Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

5A02116

Facility

$11,208.00

Service Code	ICD 5A02116
Hospital Charge Code	2769
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

5A0211D

Facility

$11,208.00

Service Code	ICD 5A0211D
Hospital Charge Code	2770
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

5A02210

Facility

$11,208.00

Service Code	ICD 5A02210
Hospital Charge Code	5378
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

5A02216

Facility

$11,208.00

Service Code	ICD 5A02216
Hospital Charge Code	2772
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

5A02216

Facility

$11,208.00

Service Code	ICD 5A02216
Hospital Charge Code	2771
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

5A0221D

Facility

$11,208.00

Service Code	ICD 5A0221D
Hospital Charge Code	5379
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

5A1213Z

Facility

$11,208.00

Service Code	ICD 5A1213Z
Hospital Charge Code	2773
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

5A1221Z

Facility

$11,208.00

Service Code	ICD 5A1221Z
Hospital Charge Code	5380
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

5A1221Z

Facility

$11,208.00

Service Code	ICD 5A1221Z
Hospital Charge Code	13987
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

5A1223Z

Facility

$11,208.00

Service Code	ICD 5A1223Z
Hospital Charge Code	5381
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

5A1522F

Facility

$11,208.00

Service Code	ICD 5A1522F
Hospital Charge Code	5382
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

5A1522G

Facility

$11,208.00

Service Code	ICD 5A1522G
Hospital Charge Code	5383
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

5A1522H

Facility

$11,208.00

Service Code	ICD 5A1522H
Hospital Charge Code	5384
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

8E023DZ

Facility

$11,208.00

Service Code	ICD 8E023DZ
Hospital Charge Code	2774
Min. Negotiated Rate	$11,208.00
Max. Negotiated Rate	$11,208.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$11,208.00

8E0W4CZ

Facility

$11,114.00

Service Code	ICD 8E0W4CZ
Hospital Charge Code	5385
Min. Negotiated Rate	$11,114.00
Max. Negotiated Rate	$11,114.00
Rate for Payer: Kaiser Foundation Hospitals Commercial	$11,114.00

8E0W4CZ

Facility

$11,114.00

Service Code	ICD 8E0W4CZ
Hospital Charge Code	13989
Min. Negotiated Rate	$11,114.00
Max. Negotiated Rate	$11,114.00
Rate for Payer: Kaiser Foundation Hospitals Commercial	$11,114.00

ABACAVIR 20 MG/ML ORAL SOLUTION [24439]

Facility

$0.63

Service Code	NDC 3172256224
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.54
Rate for Payer: Adventist Health Commercial	$0.13
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.39
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$0.54
Rate for Payer: Alpha Care Medical Group Medi-Cal	$0.35
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$0.47
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$0.32
Rate for Payer: Blue Shield of California Commercial	$0.38
Rate for Payer: Blue Shield of California EPN	$0.31
Rate for Payer: Cash Price	$0.28
Rate for Payer: Cigna of CA HMO/PPO	$0.41
Rate for Payer: Dignity Health Commercial/Exchange	$0.54
Rate for Payer: Dignity Health Medi-Cal	$0.54
Rate for Payer: Dignity Health Medicare Advantage	$0.54
Rate for Payer: EPIC Health Plan Commercial	$0.40
Rate for Payer: Heritage Provider Network Commercial	$0.39
Rate for Payer: Heritage Provider Network Senior	$0.39
Rate for Payer: Kaiser Foundation Hospitals Commercial	$0.30
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.16
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$0.44
Rate for Payer: Multiplan Commercial	$0.47
Rate for Payer: TriValley Medical Group Commercial	$0.25
Rate for Payer: TriValley Medical Group Senior	$0.25
Rate for Payer: United Healthcare All Other HMO/non HMO	$0.32
Rate for Payer: United Healthcare Navigate/Select/Select+	$0.32
Rate for Payer: Vantage Medical Group Commercial/Exchange	$0.54
Rate for Payer: Vantage Medical Group Medi-Cal	$0.54
Rate for Payer: Vantage Medical Group Senior	$0.54

ABACAVIR 20 MG/ML ORAL SOLUTION [24439]

Facility

$0.63

Service Code	NDC 3172256224
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.47
Rate for Payer: Adventist Health Commercial	$0.13
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.41
Rate for Payer: Cash Price	$0.28
Rate for Payer: EPIC Health Plan Commercial	$0.34
Rate for Payer: Heritage Provider Network Commercial	$0.43
Rate for Payer: Heritage Provider Network Senior	$0.43
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$0.11
Rate for Payer: LLUH Dept of Risk Management WC	$0.16
Rate for Payer: Multiplan Commercial	$0.47

ABACAVIR 300 MG TABLET [24438]

Facility

$10.59

Service Code	NDC 6808402111
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$7.94
Rate for Payer: Adventist Health Commercial	$2.12
Rate for Payer: Aetna of CA Non-Gatekeeper	$6.82
Rate for Payer: Cash Price	$4.77
Rate for Payer: EPIC Health Plan Commercial	$5.72
Rate for Payer: Heritage Provider Network Commercial	$7.17
Rate for Payer: Heritage Provider Network Senior	$7.17
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$1.92
Rate for Payer: LLUH Dept of Risk Management WC	$2.65
Rate for Payer: Multiplan Commercial	$7.94

ABACAVIR 300 MG TABLET [24438]

Facility

$3.00

Service Code	NDC 3172255760
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$2.25
Rate for Payer: Adventist Health Commercial	$0.60
Rate for Payer: Aetna of CA Non-Gatekeeper	$1.93
Rate for Payer: Cash Price	$1.35
Rate for Payer: EPIC Health Plan Commercial	$1.62
Rate for Payer: Heritage Provider Network Commercial	$2.03
Rate for Payer: Heritage Provider Network Senior	$2.03
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$0.54
Rate for Payer: LLUH Dept of Risk Management WC	$0.75
Rate for Payer: Multiplan Commercial	$2.25

ABACAVIR 300 MG TABLET [24438]

Facility

$3.00

Service Code	NDC 3172255760
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$2.55
Rate for Payer: Adventist Health Commercial	$0.60
Rate for Payer: Aetna of CA Non-Gatekeeper	$1.85
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$2.55
Rate for Payer: Alpha Care Medical Group Medi-Cal	$1.65
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$2.25
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$1.50
Rate for Payer: Blue Shield of California Commercial	$1.83
Rate for Payer: Blue Shield of California EPN	$1.46
Rate for Payer: Cash Price	$1.35
Rate for Payer: Cigna of CA HMO/PPO	$1.95
Rate for Payer: Dignity Health Commercial/Exchange	$2.55
Rate for Payer: Dignity Health Medi-Cal	$2.55
Rate for Payer: Dignity Health Medicare Advantage	$2.55
Rate for Payer: EPIC Health Plan Commercial	$1.92
Rate for Payer: Heritage Provider Network Commercial	$1.86
Rate for Payer: Heritage Provider Network Senior	$1.86
Rate for Payer: Kaiser Foundation Hospitals Commercial	$1.43
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$0.54
Rate for Payer: LLUH Dept of Risk Management WC	$0.75
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$2.10
Rate for Payer: Multiplan Commercial	$2.25
Rate for Payer: TriValley Medical Group Commercial	$1.20
Rate for Payer: TriValley Medical Group Senior	$1.20
Rate for Payer: United Healthcare All Other HMO/non HMO	$1.50
Rate for Payer: United Healthcare Navigate/Select/Select+	$1.50
Rate for Payer: Vantage Medical Group Commercial/Exchange	$2.55
Rate for Payer: Vantage Medical Group Medi-Cal	$2.55
Rate for Payer: Vantage Medical Group Senior	$2.55

ABACAVIR 300 MG TABLET [24438]

Facility

$10.59

Service Code	NDC 6808402111
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$9.00
Rate for Payer: Adventist Health Commercial	$2.12
Rate for Payer: Aetna of CA Non-Gatekeeper	$6.54
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$9.00
Rate for Payer: Alpha Care Medical Group Medi-Cal	$5.82
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$7.94
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$5.30
Rate for Payer: Blue Shield of California Commercial	$6.46
Rate for Payer: Blue Shield of California EPN	$5.17
Rate for Payer: Cash Price	$4.77
Rate for Payer: Cigna of CA HMO/PPO	$6.88
Rate for Payer: Dignity Health Commercial/Exchange	$9.00
Rate for Payer: Dignity Health Medi-Cal	$9.00
Rate for Payer: Dignity Health Medicare Advantage	$9.00
Rate for Payer: EPIC Health Plan Commercial	$6.78
Rate for Payer: Heritage Provider Network Commercial	$6.56
Rate for Payer: Heritage Provider Network Senior	$6.56
Rate for Payer: Kaiser Foundation Hospitals Commercial	$5.05
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$1.92
Rate for Payer: LLUH Dept of Risk Management WC	$2.65
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$7.41
Rate for Payer: Multiplan Commercial	$7.94
Rate for Payer: TriValley Medical Group Commercial	$4.24
Rate for Payer: TriValley Medical Group Senior	$4.24
Rate for Payer: United Healthcare All Other HMO/non HMO	$5.29
Rate for Payer: United Healthcare Navigate/Select/Select+	$5.29
Rate for Payer: Vantage Medical Group Commercial/Exchange	$9.00
Rate for Payer: Vantage Medical Group Medi-Cal	$9.00
Rate for Payer: Vantage Medical Group Senior	$9.00

ABACAVIR 600 MG-DOLUTEGRAVIR 50 MG-LAMIVUDINE 300 MG TABLET [207101]

Facility

$160.57

Service Code	NDC 4970223113
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$29.06
Max. Negotiated Rate	$120.43
Rate for Payer: Adventist Health Commercial	$32.11
Rate for Payer: Aetna of CA Non-Gatekeeper	$103.41
Rate for Payer: Cash Price	$72.26
Rate for Payer: EPIC Health Plan Commercial	$86.71
Rate for Payer: Heritage Provider Network Commercial	$108.71
Rate for Payer: Heritage Provider Network Senior	$108.71
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$29.06
Rate for Payer: LLUH Dept of Risk Management WC	$40.14
Rate for Payer: Multiplan Commercial	$120.43

ABACAVIR 600 MG-DOLUTEGRAVIR 50 MG-LAMIVUDINE 300 MG TABLET [207101]

Facility

$160.57

Service Code	NDC 4970223113
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$29.06
Max. Negotiated Rate	$136.48
Rate for Payer: Adventist Health Commercial	$32.11
Rate for Payer: Aetna of CA Non-Gatekeeper	$99.23
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$136.48
Rate for Payer: Alpha Care Medical Group Medi-Cal	$88.31
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$120.43
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$80.32
Rate for Payer: Blue Shield of California Commercial	$97.95
Rate for Payer: Blue Shield of California EPN	$78.36
Rate for Payer: Cash Price	$72.26
Rate for Payer: Cigna of CA HMO/PPO	$104.37
Rate for Payer: Dignity Health Commercial/Exchange	$136.48
Rate for Payer: Dignity Health Medi-Cal	$136.48
Rate for Payer: Dignity Health Medicare Advantage	$136.48
Rate for Payer: EPIC Health Plan Commercial	$102.76
Rate for Payer: Heritage Provider Network Commercial	$99.39
Rate for Payer: Heritage Provider Network Senior	$99.39
Rate for Payer: Kaiser Foundation Hospitals Commercial	$76.59
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$29.06
Rate for Payer: LLUH Dept of Risk Management WC	$40.14
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$112.40
Rate for Payer: Multiplan Commercial	$120.43
Rate for Payer: TriValley Medical Group Commercial	$64.23
Rate for Payer: TriValley Medical Group Senior	$64.23
Rate for Payer: United Healthcare All Other HMO/non HMO	$80.28
Rate for Payer: United Healthcare Navigate/Select/Select+	$80.28
Rate for Payer: Vantage Medical Group Commercial/Exchange	$136.48
Rate for Payer: Vantage Medical Group Medi-Cal	$136.48
Rate for Payer: Vantage Medical Group Senior	$136.48

ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET [39301]

Facility

$4.00

Service Code	NDC 6909736202
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$3.00
Rate for Payer: Adventist Health Commercial	$0.80
Rate for Payer: Aetna of CA Non-Gatekeeper	$2.58
Rate for Payer: Cash Price	$1.80
Rate for Payer: EPIC Health Plan Commercial	$2.16
Rate for Payer: Heritage Provider Network Commercial	$2.71
Rate for Payer: Heritage Provider Network Senior	$2.71
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$0.72
Rate for Payer: LLUH Dept of Risk Management WC	$1.00
Rate for Payer: Multiplan Commercial	$3.00

Know your out-of-pocket cost for care.

All Charges