Loma Linda University Medical Center

All Charges

Charge

Type

Price

Knee Implant - #2072

Facility IP

$8,448.00

Service Code	ICD 0SUV09Z
Min. Negotiated Rate	$8,448.00
Max. Negotiated Rate	$8,448.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$8,448.00

Knee Implant - #2072

Facility IP

$8,448.00

Service Code	ICD 0SWU4JZ
Min. Negotiated Rate	$8,448.00
Max. Negotiated Rate	$8,448.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$8,448.00

Knee Implant - #2072

Facility IP

$8,448.00

Service Code	ICD 0SWV0JZ
Min. Negotiated Rate	$8,448.00
Max. Negotiated Rate	$8,448.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$8,448.00

Knee Implant - #2072

Facility IP

$8,448.00

Service Code	ICD 0SWV3JZ
Min. Negotiated Rate	$8,448.00
Max. Negotiated Rate	$8,448.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$8,448.00

Knee Implant - #2072

Facility IP

$8,448.00

Service Code	ICD 0QPD3JZ
Min. Negotiated Rate	$8,448.00
Max. Negotiated Rate	$8,448.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$8,448.00

Knee Implant - #2072

Facility IP

$8,448.00

Service Code	ICD 0SUD09C
Min. Negotiated Rate	$8,448.00
Max. Negotiated Rate	$8,448.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$8,448.00

Knee Implant - #2072

Facility IP

$8,448.00

Service Code	ICD 0QRF3JZ
Min. Negotiated Rate	$8,448.00
Max. Negotiated Rate	$8,448.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$8,448.00

Knee Implant - #2072

Facility IP

$8,448.00

Service Code	ICD 0QUD3JZ
Min. Negotiated Rate	$8,448.00
Max. Negotiated Rate	$8,448.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$8,448.00

Knee Implant - #2072

Facility IP

$8,448.00

Service Code	ICD 0QPF0JZ
Min. Negotiated Rate	$8,448.00
Max. Negotiated Rate	$8,448.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$8,448.00

Knee Implant - #2072

Facility IP

$8,448.00

Service Code	ICD 0SRC0LA
Min. Negotiated Rate	$8,448.00
Max. Negotiated Rate	$8,448.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$8,448.00

Knee Implant - #2072

Facility IP

$8,448.00

Service Code	ICD 0SRD0LZ
Min. Negotiated Rate	$8,448.00
Max. Negotiated Rate	$8,448.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$8,448.00

Knee Implant - #2072

Facility IP

$8,448.00

Service Code	ICD 0QUD4JZ
Min. Negotiated Rate	$8,448.00
Max. Negotiated Rate	$8,448.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$8,448.00

K-PHOS NEUTRAL ORAL SUSP CMPD 25 MG/ML (0.1 MEQ/ML) [4080284]

Facility OP

$0.49

Service Code	NDC 9994-0802-84
Hospital Charge Code	1715213
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.42
Rate for Payer: Adventist Health Commercial	$0.10
Rate for Payer: Aetna of CA Gatekeeper	$0.26
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.34
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$0.42
Rate for Payer: AlphaCare Medical Group Medi-Cal	$0.27
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$0.37
Rate for Payer: Blue Shield of California Commercial	$0.30
Rate for Payer: Blue Shield of California EPN	$0.29
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cigna of CA HMO/PPO	$0.32
Rate for Payer: Dignity Health Commercial/Exchange	$0.42
Rate for Payer: Dignity Health Medi-Cal	$0.42
Rate for Payer: Dignity Health Senior	$0.42
Rate for Payer: EPIC Health Plan Commercial	$0.31
Rate for Payer: Heritage Provider Network Commercial	$0.30
Rate for Payer: Heritage Provider Network Senior	$0.30
Rate for Payer: Kaiser Permanente of CA Commercial	$0.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Commercial	$0.37
Rate for Payer: Vantage Medical Group Medi-Cal	$0.42
Rate for Payer: Vantage Medical Group Senior	$0.42

K-PHOS NEUTRAL ORAL SUSP CMPD 25 MG/ML (0.1 MEQ/ML) [4080284]

Facility IP

$0.49

Service Code	NDC 9994-0802-84
Hospital Charge Code	1715213
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.37
Rate for Payer: Adventist Health Commercial	$0.10
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.34
Rate for Payer: Cash Price	$0.22
Rate for Payer: EPIC Health Plan Commercial	$0.26
Rate for Payer: Heritage Provider Network Commercial	$0.33
Rate for Payer: Heritage Provider Network Senior	$0.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Commercial	$0.37

LABETALOL 100 MG TABLET [10373]

Facility IP

$0.54

Service Code	NDC 60687-439-11
Hospital Charge Code	1711384
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.41
Rate for Payer: Adventist Health Commercial	$0.11
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.37
Rate for Payer: Cash Price	$0.24
Rate for Payer: EPIC Health Plan Commercial	$0.29
Rate for Payer: Heritage Provider Network Commercial	$0.37
Rate for Payer: Heritage Provider Network Senior	$0.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Commercial	$0.41

LABETALOL 100 MG TABLET [10373]

Facility OP

$0.49

Service Code	NDC 0185-0010-01
Hospital Charge Code	1711384
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.42
Rate for Payer: Adventist Health Commercial	$0.10
Rate for Payer: Aetna of CA Gatekeeper	$0.26
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.34
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$0.42
Rate for Payer: AlphaCare Medical Group Medi-Cal	$0.27
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$0.37
Rate for Payer: Blue Shield of California Commercial	$0.30
Rate for Payer: Blue Shield of California EPN	$0.29
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cigna of CA HMO/PPO	$0.32
Rate for Payer: Dignity Health Commercial/Exchange	$0.42
Rate for Payer: Dignity Health Medi-Cal	$0.42
Rate for Payer: Dignity Health Senior	$0.42
Rate for Payer: EPIC Health Plan Commercial	$0.31
Rate for Payer: Heritage Provider Network Commercial	$0.30
Rate for Payer: Heritage Provider Network Senior	$0.30
Rate for Payer: Kaiser Permanente of CA Commercial	$0.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Commercial	$0.37
Rate for Payer: Vantage Medical Group Medi-Cal	$0.42
Rate for Payer: Vantage Medical Group Senior	$0.42

LABETALOL 100 MG TABLET [10373]

Facility IP

$0.54

Service Code	NDC 60687-439-01
Hospital Charge Code	1711384
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.41
Rate for Payer: Adventist Health Commercial	$0.11
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.37
Rate for Payer: Cash Price	$0.24
Rate for Payer: EPIC Health Plan Commercial	$0.29
Rate for Payer: Heritage Provider Network Commercial	$0.37
Rate for Payer: Heritage Provider Network Senior	$0.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Commercial	$0.41

LABETALOL 100 MG TABLET [10373]

Facility OP

$0.54

Service Code	NDC 60687-439-01
Hospital Charge Code	1711384
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.46
Rate for Payer: Adventist Health Commercial	$0.11
Rate for Payer: Aetna of CA Gatekeeper	$0.29
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.37
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$0.46
Rate for Payer: AlphaCare Medical Group Medi-Cal	$0.30
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$0.41
Rate for Payer: Blue Shield of California Commercial	$0.34
Rate for Payer: Blue Shield of California EPN	$0.32
Rate for Payer: Cash Price	$0.24
Rate for Payer: Cigna of CA HMO/PPO	$0.35
Rate for Payer: Dignity Health Commercial/Exchange	$0.46
Rate for Payer: Dignity Health Medi-Cal	$0.46
Rate for Payer: Dignity Health Senior	$0.46
Rate for Payer: EPIC Health Plan Commercial	$0.35
Rate for Payer: Heritage Provider Network Commercial	$0.33
Rate for Payer: Heritage Provider Network Senior	$0.33
Rate for Payer: Kaiser Permanente of CA Commercial	$0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Commercial	$0.41
Rate for Payer: Vantage Medical Group Medi-Cal	$0.46
Rate for Payer: Vantage Medical Group Senior	$0.46

LABETALOL 100 MG TABLET [10373]

Facility OP

$0.54

Service Code	NDC 60687-439-11
Hospital Charge Code	1711384
Hospital Revenue Code	259
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.46
Rate for Payer: Adventist Health Commercial	$0.11
Rate for Payer: Aetna of CA Gatekeeper	$0.29
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.37
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$0.46
Rate for Payer: AlphaCare Medical Group Medi-Cal	$0.30
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$0.41
Rate for Payer: Blue Shield of California Commercial	$0.34
Rate for Payer: Blue Shield of California EPN	$0.32
Rate for Payer: Cash Price	$0.24
Rate for Payer: Cigna of CA HMO/PPO	$0.35
Rate for Payer: Dignity Health Commercial/Exchange	$0.46
Rate for Payer: Dignity Health Medi-Cal	$0.46
Rate for Payer: Dignity Health Senior	$0.46
Rate for Payer: EPIC Health Plan Commercial	$0.35
Rate for Payer: Heritage Provider Network Commercial	$0.33
Rate for Payer: Heritage Provider Network Senior	$0.33
Rate for Payer: Kaiser Permanente of CA Commercial	$0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.14
Rate for Payer: Multiplan Commercial	$0.41
Rate for Payer: Vantage Medical Group Medi-Cal	$0.46
Rate for Payer: Vantage Medical Group Senior	$0.46

LABETALOL 100 MG TABLET [10373]

Facility IP

$0.49

Service Code	NDC 68001-381-00
Hospital Charge Code	1711384
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.37
Rate for Payer: Adventist Health Commercial	$0.10
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.34
Rate for Payer: Cash Price	$0.22
Rate for Payer: EPIC Health Plan Commercial	$0.26
Rate for Payer: Heritage Provider Network Commercial	$0.33
Rate for Payer: Heritage Provider Network Senior	$0.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Commercial	$0.37

LABETALOL 100 MG TABLET [10373]

Facility OP

$0.49

Service Code	NDC 68001-381-00
Hospital Charge Code	1711384
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.42
Rate for Payer: Adventist Health Commercial	$0.10
Rate for Payer: Aetna of CA Gatekeeper	$0.26
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.34
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$0.42
Rate for Payer: AlphaCare Medical Group Medi-Cal	$0.27
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$0.37
Rate for Payer: Blue Shield of California Commercial	$0.30
Rate for Payer: Blue Shield of California EPN	$0.29
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cigna of CA HMO/PPO	$0.32
Rate for Payer: Dignity Health Commercial/Exchange	$0.42
Rate for Payer: Dignity Health Medi-Cal	$0.42
Rate for Payer: Dignity Health Senior	$0.42
Rate for Payer: EPIC Health Plan Commercial	$0.31
Rate for Payer: Heritage Provider Network Commercial	$0.30
Rate for Payer: Heritage Provider Network Senior	$0.30
Rate for Payer: Kaiser Permanente of CA Commercial	$0.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Commercial	$0.37
Rate for Payer: Vantage Medical Group Medi-Cal	$0.42
Rate for Payer: Vantage Medical Group Senior	$0.42

LABETALOL 100 MG TABLET [10373]

Facility IP

$0.49

Service Code	NDC 0185-0010-01
Hospital Charge Code	1711384
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.37
Rate for Payer: Adventist Health Commercial	$0.10
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.34
Rate for Payer: Cash Price	$0.22
Rate for Payer: EPIC Health Plan Commercial	$0.26
Rate for Payer: Heritage Provider Network Commercial	$0.33
Rate for Payer: Heritage Provider Network Senior	$0.33
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Commercial	$0.37

LABETALOL 200 MG TABLET [10374]

Facility IP

$0.68

Service Code	NDC 68001-382-00
Hospital Charge Code	1711385
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.51
Rate for Payer: Adventist Health Commercial	$0.14
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.47
Rate for Payer: Cash Price	$0.31
Rate for Payer: EPIC Health Plan Commercial	$0.37
Rate for Payer: Heritage Provider Network Commercial	$0.46
Rate for Payer: Heritage Provider Network Senior	$0.46
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.12
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Commercial	$0.51

LABETALOL 200 MG TABLET [10374]

Facility IP

$0.34

Service Code	NDC 68382-799-01
Hospital Charge Code	1711385
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.26
Rate for Payer: Adventist Health Commercial	$0.07
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.23
Rate for Payer: Cash Price	$0.15
Rate for Payer: EPIC Health Plan Commercial	$0.18
Rate for Payer: Heritage Provider Network Commercial	$0.23
Rate for Payer: Heritage Provider Network Senior	$0.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Commercial	$0.26

LABETALOL 200 MG TABLET [10374]

Facility OP

$0.34

Service Code	NDC 68382-799-01
Hospital Charge Code	1711385
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.29
Rate for Payer: Adventist Health Commercial	$0.07
Rate for Payer: Aetna of CA Gatekeeper	$0.18
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.23
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$0.29
Rate for Payer: AlphaCare Medical Group Medi-Cal	$0.19
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$0.26
Rate for Payer: Blue Shield of California Commercial	$0.21
Rate for Payer: Blue Shield of California EPN	$0.20
Rate for Payer: Cash Price	$0.15
Rate for Payer: Cigna of CA HMO/PPO	$0.22
Rate for Payer: Dignity Health Commercial/Exchange	$0.29
Rate for Payer: Dignity Health Medi-Cal	$0.29
Rate for Payer: Dignity Health Senior	$0.29
Rate for Payer: EPIC Health Plan Commercial	$0.22
Rate for Payer: Heritage Provider Network Commercial	$0.21
Rate for Payer: Heritage Provider Network Senior	$0.21
Rate for Payer: Kaiser Permanente of CA Commercial	$0.16
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Commercial	$0.26
Rate for Payer: Vantage Medical Group Medi-Cal	$0.29
Rate for Payer: Vantage Medical Group Senior	$0.29

Price Transparency.

All Charges