Loma Linda University Medical Center

All Charges

Charge

Type

Price

ALLERGIC REACTIONS

Facility IP

$2,825.51

Service Code	APR-DRG 8111
Min. Negotiated Rate	$2,825.51
Max. Negotiated Rate	$2,825.51
Rate for Payer: IEHP Medi-Cal	$2,825.51

ALLOGENEIC BONE MARROW TRANSPLANT

Facility IP

$78,403.78

Service Code	APR-DRG 0073
Min. Negotiated Rate	$78,403.78
Max. Negotiated Rate	$78,403.78
Rate for Payer: IEHP Medi-Cal	$78,403.78

ALLOGENEIC BONE MARROW TRANSPLANT

Facility IP

$61,328.37

Service Code	APR-DRG 0072
Min. Negotiated Rate	$61,328.37
Max. Negotiated Rate	$61,328.37
Rate for Payer: IEHP Medi-Cal	$61,328.37

ALLOGENEIC BONE MARROW TRANSPLANT

Facility IP

$54,607.86

Service Code	APR-DRG 0071
Min. Negotiated Rate	$54,607.86
Max. Negotiated Rate	$54,607.86
Rate for Payer: IEHP Medi-Cal	$54,607.86

ALLOGENEIC BONE MARROW TRANSPLANT

Facility IP

$133,040.48

Service Code	APR-DRG 0074
Min. Negotiated Rate	$133,040.48
Max. Negotiated Rate	$133,040.48
Rate for Payer: IEHP Medi-Cal	$133,040.48

Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure)

Facility OP

$9,616.00

Service Code	CPT 20930
Min. Negotiated Rate	$1,335.00
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	$3,237.00
Rate for Payer: EPIC Health Plan Commercial	$9,616.00

Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure)

Facility OP

$9,616.00

Service Code	CPT 20931
Min. Negotiated Rate	$130.68
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	$3,237.00
Rate for Payer: EPIC Health Plan Commercial	$9,616.00
Rate for Payer: IEHP Medi-Cal	$130.68

ALLOPURINOL 100 MG TABLET [310]

Facility OP

$0.13

Service Code	NDC 29300-349-01
Hospital Charge Code	1711276
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.11
Rate for Payer: Adventist Health Commercial	$0.03
Rate for Payer: Aetna of CA Gatekeeper	$0.07
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.09
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$0.11
Rate for Payer: AlphaCare Medical Group Medi-Cal	$0.07
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$0.10
Rate for Payer: Blue Shield of California Commercial	$0.08
Rate for Payer: Blue Shield of California EPN	$0.08
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of CA HMO/PPO	$0.08
Rate for Payer: Dignity Health Commercial/Exchange	$0.11
Rate for Payer: Dignity Health Medi-Cal	$0.11
Rate for Payer: Dignity Health Senior	$0.11
Rate for Payer: EPIC Health Plan Commercial	$0.08
Rate for Payer: Heritage Provider Network Commercial	$0.08
Rate for Payer: Heritage Provider Network Senior	$0.08
Rate for Payer: Kaiser Permanente of CA Commercial	$0.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Commercial	$0.10
Rate for Payer: Vantage Medical Group Medi-Cal	$0.11
Rate for Payer: Vantage Medical Group Senior	$0.11

ALLOPURINOL 100 MG TABLET [310]

Facility OP

$0.50

Service Code	NDC 62584-988-01
Hospital Charge Code	1711276
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.43
Rate for Payer: Adventist Health Commercial	$0.10
Rate for Payer: Aetna of CA Gatekeeper	$0.27
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.34
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$0.43
Rate for Payer: AlphaCare Medical Group Medi-Cal	$0.28
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$0.38
Rate for Payer: Blue Shield of California Commercial	$0.31
Rate for Payer: Blue Shield of California EPN	$0.29
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cigna of CA HMO/PPO	$0.33
Rate for Payer: Dignity Health Commercial/Exchange	$0.43
Rate for Payer: Dignity Health Medi-Cal	$0.43
Rate for Payer: Dignity Health Senior	$0.43
Rate for Payer: EPIC Health Plan Commercial	$0.32
Rate for Payer: Heritage Provider Network Commercial	$0.31
Rate for Payer: Heritage Provider Network Senior	$0.31
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	$0.13
Rate for Payer: Multiplan Commercial	$0.38
Rate for Payer: Vantage Medical Group Medi-Cal	$0.43
Rate for Payer: Vantage Medical Group Senior	$0.43

ALLOPURINOL 100 MG TABLET [310]

Facility IP

$0.40

Service Code	NDC 0904-7041-61
Hospital Charge Code	1711276
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.30
Rate for Payer: Adventist Health Commercial	$0.08
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.27
Rate for Payer: Cash Price	$0.18
Rate for Payer: EPIC Health Plan Commercial	$0.22
Rate for Payer: Heritage Provider Network Commercial	$0.27
Rate for Payer: Heritage Provider Network Senior	$0.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Commercial	$0.30

ALLOPURINOL 100 MG TABLET [310]

Facility OP

$0.50

Service Code	NDC 62584-988-11
Hospital Charge Code	1711276
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.43
Rate for Payer: Adventist Health Commercial	$0.10
Rate for Payer: Aetna of CA Gatekeeper	$0.27
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.34
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$0.43
Rate for Payer: AlphaCare Medical Group Medi-Cal	$0.28
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$0.38
Rate for Payer: Blue Shield of California Commercial	$0.31
Rate for Payer: Blue Shield of California EPN	$0.29
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cigna of CA HMO/PPO	$0.33
Rate for Payer: Dignity Health Commercial/Exchange	$0.43
Rate for Payer: Dignity Health Medi-Cal	$0.43
Rate for Payer: Dignity Health Senior	$0.43
Rate for Payer: EPIC Health Plan Commercial	$0.32
Rate for Payer: Heritage Provider Network Commercial	$0.31
Rate for Payer: Heritage Provider Network Senior	$0.31
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	$0.13
Rate for Payer: Multiplan Commercial	$0.38
Rate for Payer: Vantage Medical Group Medi-Cal	$0.43
Rate for Payer: Vantage Medical Group Senior	$0.43

ALLOPURINOL 100 MG TABLET [310]

Facility IP

$0.38

Service Code	NDC 51079-205-01
Hospital Charge Code	1711276
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.29
Rate for Payer: Adventist Health Commercial	$0.08
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.26
Rate for Payer: Cash Price	$0.17
Rate for Payer: EPIC Health Plan Commercial	$0.21
Rate for Payer: Heritage Provider Network Commercial	$0.26
Rate for Payer: Heritage Provider Network Senior	$0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Commercial	$0.29

ALLOPURINOL 100 MG TABLET [310]

Facility IP

$0.14

Service Code	NDC 53489-156-01
Hospital Charge Code	1711276
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.11
Rate for Payer: Adventist Health Commercial	$0.03
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.10
Rate for Payer: Cash Price	$0.06
Rate for Payer: EPIC Health Plan Commercial	$0.08
Rate for Payer: Heritage Provider Network Commercial	$0.09
Rate for Payer: Heritage Provider Network Senior	$0.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Commercial	$0.11

ALLOPURINOL 100 MG TABLET [310]

Facility IP

$0.13

Service Code	NDC 29300-349-01
Hospital Charge Code	1711276
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.10
Rate for Payer: Adventist Health Commercial	$0.03
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.09
Rate for Payer: Cash Price	$0.06
Rate for Payer: EPIC Health Plan Commercial	$0.07
Rate for Payer: Heritage Provider Network Commercial	$0.09
Rate for Payer: Heritage Provider Network Senior	$0.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Commercial	$0.10

ALLOPURINOL 100 MG TABLET [310]

Facility OP

$0.38

Service Code	NDC 51079-205-20
Hospital Charge Code	1711276
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.32
Rate for Payer: Adventist Health Commercial	$0.08
Rate for Payer: Aetna of CA Gatekeeper	$0.20
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.26
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$0.32
Rate for Payer: AlphaCare Medical Group Medi-Cal	$0.21
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$0.29
Rate for Payer: Blue Shield of California Commercial	$0.24
Rate for Payer: Blue Shield of California EPN	$0.22
Rate for Payer: Cash Price	$0.17
Rate for Payer: Cigna of CA HMO/PPO	$0.25
Rate for Payer: Dignity Health Commercial/Exchange	$0.32
Rate for Payer: Dignity Health Medi-Cal	$0.32
Rate for Payer: Dignity Health Senior	$0.32
Rate for Payer: EPIC Health Plan Commercial	$0.24
Rate for Payer: Heritage Provider Network Commercial	$0.24
Rate for Payer: Heritage Provider Network Senior	$0.24
Rate for Payer: Kaiser Permanente of CA Commercial	$0.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Commercial	$0.29
Rate for Payer: Vantage Medical Group Medi-Cal	$0.32
Rate for Payer: Vantage Medical Group Senior	$0.32

ALLOPURINOL 100 MG TABLET [310]

Facility IP

$0.38

Service Code	NDC 51079-205-20
Hospital Charge Code	1711276
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.29
Rate for Payer: Adventist Health Commercial	$0.08
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.26
Rate for Payer: Cash Price	$0.17
Rate for Payer: EPIC Health Plan Commercial	$0.21
Rate for Payer: Heritage Provider Network Commercial	$0.26
Rate for Payer: Heritage Provider Network Senior	$0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Commercial	$0.29

ALLOPURINOL 100 MG TABLET [310]

Facility OP

$0.14

Service Code	NDC 53489-156-01
Hospital Charge Code	1711276
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.12
Rate for Payer: Adventist Health Commercial	$0.03
Rate for Payer: Aetna of CA Gatekeeper	$0.07
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.10
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$0.12
Rate for Payer: AlphaCare Medical Group Medi-Cal	$0.08
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$0.11
Rate for Payer: Blue Shield of California Commercial	$0.09
Rate for Payer: Blue Shield of California EPN	$0.08
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of CA HMO/PPO	$0.09
Rate for Payer: Dignity Health Commercial/Exchange	$0.12
Rate for Payer: Dignity Health Medi-Cal	$0.12
Rate for Payer: Dignity Health Senior	$0.12
Rate for Payer: EPIC Health Plan Commercial	$0.09
Rate for Payer: Heritage Provider Network Commercial	$0.09
Rate for Payer: Heritage Provider Network Senior	$0.09
Rate for Payer: Kaiser Permanente of CA Commercial	$0.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.04
Rate for Payer: Multiplan Commercial	$0.11
Rate for Payer: Vantage Medical Group Medi-Cal	$0.12
Rate for Payer: Vantage Medical Group Senior	$0.12

ALLOPURINOL 100 MG TABLET [310]

Facility IP

$0.50

Service Code	NDC 62584-988-01
Hospital Charge Code	1711276
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.38
Rate for Payer: Adventist Health Commercial	$0.10
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.34
Rate for Payer: Cash Price	$0.23
Rate for Payer: EPIC Health Plan Commercial	$0.27
Rate for Payer: Heritage Provider Network Commercial	$0.34
Rate for Payer: Heritage Provider Network Senior	$0.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Commercial	$0.38

ALLOPURINOL 100 MG TABLET [310]

Facility IP

$0.38

Service Code	NDC 0603-2115-21
Hospital Charge Code	1711276
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.29
Rate for Payer: Adventist Health Commercial	$0.08
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.26
Rate for Payer: Cash Price	$0.17
Rate for Payer: EPIC Health Plan Commercial	$0.21
Rate for Payer: Heritage Provider Network Commercial	$0.26
Rate for Payer: Heritage Provider Network Senior	$0.26
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Commercial	$0.29

ALLOPURINOL 100 MG TABLET [310]

Facility IP

$0.50

Service Code	NDC 62584-988-11
Hospital Charge Code	1711276
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.38
Rate for Payer: Adventist Health Commercial	$0.10
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.34
Rate for Payer: Cash Price	$0.23
Rate for Payer: EPIC Health Plan Commercial	$0.27
Rate for Payer: Heritage Provider Network Commercial	$0.34
Rate for Payer: Heritage Provider Network Senior	$0.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.09
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Commercial	$0.38

ALLOPURINOL 100 MG TABLET [310]

Facility OP

$0.40

Service Code	NDC 0904-7041-61
Hospital Charge Code	1711276
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.34
Rate for Payer: Adventist Health Commercial	$0.08
Rate for Payer: Aetna of CA Gatekeeper	$0.21
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.27
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$0.34
Rate for Payer: AlphaCare Medical Group Medi-Cal	$0.22
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$0.30
Rate for Payer: Blue Shield of California Commercial	$0.25
Rate for Payer: Blue Shield of California EPN	$0.23
Rate for Payer: Cash Price	$0.18
Rate for Payer: Cigna of CA HMO/PPO	$0.26
Rate for Payer: Dignity Health Commercial/Exchange	$0.34
Rate for Payer: Dignity Health Medi-Cal	$0.34
Rate for Payer: Dignity Health Senior	$0.34
Rate for Payer: EPIC Health Plan Commercial	$0.26
Rate for Payer: Heritage Provider Network Commercial	$0.25
Rate for Payer: Heritage Provider Network Senior	$0.25
Rate for Payer: Kaiser Permanente of CA Commercial	$0.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Commercial	$0.30
Rate for Payer: Vantage Medical Group Medi-Cal	$0.34
Rate for Payer: Vantage Medical Group Senior	$0.34

ALLOPURINOL 100 MG TABLET [310]

Facility OP

$0.38

Service Code	NDC 51079-205-01
Hospital Charge Code	1711276
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.32
Rate for Payer: Adventist Health Commercial	$0.08
Rate for Payer: Aetna of CA Gatekeeper	$0.20
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.26
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$0.32
Rate for Payer: AlphaCare Medical Group Medi-Cal	$0.21
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$0.29
Rate for Payer: Blue Shield of California Commercial	$0.24
Rate for Payer: Blue Shield of California EPN	$0.22
Rate for Payer: Cash Price	$0.17
Rate for Payer: Cigna of CA HMO/PPO	$0.25
Rate for Payer: Dignity Health Commercial/Exchange	$0.32
Rate for Payer: Dignity Health Medi-Cal	$0.32
Rate for Payer: Dignity Health Senior	$0.32
Rate for Payer: EPIC Health Plan Commercial	$0.24
Rate for Payer: Heritage Provider Network Commercial	$0.24
Rate for Payer: Heritage Provider Network Senior	$0.24
Rate for Payer: Kaiser Permanente of CA Commercial	$0.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Commercial	$0.29
Rate for Payer: Vantage Medical Group Medi-Cal	$0.32
Rate for Payer: Vantage Medical Group Senior	$0.32

ALLOPURINOL 100 MG TABLET [310]

Facility OP

$0.38

Service Code	NDC 0603-2115-21
Hospital Charge Code	1711276
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.32
Rate for Payer: Adventist Health Commercial	$0.08
Rate for Payer: Aetna of CA Gatekeeper	$0.20
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.26
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$0.32
Rate for Payer: AlphaCare Medical Group Medi-Cal	$0.21
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$0.29
Rate for Payer: Blue Shield of California Commercial	$0.24
Rate for Payer: Blue Shield of California EPN	$0.22
Rate for Payer: Cash Price	$0.17
Rate for Payer: Cigna of CA HMO/PPO	$0.25
Rate for Payer: Dignity Health Commercial/Exchange	$0.32
Rate for Payer: Dignity Health Medi-Cal	$0.32
Rate for Payer: Dignity Health Senior	$0.32
Rate for Payer: EPIC Health Plan Commercial	$0.24
Rate for Payer: Heritage Provider Network Commercial	$0.24
Rate for Payer: Heritage Provider Network Senior	$0.24
Rate for Payer: Kaiser Permanente of CA Commercial	$0.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.10
Rate for Payer: Multiplan Commercial	$0.29
Rate for Payer: Vantage Medical Group Medi-Cal	$0.32
Rate for Payer: Vantage Medical Group Senior	$0.32

ALLOPURINOL 300 MG TABLET [311]

Facility OP

$0.68

Service Code	NDC 0378-0181-01
Hospital Charge Code	1711280
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.58
Rate for Payer: Adventist Health Commercial	$0.14
Rate for Payer: Aetna of CA Gatekeeper	$0.36
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.47
Rate for Payer: AlphaCare Medical Group Commercial/Exchange	$0.58
Rate for Payer: AlphaCare Medical Group Medi-Cal	$0.37
Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product	$0.51
Rate for Payer: Blue Shield of California Commercial	$0.42
Rate for Payer: Blue Shield of California EPN	$0.40
Rate for Payer: Cash Price	$0.31
Rate for Payer: Cigna of CA HMO/PPO	$0.44
Rate for Payer: Dignity Health Commercial/Exchange	$0.58
Rate for Payer: Dignity Health Medi-Cal	$0.58
Rate for Payer: Dignity Health Senior	$0.58
Rate for Payer: EPIC Health Plan Commercial	$0.44
Rate for Payer: Heritage Provider Network Commercial	$0.42
Rate for Payer: Heritage Provider Network Senior	$0.42
Rate for Payer: Kaiser Permanente of CA Commercial	$0.33
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
Rate for Payer: Vantage Medical Group Medi-Cal	$0.58
Rate for Payer: Vantage Medical Group Senior	$0.58

ALLOPURINOL 300 MG TABLET [311]

Facility IP

$0.88

Service Code	NDC 60687-688-01
Hospital Charge Code	1711280
Hospital Revenue Code	259
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.66
Rate for Payer: Adventist Health Commercial	$0.18
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.60
Rate for Payer: Cash Price	$0.40
Rate for Payer: EPIC Health Plan Commercial	$0.48
Rate for Payer: Heritage Provider Network Commercial	$0.60
Rate for Payer: Heritage Provider Network Senior	$0.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.16
Rate for Payer: LLUH Dept of Risk Management WC	$0.22
Rate for Payer: Multiplan Commercial	$0.66

Price Transparency.

All Charges