Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

B214YZZ

Facility

$4,982.00

Hospital Charge Code	5430
Min. Negotiated Rate	$4,982.00
Max. Negotiated Rate	$4,982.00
Rate for Payer: Heritage Provider Network Senior	$4,982.00

B2150ZZ

Facility

$4,982.00

Hospital Charge Code	5431
Min. Negotiated Rate	$4,982.00
Max. Negotiated Rate	$4,982.00
Rate for Payer: Heritage Provider Network Senior	$4,982.00

B2151ZZ

Facility

$4,982.00

Hospital Charge Code	5432
Min. Negotiated Rate	$4,982.00
Max. Negotiated Rate	$4,982.00
Rate for Payer: Heritage Provider Network Senior	$4,982.00

B215YZZ

Facility

$4,982.00

Hospital Charge Code	5433
Min. Negotiated Rate	$4,982.00
Max. Negotiated Rate	$4,982.00
Rate for Payer: Heritage Provider Network Senior	$4,982.00

B2160ZZ

Facility

$4,982.00

Hospital Charge Code	5434
Min. Negotiated Rate	$4,982.00
Max. Negotiated Rate	$4,982.00
Rate for Payer: Heritage Provider Network Senior	$4,982.00

B2161ZZ

Facility

$4,982.00

Hospital Charge Code	5435
Min. Negotiated Rate	$4,982.00
Max. Negotiated Rate	$4,982.00
Rate for Payer: Heritage Provider Network Senior	$4,982.00

B216YZZ

Facility

$4,982.00

Hospital Charge Code	5436
Min. Negotiated Rate	$4,982.00
Max. Negotiated Rate	$4,982.00
Rate for Payer: Heritage Provider Network Senior	$4,982.00

B2170ZZ

Facility

$4,982.00

Hospital Charge Code	5437
Min. Negotiated Rate	$4,982.00
Max. Negotiated Rate	$4,982.00
Rate for Payer: Heritage Provider Network Senior	$4,982.00

B2171ZZ

Facility

$4,982.00

Hospital Charge Code	5438
Min. Negotiated Rate	$4,982.00
Max. Negotiated Rate	$4,982.00
Rate for Payer: Heritage Provider Network Senior	$4,982.00

B217YZZ

Facility

$4,982.00

Hospital Charge Code	5439
Min. Negotiated Rate	$4,982.00
Max. Negotiated Rate	$4,982.00
Rate for Payer: Heritage Provider Network Senior	$4,982.00

B2180ZZ

Facility

$4,982.00

Hospital Charge Code	5440
Min. Negotiated Rate	$4,982.00
Max. Negotiated Rate	$4,982.00
Rate for Payer: Heritage Provider Network Senior	$4,982.00

B2181ZZ

Facility

$4,982.00

Hospital Charge Code	5441
Min. Negotiated Rate	$4,982.00
Max. Negotiated Rate	$4,982.00
Rate for Payer: Heritage Provider Network Senior	$4,982.00

B218YZZ

Facility

$4,982.00

Hospital Charge Code	5442
Min. Negotiated Rate	$4,982.00
Max. Negotiated Rate	$4,982.00
Rate for Payer: Heritage Provider Network Senior	$4,982.00

B21F0ZZ

Facility

$4,982.00

Hospital Charge Code	5443
Min. Negotiated Rate	$4,982.00
Max. Negotiated Rate	$4,982.00
Rate for Payer: Heritage Provider Network Senior	$4,982.00

B21F1ZZ

Facility

$4,982.00

Hospital Charge Code	5444
Min. Negotiated Rate	$4,982.00
Max. Negotiated Rate	$4,982.00
Rate for Payer: Heritage Provider Network Senior	$4,982.00

B21FYZZ

Facility

$4,982.00

Hospital Charge Code	5445
Min. Negotiated Rate	$4,982.00
Max. Negotiated Rate	$4,982.00
Rate for Payer: Heritage Provider Network Senior	$4,982.00

B221Z2Z

Facility

$10,777.00

Hospital Charge Code	2775
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

B223Z2Z

Facility

$10,777.00

Hospital Charge Code	2776
Min. Negotiated Rate	$10,777.00
Max. Negotiated Rate	$10,777.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$10,777.00

BACITRACIN 500 UNIT/GRAM EYE OINTMENT [852]

Facility

$37.06

Service Code	NDC 0574-4022-35
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$6.71
Max. Negotiated Rate	$31.50
Rate for Payer: Adventist Health Commercial	$7.41
Rate for Payer: Aetna of CA Gatekeeper	$19.81
Rate for Payer: Aetna of CA Non-Gatekeeper	$25.46
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$31.50
Rate for Payer: Alpha Care Medical Group Medi-Cal	$20.38
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$27.80
Rate for Payer: Blue Shield of California Commercial	$22.61
Rate for Payer: Blue Shield of California EPN	$18.09
Rate for Payer: Cash Price	$20.38
Rate for Payer: Cigna of CA HMO/PPO	$24.09
Rate for Payer: Dignity Health Commercial/Exchange	$31.50
Rate for Payer: Dignity Health Medi-Cal	$31.50
Rate for Payer: Dignity Health Senior	$31.50
Rate for Payer: EPIC Health Plan Commercial	$23.72
Rate for Payer: Heritage Provider Network Commercial	$22.94
Rate for Payer: Heritage Provider Network Senior	$22.94
Rate for Payer: Kaiser Permanente of CA Commercial	$17.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$6.71
Rate for Payer: LLUH Dept of Risk Management WC	$9.27
Rate for Payer: Molina Healthcare of CA Medi-Cal	$25.94
Rate for Payer: Molina Healthcare of CA Medicare	$25.94
Rate for Payer: Multiplan Commercial	$27.80
Rate for Payer: TriValley Medical Group Commercial	$14.82
Rate for Payer: TriValley Medical Group Senior	$14.82
Rate for Payer: United Healthcare All Other HMO/non HMO	$18.53
Rate for Payer: United Healthcare Navigate/Select/Select+	$18.53
Rate for Payer: Vantage Medical Group Commercial/Exchange	$31.50
Rate for Payer: Vantage Medical Group Medi-Cal	$31.50
Rate for Payer: Vantage Medical Group Senior	$31.50

BACITRACIN 500 UNIT/GRAM EYE OINTMENT [852]

Facility

$37.06

Service Code	NDC 0574-4022-35
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$6.71
Max. Negotiated Rate	$27.80
Rate for Payer: Adventist Health Commercial	$7.41
Rate for Payer: Cash Price	$20.38
Rate for Payer: EPIC Health Plan Commercial	$20.01
Rate for Payer: Heritage Provider Network Commercial	$25.09
Rate for Payer: Heritage Provider Network Senior	$25.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$6.71
Rate for Payer: LLUH Dept of Risk Management WC	$9.27
Rate for Payer: Multiplan Commercial	$27.80

BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]

Facility

$0.15

Service Code	NDC 45802-060-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.13
Rate for Payer: Adventist Health Commercial	$0.03
Rate for Payer: Aetna of CA Gatekeeper	$0.08
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.10
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$0.13
Rate for Payer: Alpha Care Medical Group Medi-Cal	$0.08
Rate for Payer: Alpha Care 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	$0.07
Rate for Payer: Cash Price	$0.08
Rate for Payer: Cigna of CA HMO/PPO	$0.10
Rate for Payer: Dignity Health Commercial/Exchange	$0.13
Rate for Payer: Dignity Health Medi-Cal	$0.13
Rate for Payer: Dignity Health Senior	$0.13
Rate for Payer: EPIC Health Plan Commercial	$0.10
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: Molina Healthcare of CA Medi-Cal	$0.11
Rate for Payer: Molina Healthcare of CA Medicare	$0.11
Rate for Payer: Multiplan Commercial	$0.11
Rate for Payer: TriValley Medical Group Commercial	$0.06
Rate for Payer: TriValley Medical Group Senior	$0.06
Rate for Payer: United Healthcare All Other HMO/non HMO	$0.08
Rate for Payer: United Healthcare Navigate/Select/Select+	$0.08
Rate for Payer: Vantage Medical Group Commercial/Exchange	$0.13
Rate for Payer: Vantage Medical Group Medi-Cal	$0.13
Rate for Payer: Vantage Medical Group Senior	$0.13

BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]

Facility

$0.08

Service Code	NDC 0536-1256-28
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.07
Rate for Payer: Adventist Health Commercial	$0.02
Rate for Payer: Aetna of CA Gatekeeper	$0.04
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.05
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$0.07
Rate for Payer: Alpha Care Medical Group Medi-Cal	$0.04
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$0.06
Rate for Payer: Blue Shield of California Commercial	$0.05
Rate for Payer: Blue Shield of California EPN	$0.04
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cigna of CA HMO/PPO	$0.05
Rate for Payer: Dignity Health Commercial/Exchange	$0.07
Rate for Payer: Dignity Health Medi-Cal	$0.07
Rate for Payer: Dignity Health Senior	$0.07
Rate for Payer: EPIC Health Plan Commercial	$0.05
Rate for Payer: Heritage Provider Network Commercial	$0.05
Rate for Payer: Heritage Provider Network Senior	$0.05
Rate for Payer: Kaiser Permanente of CA Commercial	$0.04
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Molina Healthcare of CA Medi-Cal	$0.06
Rate for Payer: Molina Healthcare of CA Medicare	$0.06
Rate for Payer: Multiplan Commercial	$0.06
Rate for Payer: TriValley Medical Group Commercial	$0.03
Rate for Payer: TriValley Medical Group Senior	$0.03
Rate for Payer: United Healthcare All Other HMO/non HMO	$0.04
Rate for Payer: United Healthcare Navigate/Select/Select+	$0.04
Rate for Payer: Vantage Medical Group Commercial/Exchange	$0.07
Rate for Payer: Vantage Medical Group Medi-Cal	$0.07
Rate for Payer: Vantage Medical Group Senior	$0.07

BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]

Facility

$0.15

Service Code	NDC 45802-060-01
Hospital Charge Code	901700029
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: Cash Price	$0.08
Rate for Payer: EPIC Health Plan Commercial	$0.08
Rate for Payer: Heritage Provider Network Commercial	$0.10
Rate for Payer: Heritage Provider Network Senior	$0.10
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

BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]

Facility

$0.09

Service Code	NDC 0713-0280-31
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.07
Rate for Payer: Adventist Health Commercial	$0.02
Rate for Payer: Cash Price	$0.05
Rate for Payer: EPIC Health Plan Commercial	$0.05
Rate for Payer: Heritage Provider Network Commercial	$0.06
Rate for Payer: Heritage Provider Network Senior	$0.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Commercial	$0.07

BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT [850]

Facility

$0.08

Service Code	NDC 0536-1256-28
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.06
Rate for Payer: Adventist Health Commercial	$0.02
Rate for Payer: Cash Price	$0.04
Rate for Payer: EPIC Health Plan Commercial	$0.04
Rate for Payer: Heritage Provider Network Commercial	$0.05
Rate for Payer: Heritage Provider Network Senior	$0.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal	$0.01
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Commercial	$0.06

Know your out-of-pocket cost for care.

All Charges