Loma Linda University Medical Center

All Charges

Charge

Type

Setting

Price

CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS IN A DROPPERETTE [27991]

Facility

$0.33

Service Code	NDC 0023040350
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.25
Rate for Payer: Adventist Health Commercial	$0.07
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.21
Rate for Payer: Cash Price	$0.15
Rate for Payer: EPIC Health Plan Commercial	$0.18
Rate for Payer: Heritage Provider Network Commercial	$0.22
Rate for Payer: Heritage Provider Network Senior	$0.22
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Multiplan Commercial	$0.25

CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS IN A DROPPERETTE [27991]

Facility

$0.36

Service Code	NDC 0023040330
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.27
Rate for Payer: Adventist Health Commercial	$0.07
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.23
Rate for Payer: Cash Price	$0.16
Rate for Payer: EPIC Health Plan Commercial	$0.19
Rate for Payer: Heritage Provider Network Commercial	$0.24
Rate for Payer: Heritage Provider Network Senior	$0.24
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Commercial	$0.27

CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS IN A DROPPERETTE [27991]

Facility

$0.33

Service Code	NDC 0023040350
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.28
Rate for Payer: Adventist Health Commercial	$0.07
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.20
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$0.28
Rate for Payer: Alpha Care Medical Group Medi-Cal	$0.18
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$0.25
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$0.17
Rate for Payer: Blue Shield of California Commercial	$0.20
Rate for Payer: Blue Shield of California EPN	$0.16
Rate for Payer: Cash Price	$0.15
Rate for Payer: Cigna of CA HMO/PPO	$0.21
Rate for Payer: Dignity Health Commercial/Exchange	$0.28
Rate for Payer: Dignity Health Medi-Cal	$0.28
Rate for Payer: Dignity Health Medicare Advantage	$0.28
Rate for Payer: EPIC Health Plan Commercial	$0.21
Rate for Payer: Heritage Provider Network Commercial	$0.20
Rate for Payer: Heritage Provider Network Senior	$0.20
Rate for Payer: Kaiser Foundation Hospitals Commercial	$0.16
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.08
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$0.23
Rate for Payer: Multiplan Commercial	$0.25
Rate for Payer: TriValley Medical Group Commercial	$0.13
Rate for Payer: TriValley Medical Group Senior	$0.13
Rate for Payer: United Healthcare All Other HMO/non HMO	$0.17
Rate for Payer: United Healthcare Navigate/Select/Select+	$0.17
Rate for Payer: Vantage Medical Group Commercial/Exchange	$0.28
Rate for Payer: Vantage Medical Group Medi-Cal	$0.28
Rate for Payer: Vantage Medical Group Senior	$0.28

CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS IN A DROPPERETTE [27991]

Facility

$0.36

Service Code	NDC 0023040330
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.31
Rate for Payer: Adventist Health Commercial	$0.07
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.22
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$0.31
Rate for Payer: Alpha Care Medical Group Medi-Cal	$0.20
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$0.27
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$0.18
Rate for Payer: Blue Shield of California Commercial	$0.22
Rate for Payer: Blue Shield of California EPN	$0.18
Rate for Payer: Cash Price	$0.16
Rate for Payer: Cigna of CA HMO/PPO	$0.23
Rate for Payer: Dignity Health Commercial/Exchange	$0.31
Rate for Payer: Dignity Health Medi-Cal	$0.31
Rate for Payer: Dignity Health Medicare Advantage	$0.31
Rate for Payer: EPIC Health Plan Commercial	$0.23
Rate for Payer: Heritage Provider Network Commercial	$0.22
Rate for Payer: Heritage Provider Network Senior	$0.22
Rate for Payer: Kaiser Foundation Hospitals Commercial	$0.17
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$0.25
Rate for Payer: Multiplan Commercial	$0.27
Rate for Payer: TriValley Medical Group Commercial	$0.14
Rate for Payer: TriValley Medical Group Senior	$0.14
Rate for Payer: United Healthcare All Other HMO/non HMO	$0.18
Rate for Payer: United Healthcare Navigate/Select/Select+	$0.18
Rate for Payer: Vantage Medical Group Commercial/Exchange	$0.31
Rate for Payer: Vantage Medical Group Medi-Cal	$0.31
Rate for Payer: Vantage Medical Group Senior	$0.31

CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE [38321]

Facility

$0.44

Service Code	NDC 0023455430
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.33
Rate for Payer: Adventist Health Commercial	$0.09
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.28
Rate for Payer: Cash Price	$0.20
Rate for Payer: EPIC Health Plan Commercial	$0.24
Rate for Payer: Heritage Provider Network Commercial	$0.30
Rate for Payer: Heritage Provider Network Senior	$0.30
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.11
Rate for Payer: Multiplan Commercial	$0.33

CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE [38321]

Facility

$0.44

Service Code	NDC 0023455430
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.37
Rate for Payer: Adventist Health Commercial	$0.09
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.27
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$0.37
Rate for Payer: Alpha Care Medical Group Medi-Cal	$0.24
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$0.33
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$0.22
Rate for Payer: Blue Shield of California Commercial	$0.27
Rate for Payer: Blue Shield of California EPN	$0.21
Rate for Payer: Cash Price	$0.20
Rate for Payer: Cigna of CA HMO/PPO	$0.29
Rate for Payer: Dignity Health Commercial/Exchange	$0.37
Rate for Payer: Dignity Health Medi-Cal	$0.37
Rate for Payer: Dignity Health Medicare Advantage	$0.37
Rate for Payer: EPIC Health Plan Commercial	$0.28
Rate for Payer: Heritage Provider Network Commercial	$0.27
Rate for Payer: Heritage Provider Network Senior	$0.27
Rate for Payer: Kaiser Foundation Hospitals Commercial	$0.21
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.11
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$0.31
Rate for Payer: Multiplan Commercial	$0.33
Rate for Payer: TriValley Medical Group Commercial	$0.18
Rate for Payer: TriValley Medical Group Senior	$0.18
Rate for Payer: United Healthcare All Other HMO/non HMO	$0.22
Rate for Payer: United Healthcare Navigate/Select/Select+	$0.22
Rate for Payer: Vantage Medical Group Commercial/Exchange	$0.37
Rate for Payer: Vantage Medical Group Medi-Cal	$0.37
Rate for Payer: Vantage Medical Group Senior	$0.37

CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS [27992]

Facility

$0.69

Service Code	NDC 0023920515
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.52
Rate for Payer: Adventist Health Commercial	$0.14
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.44
Rate for Payer: Cash Price	$0.31
Rate for Payer: EPIC Health Plan Commercial	$0.37
Rate for Payer: Heritage Provider Network Commercial	$0.47
Rate for Payer: Heritage Provider Network Senior	$0.47
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$0.12
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Commercial	$0.52

CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS [27992]

Facility

$0.69

Service Code	NDC 0023920515
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.59
Rate for Payer: Adventist Health Commercial	$0.14
Rate for Payer: Aetna of CA Non-Gatekeeper	$0.43
Rate for Payer: Alpha Care Medical Group Commercial/Exchange	$0.59
Rate for Payer: Alpha Care Medical Group Medi-Cal	$0.38
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product	$0.52
Rate for Payer: Anthem Blue Cross of CA HMO/PPO	$0.35
Rate for Payer: Blue Shield of California Commercial	$0.42
Rate for Payer: Blue Shield of California EPN	$0.34
Rate for Payer: Cash Price	$0.31
Rate for Payer: Cigna of CA HMO/PPO	$0.45
Rate for Payer: Dignity Health Commercial/Exchange	$0.59
Rate for Payer: Dignity Health Medi-Cal	$0.59
Rate for Payer: Dignity Health Medicare Advantage	$0.59
Rate for Payer: EPIC Health Plan Commercial	$0.44
Rate for Payer: Heritage Provider Network Commercial	$0.43
Rate for Payer: Heritage Provider Network Senior	$0.43
Rate for Payer: Kaiser Foundation Hospitals Commercial	$0.33
Rate for Payer: Kaiser Foundation Hospitals Medi-Cal	$0.12
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$0.48
Rate for Payer: Multiplan Commercial	$0.52
Rate for Payer: TriValley Medical Group Commercial	$0.28
Rate for Payer: TriValley Medical Group Senior	$0.28
Rate for Payer: United Healthcare All Other HMO/non HMO	$0.35
Rate for Payer: United Healthcare Navigate/Select/Select+	$0.35
Rate for Payer: Vantage Medical Group Commercial/Exchange	$0.59
Rate for Payer: Vantage Medical Group Medi-Cal	$0.59
Rate for Payer: Vantage Medical Group Senior	$0.59

CARDIAC ARREST, UNEXPLAINED WITH CC

Facility

$10,436.95

Service Code	MSDRG 297
Min. Negotiated Rate	$7,788.77
Max. Negotiated Rate	$10,436.95
Rate for Payer: EPIC Health Plan Medicare	$7,788.77
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,788.77
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$8,957.09
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$10,436.95

CARDIAC ARREST, UNEXPLAINED WITH MCC

Facility

$24,685.31

Service Code	MSDRG 296
Min. Negotiated Rate	$18,421.87
Max. Negotiated Rate	$24,685.31
Rate for Payer: EPIC Health Plan Medicare	$18,421.87
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,421.87
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$21,185.15
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$24,685.31

CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC

Facility

$7,689.88

Service Code	MSDRG 298
Min. Negotiated Rate	$5,738.72
Max. Negotiated Rate	$7,689.88
Rate for Payer: EPIC Health Plan Medicare	$5,738.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$5,738.72
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$6,599.53
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$7,689.88

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC

Facility

$11,998.61

Service Code	MSDRG 309
Min. Negotiated Rate	$8,954.19
Max. Negotiated Rate	$11,998.61
Rate for Payer: EPIC Health Plan Medicare	$8,954.19
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$8,954.19
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$10,297.32
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$11,998.61

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC

Facility

$19,189.56

Service Code	MSDRG 308
Min. Negotiated Rate	$14,320.57
Max. Negotiated Rate	$19,189.56
Rate for Payer: EPIC Health Plan Medicare	$14,320.57
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$14,320.57
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$16,468.66
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$19,189.56

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC

Facility

$9,394.34

Service Code	MSDRG 310
Min. Negotiated Rate	$7,010.70
Max. Negotiated Rate	$9,394.34
Rate for Payer: EPIC Health Plan Medicare	$7,010.70
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$7,010.70
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$8,062.31
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$9,394.34

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC

Facility

$24,898.73

Service Code	MSDRG 306
Min. Negotiated Rate	$18,581.14
Max. Negotiated Rate	$24,898.73
Rate for Payer: EPIC Health Plan Medicare	$18,581.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$18,581.14
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$21,368.31
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$24,898.73

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC

Facility

$14,724.21

Service Code	MSDRG 307
Min. Negotiated Rate	$10,988.22
Max. Negotiated Rate	$14,724.21
Rate for Payer: EPIC Health Plan Medicare	$10,988.22
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$10,988.22
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$12,636.45
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$14,724.21

CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC

Facility

$110,192.18

Service Code	MSDRG 275
Min. Negotiated Rate	$82,232.97
Max. Negotiated Rate	$110,192.18
Rate for Payer: EPIC Health Plan Medicare	$82,232.97
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$82,232.97
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$94,567.92
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$110,192.18

CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR

Facility

$92,935.71

Service Code	MSDRG 276
Min. Negotiated Rate	$69,355.01
Max. Negotiated Rate	$92,935.71
Rate for Payer: EPIC Health Plan Medicare	$69,355.01
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$69,355.01
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$79,758.26
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$92,935.71

CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC

Facility

$71,620.83

Service Code	MSDRG 277
Min. Negotiated Rate	$53,448.38
Max. Negotiated Rate	$71,620.83
Rate for Payer: EPIC Health Plan Medicare	$53,448.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$53,448.38
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$61,465.64
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$71,620.83

CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC

Facility

$48,950.01

Service Code	MSDRG 258
Min. Negotiated Rate	$8,850.00
Max. Negotiated Rate	$48,950.01
Rate for Payer: EPIC Health Plan Medicare	$36,529.86
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,529.86
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$42,009.34
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$48,950.01

CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC

Facility

$31,751.86

Service Code	MSDRG 259
Min. Negotiated Rate	$8,850.00
Max. Negotiated Rate	$31,751.86
Rate for Payer: EPIC Health Plan Medicare	$23,695.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$23,695.42
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$27,249.73
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$31,751.86

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC

Facility

$29,731.09

Service Code	MSDRG 261
Min. Negotiated Rate	$8,850.00
Max. Negotiated Rate	$29,731.09
Rate for Payer: EPIC Health Plan Medicare	$22,187.38
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$22,187.38
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$25,515.49
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$29,731.09

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC

Facility

$50,649.88

Service Code	MSDRG 260
Min. Negotiated Rate	$8,850.00
Max. Negotiated Rate	$50,649.88
Rate for Payer: EPIC Health Plan Medicare	$37,798.42
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$37,798.42
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$43,468.18
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$50,649.88

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC

Facility

$25,729.46

Service Code	MSDRG 262
Min. Negotiated Rate	$8,850.00
Max. Negotiated Rate	$25,729.46
Rate for Payer: EPIC Health Plan Medicare	$19,201.09
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$19,201.09
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$22,081.25
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$25,729.46

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC

Facility

$101,668.37

Service Code	MSDRG 217
Min. Negotiated Rate	$28,410.00
Max. Negotiated Rate	$101,668.37
Rate for Payer: EPIC Health Plan Medicare	$75,871.92
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$75,871.92
Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage	$87,252.71
Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare	$101,668.37

Know your out-of-pocket cost for care.

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