Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]

Facility

$5.08

Service Code	NDC 68180-963-01
Hospital Charge Code	1744112
Hospital Revenue Code	259
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$3.81
Rate for Payer: Adventist Health Commercial	$1.02
Rate for Payer: Aetna of CA Non-Gatekeeper	$3.49
Rate for Payer: Cash Price	$2.29
Rate for Payer: EPIC Health Plan Commercial	$2.74
Rate for Payer: Heritage Provider Network Commercial	$3.44
Rate for Payer: Heritage Provider Network Senior	$3.44
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.92
Rate for Payer: LLUH Dept of Risk Management WC	$1.27
Rate for Payer: Multiplan Commercial	$3.81

ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]

Facility

$5.08

Service Code	NDC 68180-963-01
Hospital Charge Code	1744112
Hospital Revenue Code	259
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$4.32
Rate for Payer: Adventist Health Commercial	$1.02
Rate for Payer: Aetna of CA Gatekeeper	$2.72
Rate for Payer: Aetna of CA Non-Gatekeeper	$3.49
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$4.32
Rate for Payer: Alpha Care Medical Group Medi-Cal	$2.79
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$3.81
Rate for Payer: Blue Shield of California Commercial	$3.15
Rate for Payer: Blue Shield of California EPN	$2.98
Rate for Payer: Cash Price	$2.29
Rate for Payer: Cigna of CA HMO/PPO	$3.30
Rate for Payer: Dignity Health Commercial/Exchange	$4.32
Rate for Payer: Dignity Health Medi-Cal	$4.32
Rate for Payer: Dignity Health Senior	$4.32
Rate for Payer: EPIC Health Plan Commercial	$3.25
Rate for Payer: Heritage Provider Network Commercial	$3.14
Rate for Payer: Heritage Provider Network Senior	$3.14
Rate for Payer: Kaiser Permanente of CA Commercial	$2.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.92
Rate for Payer: LLUH Dept of Risk Management WC	$1.27
Rate for Payer: Multiplan Commercial	$3.81
Rate for Payer: TriValley Medical Group Commercial	$2.03
Rate for Payer: TriValley Medical Group Senior	$2.03
Rate for Payer: Vantage Medical Group Medi-Cal	$4.32
Rate for Payer: Vantage Medical Group Senior	$4.32

ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17837]

Facility

$3.41

Service Code	NDC 0173-0682-24
Hospital Charge Code	1744126
Hospital Revenue Code	259
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$2.56
Rate for Payer: Adventist Health Commercial	$0.68
Rate for Payer: Aetna of CA Non-Gatekeeper	$2.34
Rate for Payer: Cash Price	$1.53
Rate for Payer: EPIC Health Plan Commercial	$1.84
Rate for Payer: Heritage Provider Network Commercial	$2.31
Rate for Payer: Heritage Provider Network Senior	$2.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.62
Rate for Payer: LLUH Dept of Risk Management WC	$0.85
Rate for Payer: Multiplan Commercial	$2.56

ALCOHOL ABUSE AND DEPENDENCE

Facility

$7,753.22

Service Code	APR-DRG 7753
Min. Negotiated Rate	$7,753.22
Max. Negotiated Rate	$7,753.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,753.22

ALCOHOL ABUSE AND DEPENDENCE

Facility

$17,173.89

Service Code	APR-DRG 7754
Min. Negotiated Rate	$17,173.89
Max. Negotiated Rate	$17,173.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$17,173.89

ALCOHOL ABUSE AND DEPENDENCE

Facility

$4,555.62

Service Code	APR-DRG 7752
Min. Negotiated Rate	$4,555.62
Max. Negotiated Rate	$4,555.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$4,555.62

ALCOHOL ABUSE AND DEPENDENCE

Facility

$3,325.94

Service Code	APR-DRG 7751
Min. Negotiated Rate	$3,325.94
Max. Negotiated Rate	$3,325.94
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$3,325.94

ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY

Facility

$4,050.23

Service Code	APR-DRG 7721
Min. Negotiated Rate	$4,050.23
Max. Negotiated Rate	$4,050.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$4,050.23

ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY

Facility

$6,097.71

Service Code	APR-DRG 7723
Min. Negotiated Rate	$6,097.71
Max. Negotiated Rate	$6,097.71
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,097.71

ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY

Facility

$4,979.46

Service Code	APR-DRG 7722
Min. Negotiated Rate	$4,979.46
Max. Negotiated Rate	$4,979.46
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$4,979.46

ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY

Facility

$16,099.41

Service Code	APR-DRG 7724
Min. Negotiated Rate	$16,099.41
Max. Negotiated Rate	$16,099.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$16,099.41

ALCOHOLIC LIVER DISEASE

Facility

$18,729.91

Service Code	APR-DRG 2804
Min. Negotiated Rate	$18,729.91
Max. Negotiated Rate	$18,729.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$18,729.91

ALCOHOLIC LIVER DISEASE

Facility

$5,848.99

Service Code	APR-DRG 2802
Min. Negotiated Rate	$5,848.99
Max. Negotiated Rate	$5,848.99
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$5,848.99

ALCOHOLIC LIVER DISEASE

Facility

$8,905.31

Service Code	APR-DRG 2803
Min. Negotiated Rate	$8,905.31
Max. Negotiated Rate	$8,905.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$8,905.31

ALCOHOLIC LIVER DISEASE

Facility

$4,532.75

Service Code	APR-DRG 2801
Min. Negotiated Rate	$4,532.75
Max. Negotiated Rate	$4,532.75
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$4,532.75

ALECTINIB 150 MG CAPSULE [212384]

Facility

$87.45

Service Code	NDC 50242-130-01
Hospital Charge Code	ERX212384
Hospital Revenue Code	259
Min. Negotiated Rate	$15.83
Max. Negotiated Rate	$65.59
Rate for Payer: Adventist Health Commercial	$17.49
Rate for Payer: Aetna of CA Non-Gatekeeper	$60.08
Rate for Payer: Cash Price	$39.35
Rate for Payer: EPIC Health Plan Commercial	$47.22
Rate for Payer: Heritage Provider Network Commercial	$59.20
Rate for Payer: Heritage Provider Network Senior	$59.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15.83
Rate for Payer: LLUH Dept of Risk Management WC	$21.86
Rate for Payer: Multiplan Commercial	$65.59

ALECTINIB 150 MG CAPSULE [212384]

Facility

$87.45

Service Code	NDC 50242-130-01
Hospital Charge Code	ERX212384
Hospital Revenue Code	259
Min. Negotiated Rate	$15.83
Max. Negotiated Rate	$74.33
Rate for Payer: Adventist Health Commercial	$17.49
Rate for Payer: Aetna of CA Gatekeeper	$46.74
Rate for Payer: Aetna of CA Non-Gatekeeper	$60.08
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$74.33
Rate for Payer: Alpha Care Medical Group Medi-Cal	$48.10
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$65.59
Rate for Payer: Blue Shield of California Commercial	$54.31
Rate for Payer: Blue Shield of California EPN	$51.33
Rate for Payer: Cash Price	$39.35
Rate for Payer: Cigna of CA HMO/PPO	$56.84
Rate for Payer: Dignity Health Commercial/Exchange	$74.33
Rate for Payer: Dignity Health Medi-Cal	$74.33
Rate for Payer: Dignity Health Senior	$74.33
Rate for Payer: EPIC Health Plan Commercial	$55.97
Rate for Payer: Heritage Provider Network Commercial	$54.13
Rate for Payer: Heritage Provider Network Senior	$54.13
Rate for Payer: Kaiser Permanente of CA Commercial	$42.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$15.83
Rate for Payer: LLUH Dept of Risk Management WC	$21.86
Rate for Payer: Multiplan Commercial	$65.59
Rate for Payer: TriValley Medical Group Commercial	$34.98
Rate for Payer: TriValley Medical Group Senior	$34.98
Rate for Payer: Vantage Medical Group Medi-Cal	$74.33
Rate for Payer: Vantage Medical Group Senior	$74.33

ALEMTUZUMAB 12 MG/1.2 ML INTRAVENOUS SOLUTION [208005]

Facility

$28,798.18

Service Code	CPT J0202
Hospital Charge Code	NDG208005
Hospital Revenue Code	636
Min. Negotiated Rate	$5,212.47
Max. Negotiated Rate	$21,598.64
Rate for Payer: Adventist Health Commercial	$5,759.64
Rate for Payer: Aetna of CA Non-Gatekeeper	$19,784.35
Rate for Payer: Cash Price	$12,959.18
Rate for Payer: Cigna of CA HMO/PPO	$13,247.16
Rate for Payer: EPIC Health Plan Commercial	$15,551.02
Rate for Payer: Heritage Provider Network Commercial	$19,496.37
Rate for Payer: Heritage Provider Network Senior	$19,496.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$5,212.47
Rate for Payer: LLUH Dept of Risk Management WC	$7,199.54
Rate for Payer: Multiplan Commercial	$21,598.64
Rate for Payer: United Healthcare All Other HMO/non HMO	$10,499.82
Rate for Payer: United Healthcare Navigate/Select/Select+	$9,621.47

ALEMTUZUMAB 12 MG/1.2 ML INTRAVENOUS SOLUTION [208005]

Facility

$28,798.18

Service Code	CPT J0202
Hospital Charge Code	NDG208005
Hospital Revenue Code	636
Min. Negotiated Rate	$2,301.13
Max. Negotiated Rate	$21,598.64
Rate for Payer: Adventist Health Commercial	$5,759.64
Rate for Payer: Aetna of CA Gatekeeper	$5,710.04
Rate for Payer: Aetna of CA Non-Gatekeeper	$19,784.35
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$2,905.43
Rate for Payer: Alpha Care Medical Group Medi-Cal	$2,556.78
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$2,556.78
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$3,517.34
Rate for Payer: Blue Shield of California Commercial	$2,301.13
Rate for Payer: Blue Shield of California EPN	$2,301.13
Rate for Payer: Cash Price	$12,959.18
Rate for Payer: Cash Price	$12,959.18
Rate for Payer: Cigna of CA HMO/PPO	$13,247.16
Rate for Payer: Dignity Health Commercial/Exchange	$3,486.52
Rate for Payer: Dignity Health Medi-Cal	$2,556.78
Rate for Payer: Dignity Health Senior	$2,556.78
Rate for Payer: EPIC Health Plan Commercial	$18,430.84
Rate for Payer: EPIC Health Plan Medicare	$2,324.34
Rate for Payer: Heritage Provider Network Commercial	$13,333.56
Rate for Payer: Heritage Provider Network Senior	$13,333.56
Rate for Payer: Humana Medicare	$2,324.34
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$3,632.93
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$2,324.34
Rate for Payer: Kaiser Permanente of CA Commercial	$4,416.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$5,212.47
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$2,742.73
Rate for Payer: LLUH Dept of Risk Management WC	$7,199.54
Rate for Payer: Molina Healthcare of CA Medi-Cal	$2,928.67
Rate for Payer: Molina Healthcare of CA Medicare	$2,928.67
Rate for Payer: Multiplan Commercial	$21,598.64
Rate for Payer: TriValley Medical Group Commercial	$11,519.27
Rate for Payer: TriValley Medical Group Senior	$11,519.27
Rate for Payer: United Healthcare All Other HMO/non HMO	$10,499.82
Rate for Payer: United Healthcare Navigate/Select/Select+	$9,621.47
Rate for Payer: Vantage Medical Group Commercial/Exchange	$3,486.52
Rate for Payer: Vantage Medical Group Medi-Cal	$2,556.78
Rate for Payer: Vantage Medical Group Senior	$2,324.34

ALENDRONATE 10 MG TABLET [15661]

Facility

$0.24

Service Code	NDC 64980-340-03
Hospital Charge Code	1711759
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.18
Rate for Payer: Adventist Health Commercial	$0.05
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.16
Rate for Payer: Cash Price	$0.11
Rate for Payer: EPIC Health Plan Commercial	$0.13
Rate for Payer: Heritage Provider Network Commercial	$0.16
Rate for Payer: Heritage Provider Network Senior	$0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Commercial	$0.18

ALENDRONATE 10 MG TABLET [15661]

Facility

$0.24

Service Code	NDC 64980-340-03
Hospital Charge Code	1711759
Hospital Revenue Code	259
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.20
Rate for Payer: Adventist Health Commercial	$0.05
Rate for Payer: Aetna of CA Gatekeeper	$0.13
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.16
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$0.20
Rate for Payer: Alpha Care Medical Group Medi-Cal	$0.13
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$0.18
Rate for Payer: Blue Shield of California Commercial	$0.15
Rate for Payer: Blue Shield of California EPN	$0.14
Rate for Payer: Cash Price	$0.11
Rate for Payer: Cigna of CA HMO/PPO	$0.16
Rate for Payer: Dignity Health Commercial/Exchange	$0.20
Rate for Payer: Dignity Health Medi-Cal	$0.20
Rate for Payer: Dignity Health Senior	$0.20
Rate for Payer: EPIC Health Plan Commercial	$0.15
Rate for Payer: Heritage Provider Network Commercial	$0.15
Rate for Payer: Heritage Provider Network Senior	$0.15
Rate for Payer: Kaiser Permanente of CA Commercial	$0.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.04
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Commercial	$0.18
Rate for Payer: TriValley Medical Group Commercial	$0.10
Rate for Payer: TriValley Medical Group Senior	$0.10
Rate for Payer: Vantage Medical Group Medi-Cal	$0.20
Rate for Payer: Vantage Medical Group Senior	$0.20

ALENDRONATE 70 MG/75 ML ORAL SOLUTION [37640]

Facility

$1.10

Service Code	NDC 0054-0282-59
Hospital Charge Code	1715162
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.83
Rate for Payer: Adventist Health Commercial	$0.22
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.76
Rate for Payer: Cash Price	$0.50
Rate for Payer: EPIC Health Plan Commercial	$0.59
Rate for Payer: Heritage Provider Network Commercial	$0.74
Rate for Payer: Heritage Provider Network Senior	$0.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Commercial	$0.83

ALENDRONATE 70 MG/75 ML ORAL SOLUTION [37640]

Facility

$1.10

Service Code	NDC 0054-0282-59
Hospital Charge Code	1715162
Hospital Revenue Code	259
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.94
Rate for Payer: Adventist Health Commercial	$0.22
Rate for Payer: Aetna of CA Gatekeeper	$0.59
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.76
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$0.94
Rate for Payer: Alpha Care Medical Group Medi-Cal	$0.61
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$0.83
Rate for Payer: Blue Shield of California Commercial	$0.68
Rate for Payer: Blue Shield of California EPN	$0.65
Rate for Payer: Cash Price	$0.50
Rate for Payer: Cigna of CA HMO/PPO	$0.72
Rate for Payer: Dignity Health Commercial/Exchange	$0.94
Rate for Payer: Dignity Health Medi-Cal	$0.94
Rate for Payer: Dignity Health Senior	$0.94
Rate for Payer: EPIC Health Plan Commercial	$0.70
Rate for Payer: Heritage Provider Network Commercial	$0.68
Rate for Payer: Heritage Provider Network Senior	$0.68
Rate for Payer: Kaiser Permanente of CA Commercial	$0.53
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.28
Rate for Payer: Multiplan Commercial	$0.83
Rate for Payer: TriValley Medical Group Commercial	$0.44
Rate for Payer: TriValley Medical Group Senior	$0.44
Rate for Payer: Vantage Medical Group Medi-Cal	$0.94
Rate for Payer: Vantage Medical Group Senior	$0.94

ALENDRONATE 70 MG TABLET [29048]

Facility

$3.35

Service Code	NDC 69543-131-20
Hospital Charge Code	1710931
Hospital Revenue Code	259
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$2.51
Rate for Payer: Adventist Health Commercial	$0.67
Rate for Payer: Aetna of CA Non-Gatekeeper	$2.30
Rate for Payer: Cash Price	$1.51
Rate for Payer: EPIC Health Plan Commercial	$1.81
Rate for Payer: Heritage Provider Network Commercial	$2.27
Rate for Payer: Heritage Provider Network Senior	$2.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.61
Rate for Payer: LLUH Dept of Risk Management WC	$0.84
Rate for Payer: Multiplan Commercial	$2.51

ALENDRONATE 70 MG TABLET [29048]

Facility

$1.65

Service Code	NDC 65862-329-04
Hospital Charge Code	1710931
Hospital Revenue Code	259
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$1.24
Rate for Payer: Adventist Health Commercial	$0.33
Rate for Payer: Aetna of CA Non-Gatekeeper	$1.13
Rate for Payer: Cash Price	$0.74
Rate for Payer: EPIC Health Plan Commercial	$0.89
Rate for Payer: Heritage Provider Network Commercial	$1.12
Rate for Payer: Heritage Provider Network Senior	$1.12
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.30
Rate for Payer: LLUH Dept of Risk Management WC	$0.41
Rate for Payer: Multiplan Commercial	$1.24

Know your out-of-pocket cost for care.

All Charges