Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

APR-DRG 41.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C

Facility

$0.63

Service Code	APR-DRG 5412
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$0.63

APR-DRG 41.00: VENTRICULAR SHUNT PROCEDURES

Facility

$3.96

Service Code	APR-DRG 0224
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$3.96
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$3.96

APR-DRG 41.00: VENTRICULAR SHUNT PROCEDURES

Facility

$2.11

Service Code	APR-DRG 0223
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$2.11
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$2.11

APR-DRG 41.00: VENTRICULAR SHUNT PROCEDURES

Facility

$1.52

Service Code	APR-DRG 0222
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$1.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1.52

APR-DRG 41.00: VENTRICULAR SHUNT PROCEDURES

Facility

$1.31

Service Code	APR-DRG 0221
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1.31

APR-DRG 41.00: VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES

Facility

$1.47

Service Code	APR-DRG 3102
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$1.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1.47

APR-DRG 41.00: VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES

Facility

$3.74

Service Code	APR-DRG 3104
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$3.74
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$3.74

APR-DRG 41.00: VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES

Facility

$2.02

Service Code	APR-DRG 3103
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$2.02
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$2.02

APR-DRG 41.00: VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES

Facility

$1.10

Service Code	APR-DRG 3101
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.10
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1.10

APR-DRG 41.00: VERTIGO AND OTHER LABYRINTH DISORDERS

Facility

$0.54

Service Code	APR-DRG 1111
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.54
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$0.54

APR-DRG 41.00: VERTIGO AND OTHER LABYRINTH DISORDERS

Facility

$0.62

Service Code	APR-DRG 1112
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.62
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$0.62

APR-DRG 41.00: VERTIGO AND OTHER LABYRINTH DISORDERS

Facility

$0.75

Service Code	APR-DRG 1113
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$0.75

APR-DRG 41.00: VERTIGO AND OTHER LABYRINTH DISORDERS

Facility

$1.56

Service Code	APR-DRG 1114
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.56
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1.56

APR-DRG 41.00: VIRAL ILLNESS

Facility

$0.76

Service Code	APR-DRG 7233
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$0.76
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$0.76

APR-DRG 41.00: VIRAL ILLNESS

Facility

$0.36

Service Code	APR-DRG 7231
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.36
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$0.36

APR-DRG 41.00: VIRAL ILLNESS

Facility

$1.59

Service Code	APR-DRG 7234
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$1.59
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1.59

APR-DRG 41.00: VIRAL ILLNESS

Facility

$0.50

Service Code	APR-DRG 7232
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$0.50

APR-DRG 41.00: VIRAL MENINGITIS

Facility

$0.71

Service Code	APR-DRG 0512
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$0.71
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$0.71

APR-DRG 41.00: VIRAL MENINGITIS

Facility

$1.19

Service Code	APR-DRG 0513
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1.19

APR-DRG 41.00: VIRAL MENINGITIS

Facility

$2.17

Service Code	APR-DRG 0514
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$2.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$2.17

APR-DRG 41.00: VIRAL MENINGITIS

Facility

$0.47

Service Code	APR-DRG 0511
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.47
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$0.47

APREPITANT 130 MG/18 ML (7.2 MG/ML) INTRAVENOUS EMULSION [220348]

Facility

$30.30

Service Code	HCPCS J0185
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$5.48
Max. Negotiated Rate	$22.73
Rate for Payer: Adventist Health Commercial	$6.06
Rate for Payer: Cash Price	$16.67
Rate for Payer: Cigna of CA HMO/PPO	$13.94
Rate for Payer: EPIC Health Plan Commercial	$16.36
Rate for Payer: Heritage Provider Network Commercial	$14.03
Rate for Payer: Heritage Provider Network Senior	$14.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$5.48
Rate for Payer: LLUH Dept of Risk Management WC	$7.58
Rate for Payer: Multiplan Commercial	$22.73
Rate for Payer: United Healthcare All Other HMO/non HMO	$10.95
Rate for Payer: United Healthcare Navigate/Select/Select+	$10.03

APREPITANT 130 MG/18 ML (7.2 MG/ML) INTRAVENOUS EMULSION [220348]

Facility

$30.30

Service Code	HCPCS J0185
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$22.73
Rate for Payer: Adventist Health Commercial	$6.06
Rate for Payer: Aetna of CA Gatekeeper	$16.20
Rate for Payer: Aetna of CA Non-Gatekeeper	$20.82
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$2.21
Rate for Payer: Alpha Care Medical Group Medi-Cal	$1.95
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$1.95
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$8.87
Rate for Payer: Blue Shield of California Commercial	$3.43
Rate for Payer: Blue Shield of California EPN	$3.43
Rate for Payer: Cash Price	$16.67
Rate for Payer: Cash Price	$16.67
Rate for Payer: Cigna of CA HMO/PPO	$13.94
Rate for Payer: Dignity Health Commercial/Exchange	$2.21
Rate for Payer: Dignity Health Medi-Cal	$1.95
Rate for Payer: Dignity Health Senior	$1.95
Rate for Payer: EPIC Health Plan Commercial	$19.39
Rate for Payer: EPIC Health Plan Medicare	$1.77
Rate for Payer: Heritage Provider Network Commercial	$14.03
Rate for Payer: Heritage Provider Network Senior	$14.03
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$1.71
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$1.77
Rate for Payer: Kaiser Permanente of CA Commercial	$14.45
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$5.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$2.04
Rate for Payer: LLUH Dept of Risk Management WC	$7.58
Rate for Payer: Molina Healthcare of CA Medi-Cal	$2.23
Rate for Payer: Molina Healthcare of CA Medicare	$2.23
Rate for Payer: Multiplan Commercial	$22.73
Rate for Payer: TriValley Medical Group Commercial	$12.12
Rate for Payer: TriValley Medical Group Senior	$12.12
Rate for Payer: United Healthcare All Other HMO/non HMO	$10.95
Rate for Payer: United Healthcare Navigate/Select/Select+	$10.03
Rate for Payer: Vantage Medical Group Commercial/Exchange	$2.21
Rate for Payer: Vantage Medical Group Medi-Cal	$1.95
Rate for Payer: Vantage Medical Group Senior	$1.95

ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]

Facility

$12.17

Service Code	NDC 27437-060-60
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$10.34
Rate for Payer: Adventist Health Commercial	$2.43
Rate for Payer: Aetna of CA Gatekeeper	$6.50
Rate for Payer: Aetna of CA Non-Gatekeeper	$8.36
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$10.34
Rate for Payer: Alpha Care Medical Group Medi-Cal	$6.69
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$9.13
Rate for Payer: Blue Shield of California Commercial	$7.42
Rate for Payer: Blue Shield of California EPN	$5.94
Rate for Payer: Cash Price	$6.70
Rate for Payer: Cigna of CA HMO/PPO	$7.91
Rate for Payer: Dignity Health Commercial/Exchange	$10.34
Rate for Payer: Dignity Health Medi-Cal	$10.34
Rate for Payer: Dignity Health Senior	$10.34
Rate for Payer: EPIC Health Plan Commercial	$7.79
Rate for Payer: Heritage Provider Network Commercial	$7.53
Rate for Payer: Heritage Provider Network Senior	$7.53
Rate for Payer: Kaiser Permanente of CA Commercial	$5.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$2.20
Rate for Payer: LLUH Dept of Risk Management WC	$3.04
Rate for Payer: Molina Healthcare of CA Medi-Cal	$8.52
Rate for Payer: Molina Healthcare of CA Medicare	$8.52
Rate for Payer: Multiplan Commercial	$9.13
Rate for Payer: TriValley Medical Group Commercial	$4.87
Rate for Payer: TriValley Medical Group Senior	$4.87
Rate for Payer: United Healthcare All Other HMO/non HMO	$6.08
Rate for Payer: United Healthcare Navigate/Select/Select+	$6.08
Rate for Payer: Vantage Medical Group Commercial/Exchange	$10.34
Rate for Payer: Vantage Medical Group Medi-Cal	$10.34
Rate for Payer: Vantage Medical Group Senior	$10.34

ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [77581]

Facility

$2.50

Service Code	NDC 62756-277-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$1.88
Rate for Payer: Adventist Health Commercial	$0.50
Rate for Payer: Cash Price	$1.38
Rate for Payer: EPIC Health Plan Commercial	$1.35
Rate for Payer: Heritage Provider Network Commercial	$1.69
Rate for Payer: Heritage Provider Network Senior	$1.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.45
Rate for Payer: LLUH Dept of Risk Management WC	$0.63
Rate for Payer: Multiplan Commercial	$1.88

Know your out-of-pocket cost for care.

All Charges