Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS

Facility

$4,162.64

Service Code	APR-DRG 1981
Min. Negotiated Rate	$4,162.64
Max. Negotiated Rate	$4,162.64
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$4,162.64

ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS

Facility

$11,411.45

Service Code	APR-DRG 1984
Min. Negotiated Rate	$11,411.45
Max. Negotiated Rate	$11,411.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,411.45

ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS

Facility

$6,563.33

Service Code	APR-DRG 1983
Min. Negotiated Rate	$6,563.33
Max. Negotiated Rate	$6,563.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$6,563.33

ANGIOTENSIN II 2.5 MG/ML INTRAVENOUS SOLUTION [220829]

Facility

$1,800.00

Service Code	CPT C9399
Hospital Charge Code	NDG220829
Hospital Revenue Code	636
Min. Negotiated Rate	$325.80
Max. Negotiated Rate	$1,350.00
Rate for Payer: Adventist Health Commercial	$360.00
Rate for Payer: Aetna of CA Non-Gatekeeper	$1,236.60
Rate for Payer: Cash Price	$810.00
Rate for Payer: Cigna of CA HMO/PPO	$828.00
Rate for Payer: EPIC Health Plan Commercial	$972.00
Rate for Payer: Heritage Provider Network Commercial	$1,218.60
Rate for Payer: Heritage Provider Network Senior	$1,218.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$325.80
Rate for Payer: LLUH Dept of Risk Management WC	$450.00
Rate for Payer: Multiplan Commercial	$1,350.00
Rate for Payer: United Healthcare All Other HMO/non HMO	$656.28
Rate for Payer: United Healthcare Navigate/Select/Select+	$601.38

ANGIOTENSIN II 2.5 MG/ML INTRAVENOUS SOLUTION [220829]

Facility

$1,800.00

Service Code	CPT C9399
Hospital Charge Code	NDG220829
Hospital Revenue Code	636
Min. Negotiated Rate	$325.80
Max. Negotiated Rate	$1,530.00
Rate for Payer: Adventist Health Commercial	$360.00
Rate for Payer: Aetna of CA Gatekeeper	$962.10
Rate for Payer: Aetna of CA Non-Gatekeeper	$1,236.60
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$1,530.00
Rate for Payer: Alpha Care Medical Group Medi-Cal	$990.00
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$1,350.00
Rate for Payer: Blue Shield of California Commercial	$1,117.80
Rate for Payer: Blue Shield of California EPN	$1,056.60
Rate for Payer: Cash Price	$810.00
Rate for Payer: Cigna of CA HMO/PPO	$828.00
Rate for Payer: Dignity Health Commercial/Exchange	$1,530.00
Rate for Payer: Dignity Health Medi-Cal	$1,530.00
Rate for Payer: Dignity Health Senior	$1,530.00
Rate for Payer: EPIC Health Plan Commercial	$1,152.00
Rate for Payer: Heritage Provider Network Commercial	$833.40
Rate for Payer: Heritage Provider Network Senior	$833.40
Rate for Payer: Kaiser Permanente of CA Commercial	$867.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$325.80
Rate for Payer: LLUH Dept of Risk Management WC	$450.00
Rate for Payer: Multiplan Commercial	$1,350.00
Rate for Payer: TriValley Medical Group Commercial	$720.00
Rate for Payer: TriValley Medical Group Senior	$720.00
Rate for Payer: United Healthcare All Other HMO/non HMO	$656.28
Rate for Payer: United Healthcare Navigate/Select/Select+	$601.38
Rate for Payer: Vantage Medical Group Medi-Cal	$1,530.00
Rate for Payer: Vantage Medical Group Senior	$1,530.00

ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION [88093]

Facility

$229.07

Service Code	CPT J0348
Hospital Charge Code	1753552
Hospital Revenue Code	636
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$194.71
Rate for Payer: Adventist Health Commercial	$45.81
Rate for Payer: Aetna of CA Gatekeeper	$1.12
Rate for Payer: Aetna of CA Non-Gatekeeper	$157.37
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$194.71
Rate for Payer: Alpha Care Medical Group Medi-Cal	$125.99
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$171.80
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$4.02
Rate for Payer: Blue Shield of California Commercial	$1.95
Rate for Payer: Blue Shield of California EPN	$1.95
Rate for Payer: Cash Price	$103.08
Rate for Payer: Cash Price	$103.08
Rate for Payer: Cigna of CA HMO/PPO	$105.37
Rate for Payer: Dignity Health Commercial/Exchange	$194.71
Rate for Payer: Dignity Health Medi-Cal	$194.71
Rate for Payer: Dignity Health Senior	$194.71
Rate for Payer: EPIC Health Plan Commercial	$146.60
Rate for Payer: Heritage Provider Network Commercial	$106.06
Rate for Payer: Heritage Provider Network Senior	$106.06
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7.68
Rate for Payer: Kaiser Permanente of CA Commercial	$110.41
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$41.46
Rate for Payer: LLUH Dept of Risk Management WC	$57.27
Rate for Payer: Multiplan Commercial	$171.80
Rate for Payer: TriValley Medical Group Commercial	$91.63
Rate for Payer: TriValley Medical Group Senior	$91.63
Rate for Payer: United Healthcare All Other HMO/non HMO	$83.52
Rate for Payer: United Healthcare Navigate/Select/Select+	$76.53
Rate for Payer: Vantage Medical Group Medi-Cal	$194.71
Rate for Payer: Vantage Medical Group Senior	$194.71

ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION [88093]

Facility

$229.07

Service Code	CPT J0348
Hospital Charge Code	1753552
Hospital Revenue Code	636
Min. Negotiated Rate	$41.46
Max. Negotiated Rate	$171.80
Rate for Payer: Adventist Health Commercial	$45.81
Rate for Payer: Aetna of CA Non-Gatekeeper	$157.37
Rate for Payer: Cash Price	$103.08
Rate for Payer: Cigna of CA HMO/PPO	$105.37
Rate for Payer: EPIC Health Plan Commercial	$123.70
Rate for Payer: Heritage Provider Network Commercial	$155.08
Rate for Payer: Heritage Provider Network Senior	$155.08
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$41.46
Rate for Payer: LLUH Dept of Risk Management WC	$57.27
Rate for Payer: Multiplan Commercial	$171.80
Rate for Payer: United Healthcare All Other HMO/non HMO	$83.52
Rate for Payer: United Healthcare Navigate/Select/Select+	$76.53

Anorectal exam, surgical, requiring anesthesia (general, spinal, or epidural), diagnostic

Facility

$9,616.00

Service Code	CPT 45990
Min. Negotiated Rate	$130.68
Max. Negotiated Rate	$9,616.00
Rate for Payer: Aetna of CA Gatekeeper	$2,869.00
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$5,262.22
Rate for Payer: Alpha Care Medical Group Medi-Cal	$3,858.96
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$3,508.15
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$3,237.00
Rate for Payer: Dignity Health Commercial/Exchange	$5,262.22
Rate for Payer: Dignity Health Medi-Cal	$3,858.96
Rate for Payer: Dignity Health Senior	$3,508.15
Rate for Payer: EPIC Health Plan Commercial	$9,616.00
Rate for Payer: EPIC Health Plan Medicare	$3,508.15
Rate for Payer: Humana Medicare	$3,508.15
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$130.68
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$3,508.15
Rate for Payer: Kaiser Permanente of CA Commercial	$6,665.48
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$4,139.62
Rate for Payer: Molina Healthcare of CA Medi-Cal	$4,420.27
Rate for Payer: Molina Healthcare of CA Medicare	$4,420.27
Rate for Payer: TriValley Medical Group Commercial	$3,858.96
Rate for Payer: TriValley Medical Group Senior	$3,508.15
Rate for Payer: Vantage Medical Group Commercial/Exchange	$5,262.22
Rate for Payer: Vantage Medical Group Medi-Cal	$3,858.96
Rate for Payer: Vantage Medical Group Senior	$3,508.15

Anoscopy; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

Facility

$9,616.00

Service Code	CPT 46600
Min. Negotiated Rate	$34.27
Max. Negotiated Rate	$9,616.00
Rate for Payer: Aetna of CA Gatekeeper	$1,335.00
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$239.40
Rate for Payer: Alpha Care Medical Group Medi-Cal	$175.56
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$159.60
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$3,237.00
Rate for Payer: Dignity Health Commercial/Exchange	$239.40
Rate for Payer: Dignity Health Medi-Cal	$175.56
Rate for Payer: Dignity Health Senior	$159.60
Rate for Payer: EPIC Health Plan Commercial	$9,616.00
Rate for Payer: EPIC Health Plan Medicare	$159.60
Rate for Payer: Humana Medicare	$159.60
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$34.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$159.60
Rate for Payer: Kaiser Permanente of CA Commercial	$303.24
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$188.33
Rate for Payer: Molina Healthcare of CA Medi-Cal	$201.10
Rate for Payer: Molina Healthcare of CA Medicare	$201.10
Rate for Payer: TriValley Medical Group Commercial	$175.56
Rate for Payer: TriValley Medical Group Senior	$159.60
Rate for Payer: Vantage Medical Group Commercial/Exchange	$239.40
Rate for Payer: Vantage Medical Group Medi-Cal	$175.56
Rate for Payer: Vantage Medical Group Senior	$159.60

Anoscopy; with biopsy, single or multiple

Facility

$9,616.00

Service Code	CPT 46606
Min. Negotiated Rate	$45.30
Max. Negotiated Rate	$9,616.00
Rate for Payer: Aetna of CA Gatekeeper	$1,335.00
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$2,211.63
Rate for Payer: Alpha Care Medical Group Medi-Cal	$1,621.86
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$1,474.42
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$3,237.00
Rate for Payer: Dignity Health Commercial/Exchange	$2,211.63
Rate for Payer: Dignity Health Medi-Cal	$1,621.86
Rate for Payer: Dignity Health Senior	$1,474.42
Rate for Payer: EPIC Health Plan Commercial	$9,616.00
Rate for Payer: EPIC Health Plan Medicare	$1,474.42
Rate for Payer: Humana Medicare	$1,474.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$45.30
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$1,474.42
Rate for Payer: Kaiser Permanente of CA Commercial	$2,801.40
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$1,739.82
Rate for Payer: Molina Healthcare of CA Medi-Cal	$1,857.77
Rate for Payer: Molina Healthcare of CA Medicare	$1,857.77
Rate for Payer: TriValley Medical Group Commercial	$1,621.86
Rate for Payer: TriValley Medical Group Senior	$1,474.42
Rate for Payer: Vantage Medical Group Commercial/Exchange	$2,211.63
Rate for Payer: Vantage Medical Group Medi-Cal	$1,621.86
Rate for Payer: Vantage Medical Group Senior	$1,474.42

ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$10,590.66

Service Code	APR-DRG 0593
Min. Negotiated Rate	$10,590.66
Max. Negotiated Rate	$10,590.66
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,590.66

ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$14,657.80

Service Code	APR-DRG 0594
Min. Negotiated Rate	$14,657.80
Max. Negotiated Rate	$14,657.80
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$14,657.80

ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$4,570.55

Service Code	APR-DRG 0591
Min. Negotiated Rate	$4,570.55
Max. Negotiated Rate	$4,570.55
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$4,570.55

ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$7,507.49

Service Code	APR-DRG 0592
Min. Negotiated Rate	$7,507.49
Max. Negotiated Rate	$7,507.49
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,507.49

ANTEPARTUM WITH O.R. PROCEDURE

Facility

$21,941.33

Service Code	APR-DRG 5474
Min. Negotiated Rate	$21,941.33
Max. Negotiated Rate	$21,941.33
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$21,941.33

ANTEPARTUM WITH O.R. PROCEDURE

Facility

$7,514.45

Service Code	APR-DRG 5472
Min. Negotiated Rate	$7,514.45
Max. Negotiated Rate	$7,514.45
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$7,514.45

ANTEPARTUM WITH O.R. PROCEDURE

Facility

$5,374.43

Service Code	APR-DRG 5471
Min. Negotiated Rate	$5,374.43
Max. Negotiated Rate	$5,374.43
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$5,374.43

ANTEPARTUM WITH O.R. PROCEDURE

Facility

$11,165.72

Service Code	APR-DRG 5473
Min. Negotiated Rate	$11,165.72
Max. Negotiated Rate	$11,165.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$11,165.72

ANTEPARTUM WITHOUT O.R. PROCEDURE

Facility

$2,099.23

Service Code	APR-DRG 5661
Min. Negotiated Rate	$2,099.23
Max. Negotiated Rate	$2,099.23
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$2,099.23

ANTEPARTUM WITHOUT O.R. PROCEDURE

Facility

$2,824.51

Service Code	APR-DRG 5662
Min. Negotiated Rate	$2,824.51
Max. Negotiated Rate	$2,824.51
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$2,824.51

ANTEPARTUM WITHOUT O.R. PROCEDURE

Facility

$4,110.91

Service Code	APR-DRG 5663
Min. Negotiated Rate	$4,110.91
Max. Negotiated Rate	$4,110.91
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$4,110.91

ANTEPARTUM WITHOUT O.R. PROCEDURE

Facility

$10,031.14

Service Code	APR-DRG 5664
Min. Negotiated Rate	$10,031.14
Max. Negotiated Rate	$10,031.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$10,031.14

Anterior colporrhaphy, repair of cystocele with or without repair of urethrocele, including cystourethroscopy, when performed

Facility

$11,807.68

Service Code	CPT 57240
Min. Negotiated Rate	$856.19
Max. Negotiated Rate	$11,807.68
Rate for Payer: Aetna of CA Gatekeeper	$5,088.00
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$9,321.86
Rate for Payer: Alpha Care Medical Group Medi-Cal	$6,836.03
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$6,214.57
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$8,054.00
Rate for Payer: Dignity Health Commercial/Exchange	$9,321.86
Rate for Payer: Dignity Health Medi-Cal	$6,836.03
Rate for Payer: Dignity Health Senior	$6,214.57
Rate for Payer: EPIC Health Plan Commercial	$9,616.00
Rate for Payer: EPIC Health Plan Medicare	$6,214.57
Rate for Payer: Humana Medicare	$6,214.57
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$856.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$6,214.57
Rate for Payer: Kaiser Permanente of CA Commercial	$11,807.68
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$7,333.19
Rate for Payer: Molina Healthcare of CA Medi-Cal	$7,830.36
Rate for Payer: Molina Healthcare of CA Medicare	$7,830.36
Rate for Payer: TriValley Medical Group Commercial	$6,836.03
Rate for Payer: TriValley Medical Group Senior	$6,214.57
Rate for Payer: Vantage Medical Group Commercial/Exchange	$9,321.86
Rate for Payer: Vantage Medical Group Medi-Cal	$6,836.03
Rate for Payer: Vantage Medical Group Senior	$6,214.57

Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure)

Facility

$9,616.00

Service Code	CPT 22845
Min. Negotiated Rate	$112.09
Max. Negotiated Rate	$9,616.00
Rate for Payer: Aetna of CA Gatekeeper	$1,335.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$7,436.00
Rate for Payer: EPIC Health Plan Commercial	$9,616.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal	$112.09

ANTICOAG CITRATE/DEXTROSE CPD UNIT 450 ML [4081055]

Facility

$55.87

Service Code	NDC 9994-0810-55
Hospital Charge Code	1771241
Hospital Revenue Code	272
Min. Negotiated Rate	$10.11
Max. Negotiated Rate	$41.90
Rate for Payer: Adventist Health Commercial	$11.17
Rate for Payer: Aetna of CA Non-Gatekeeper	$38.38
Rate for Payer: Cash Price	$25.14
Rate for Payer: Heritage Provider Network Commercial	$37.82
Rate for Payer: Heritage Provider Network Senior	$37.82
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$10.11
Rate for Payer: LLUH Dept of Risk Management WC	$13.97
Rate for Payer: Multiplan Commercial	$41.90

Know your out-of-pocket cost for care.

All Charges