna of CA Gatekeeper	$3,728.00
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$13,407.80
Rate for Payer: AlphaCare Medical Group Medi-Cal	$9,832.38
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$8,938.53
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$5,505.00
Rate for Payer: Dignity Health Commercial/Exchange	$13,407.80
Rate for Payer: Dignity Health Medi-Cal	$9,832.38
Rate for Payer: Dignity Health Senior	$8,938.53
Rate for Payer: EPIC Health Plan Commercial	$9,616.00
Rate for Payer: EPIC Health Plan Medicare	$8,938.53
Rate for Payer: Humana Medicare	$8,938.53
Rate for Payer: IEHP Medi-Cal	$921.13
Rate for Payer: IEHP Medicare Advantage	$8,938.53
Rate for Payer: Kaiser Permanente of CA Commercial	$16,983.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,547.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,262.55
Rate for Payer: Molina Healthcare of CA Medicare	$11,262.55
Rate for Payer: TriValley Medical Group Commercial	$9,832.38
Rate for Payer: TriValley Medical Group Senior	$8,938.53
Rate for Payer: Vantage Medical Group Commercial/Exchange	$13,407.80
Rate for Payer: Vantage Medical Group Medi-Cal	$9,832.38
Rate for Payer: Vantage Medical Group Senior	$8,938.53

Repair, tendon or muscle, flexor, forearm and/or wrist; primary, single, each tendon or muscle

Facility OP

$9,616.00

Service Code	CPT 25260
Min. Negotiated Rate	$583.11
Max. Negotiated Rate	$9,616.00
Rate for Payer: Aetna of CA Gatekeeper	$4,857.00
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$6,066.32
Rate for Payer: AlphaCare Medical Group Medi-Cal	$4,448.63
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$4,044.21
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$7,436.00
Rate for Payer: Dignity Health Commercial/Exchange	$6,066.32
Rate for Payer: Dignity Health Medi-Cal	$4,448.63
Rate for Payer: Dignity Health Senior	$4,044.21
Rate for Payer: EPIC Health Plan Commercial	$9,616.00
Rate for Payer: EPIC Health Plan Medicare	$4,044.21
Rate for Payer: Humana Medicare	$4,044.21
Rate for Payer: IEHP Medi-Cal	$583.11
Rate for Payer: IEHP Medicare Advantage	$4,044.21
Rate for Payer: Kaiser Permanente of CA Commercial	$7,684.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$4,772.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$5,095.70
Rate for Payer: Molina Healthcare of CA Medicare	$5,095.70
Rate for Payer: TriValley Medical Group Commercial	$4,448.63
Rate for Payer: TriValley Medical Group Senior	$4,044.21
Rate for Payer: Vantage Medical Group Commercial/Exchange	$6,066.32
Rate for Payer: Vantage Medical Group Medi-Cal	$4,448.63
Rate for Payer: Vantage Medical Group Senior	$4,044.21

Repair, tendon or muscle, upper arm or elbow, each tendon or muscle, primary or secondary (excludes rotator cuff)

Facility OP

$16,983.21

Service Code	CPT 24341
Min. Negotiated Rate	$139.96
Max. Negotiated Rate	$16,983.21
Rate for Payer: Aetna of CA Gatekeeper	$3,728.00
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$13,407.80
Rate for Payer: AlphaCare Medical Group Medi-Cal	$9,832.38
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$8,938.53
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$4,547.00
Rate for Payer: Dignity Health Commercial/Exchange	$13,407.80
Rate for Payer: Dignity Health Medi-Cal	$9,832.38
Rate for Payer: Dignity Health Senior	$8,938.53
Rate for Payer: EPIC Health Plan Commercial	$9,616.00
Rate for Payer: EPIC Health Plan Medicare	$8,938.53
Rate for Payer: Humana Medicare	$8,938.53
Rate for Payer: IEHP Medi-Cal	$139.96
Rate for Payer: IEHP Medicare Advantage	$8,938.53
Rate for Payer: Kaiser Permanente of CA Commercial	$16,983.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,547.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,262.55
Rate for Payer: Molina Healthcare of CA Medicare	$11,262.55
Rate for Payer: TriValley Medical Group Commercial	$9,832.38
Rate for Payer: TriValley Medical Group Senior	$8,938.53
Rate for Payer: Vantage Medical Group Commercial/Exchange	$13,407.80
Rate for Payer: Vantage Medical Group Medi-Cal	$9,832.38
Rate for Payer: Vantage Medical Group Senior	$8,938.53

Repair, tendon sheath, extensor, forearm and/or wrist, with free graft (includes obtaining graft) (eg, for extensor carpi ulnaris subluxation)

Facility OP

$9,616.00

Service Code	CPT 25275
Min. Negotiated Rate	$819.50
Max. Negotiated Rate	$9,616.00
Rate for Payer: Aetna of CA Gatekeeper	$4,857.00
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$6,066.32
Rate for Payer: AlphaCare Medical Group Medi-Cal	$4,448.63
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$4,044.21
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$5,505.00
Rate for Payer: Dignity Health Commercial/Exchange	$6,066.32
Rate for Payer: Dignity Health Medi-Cal	$4,448.63
Rate for Payer: Dignity Health Senior	$4,044.21
Rate for Payer: EPIC Health Plan Commercial	$9,616.00
Rate for Payer: EPIC Health Plan Medicare	$4,044.21
Rate for Payer: Humana Medicare	$4,044.21
Rate for Payer: IEHP Medi-Cal	$819.50
Rate for Payer: IEHP Medicare Advantage	$4,044.21
Rate for Payer: Kaiser Permanente of CA Commercial	$7,684.00
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$4,772.17
Rate for Payer: Molina Healthcare of CA Medi-Cal	$5,095.70
Rate for Payer: Molina Healthcare of CA Medicare	$5,095.70
Rate for Payer: TriValley Medical Group Commercial	$4,448.63
Rate for Payer: TriValley Medical Group Senior	$4,044.21
Rate for Payer: Vantage Medical Group Commercial/Exchange	$6,066.32
Rate for Payer: Vantage Medical Group Medi-Cal	$4,448.63
Rate for Payer: Vantage Medical Group Senior	$4,044.21

Replacement of tissue expander with permanent implant

Facility OP

$16,983.21

Service Code	CPT 11970
Min. Negotiated Rate	$120.23
Max. Negotiated Rate	$16,983.21
Rate for Payer: Aetna of CA Gatekeeper	$3,728.00
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$13,407.80
Rate for Payer: AlphaCare Medical Group Medi-Cal	$9,832.38
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$8,938.53
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$7,436.00
Rate for Payer: Dignity Health Commercial/Exchange	$13,407.80
Rate for Payer: Dignity Health Medi-Cal	$9,832.38
Rate for Payer: Dignity Health Senior	$8,938.53
Rate for Payer: EPIC Health Plan Commercial	$9,616.00
Rate for Payer: EPIC Health Plan Medicare	$8,938.53
Rate for Payer: Humana Medicare	$8,938.53
Rate for Payer: IEHP Medi-Cal	$120.23
Rate for Payer: IEHP Medicare Advantage	$8,938.53
Rate for Payer: Kaiser Permanente of CA Commercial	$16,983.21
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$10,547.47
Rate for Payer: Molina Healthcare of CA Medi-Cal	$11,262.55
Rate for Payer: Molina Healthcare of CA Medicare	$11,262.55
Rate for Payer: TriValley Medical Group Commercial	$9,832.38
Rate for Payer: TriValley Medical Group Senior	$8,938.53
Rate for Payer: Vantage Medical Group Commercial/Exchange	$13,407.80
Rate for Payer: Vantage Medical Group Medi-Cal	$9,832.38
Rate for Payer: Vantage Medical Group Senior	$8,938.53

Repositioning of intraocular lens prosthesis, requiring an incision (separate procedure)

Facility OP

$7,436.00

Service Code	CPT 66825
Min. Negotiated Rate	$158.56
Max. Negotiated Rate	$7,436.00
Rate for Payer: Aetna of CA Gatekeeper	$4,857.00
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$4,367.44
Rate for Payer: AlphaCare Medical Group Medi-Cal	$3,202.79
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$2,911.63
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$7,436.00
Rate for Payer: Dignity Health Commercial/Exchange	$4,367.44
Rate for Payer: Dignity Health Medi-Cal	$3,202.79
Rate for Payer: Dignity Health Senior	$2,911.63
Rate for Payer: EPIC Health Plan Medicare	$2,911.63
Rate for Payer: Humana Medicare	$2,911.63
Rate for Payer: IEHP Medi-Cal	$158.56
Rate for Payer: IEHP Medicare Advantage	$2,911.63
Rate for Payer: Kaiser Permanente of CA Commercial	$5,532.10
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$3,435.72
Rate for Payer: Molina Healthcare of CA Medi-Cal	$3,668.65
Rate for Payer: Molina Healthcare of CA Medicare	$3,668.65
Rate for Payer: TriValley Medical Group Commercial	$3,202.79
Rate for Payer: TriValley Medical Group Senior	$2,911.63
Rate for Payer: Vantage Medical Group Commercial/Exchange	$4,367.44
Rate for Payer: Vantage Medical Group Medi-Cal	$3,202.79
Rate for Payer: Vantage Medical Group Senior	$2,911.63

Resection or excision of neoplastic, vascular or infectious lesion of base of anterior cranial fossa; extradural

Facility OP

$9,792.00

Service Code	CPT 61600
Min. Negotiated Rate	$393.78
Max. Negotiated Rate	$9,792.00
Rate for Payer: Aetna of CA Gatekeeper	$4,453.95
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$9,792.00
Rate for Payer: IEHP Medi-Cal	$393.78

Resection or excision of neoplastic, vascular or infectious lesion of base of posterior cranial fossa, jugular foramen, foramen magnum, or C1-C3 vertebral bodies; extradural

Facility OP

$13,496.00

Service Code	CPT 61615
Min. Negotiated Rate	$490.76
Max. Negotiated Rate	$13,496.00
Rate for Payer: Aetna of CA Gatekeeper	$4,930.35
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$13,496.00
Rate for Payer: IEHP Medi-Cal	$490.76

Resection or excision of neoplastic, vascular or infectious lesion of infratemporal fossa, parapharyngeal space, petrous apex; extradural

Facility OP

$9,792.00

Service Code	CPT 61605
Min. Negotiated Rate	$446.63
Max. Negotiated Rate	$9,792.00
Rate for Payer: Aetna of CA Gatekeeper	$4,648.51
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$9,792.00
Rate for Payer: IEHP Medi-Cal	$446.63

RESLIZUMAB 10 MG/ML INTRAVENOUS SOLUTION [214073]

Facility IP

$126.00

Service Code	NDC 59310-610-31
Hospital Charge Code	NDG214073
Hospital Revenue Code	636
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$94.50
Rate for Payer: Adventist Health Commercial	$25.20
Rate for Payer: Aetna of CA Non-Gatekeeper	$86.56
Rate for Payer: Cash Price	$56.70
Rate for Payer: Cigna of CA HMO/PPO	$57.96
Rate for Payer: EPIC Health Plan Commercial	$68.04
Rate for Payer: Heritage Provider Network Commercial	$85.30
Rate for Payer: Heritage Provider Network Senior	$85.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$22.81
Rate for Payer: LLUH Dept of Risk Management WC	$31.50
Rate for Payer: Multiplan Commercial	$94.50
Rate for Payer: United Healthcare All Other HMO/non HMO	$45.94
Rate for Payer: United Healthcare Navigate/Select/Select+	$42.10

RESLIZUMAB 10 MG/ML INTRAVENOUS SOLUTION [214073]

Facility OP

$126.00

Service Code	NDC 59310-610-31
Hospital Charge Code	NDG214073
Hospital Revenue Code	636
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$107.10
Rate for Payer: Adventist Health Commercial	$25.20
Rate for Payer: Aetna of CA Gatekeeper	$67.35
Rate for Payer: Aetna of CA Non-Gatekeeper	$86.56
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$107.10
Rate for Payer: AlphaCare Medical Group Medi-Cal	$69.30
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$94.50
Rate for Payer: Blue Shield of California Commercial	$78.25
Rate for Payer: Blue Shield of California EPN	$73.96
Rate for Payer: Cash Price	$56.70
Rate for Payer: Cigna of CA HMO/PPO	$57.96
Rate for Payer: Dignity Health Commercial/Exchange	$107.10
Rate for Payer: Dignity Health Medi-Cal	$107.10
Rate for Payer: Dignity Health Senior	$107.10
Rate for Payer: EPIC Health Plan Commercial	$80.64
Rate for Payer: Heritage Provider Network Commercial	$58.34
Rate for Payer: Heritage Provider Network Senior	$58.34
Rate for Payer: Kaiser Permanente of CA Commercial	$60.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$22.81
Rate for Payer: LLUH Dept of Risk Management WC	$31.50
Rate for Payer: Multiplan Commercial	$94.50
Rate for Payer: United Healthcare All Other HMO/non HMO	$45.94
Rate for Payer: United Healthcare Navigate/Select/Select+	$42.10
Rate for Payer: Vantage Medical Group Medi-Cal	$107.10
Rate for Payer: Vantage Medical Group Senior	$107.10

RESPIRATORY FAILURE

Facility IP

$3,880.09

Service Code	APR-DRG 1331
Min. Negotiated Rate	$3,880.09
Max. Negotiated Rate	$3,880.09
Rate for Payer: IEHP Medi-Cal	$3,880.09

RESPIRATORY FAILURE

Facility IP

$9,648.50

Service Code	APR-DRG 1333
Min. Negotiated Rate	$9,648.50
Max. Negotiated Rate	$9,648.50
Rate for Payer: IEHP Medi-Cal	$9,648.50

RESPIRATORY FAILURE

Facility IP

$6,406.14

Service Code	APR-DRG 1332
Min. Negotiated Rate	$6,406.14
Max. Negotiated Rate	$6,406.14
Rate for Payer: IEHP Medi-Cal	$6,406.14

RESPIRATORY FAILURE

Facility IP

$15,925.30

Service Code	APR-DRG 1334
Min. Negotiated Rate	$15,925.30
Max. Negotiated Rate	$15,925.30
Rate for Payer: IEHP Medi-Cal	$15,925.30

RESPIRATORY MALIGNANCY

Facility IP

$5,328.67

Service Code	APR-DRG 1361
Min. Negotiated Rate	$5,328.67
Max. Negotiated Rate	$5,328.67
Rate for Payer: IEHP Medi-Cal	$5,328.67

RESPIRATORY MALIGNANCY

Facility IP

$7,374.16

Service Code	APR-DRG 1362
Min. Negotiated Rate	$7,374.16
Max. Negotiated Rate	$7,374.16
Rate for Payer: IEHP Medi-Cal	$7,374.16

RESPIRATORY MALIGNANCY

Facility IP

$10,482.22

Service Code	APR-DRG 1363
Min. Negotiated Rate	$10,482.22
Max. Negotiated Rate	$10,482.22
Rate for Payer: IEHP Medi-Cal	$10,482.22

RESPIRATORY MALIGNANCY

Facility IP

$14,860.76

Service Code	APR-DRG 1364
Min. Negotiated Rate	$14,860.76
Max. Negotiated Rate	$14,860.76
Rate for Payer: IEHP Medi-Cal	$14,860.76

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility IP

$13,940.48

Service Code	APR-DRG 1444
Min. Negotiated Rate	$13,940.48
Max. Negotiated Rate	$13,940.48
Rate for Payer: IEHP Medi-Cal	$13,940.48

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility IP

$5,658.97

Service Code	APR-DRG 1442
Min. Negotiated Rate	$5,658.97
Max. Negotiated Rate	$5,658.97
Rate for Payer: IEHP Medi-Cal	$5,658.97

Price Transparency.

All Charges